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CARDIOVASCULAR ANESTHESIA

Bronchoscopic Lung Volume Reduction in Patients with Severe Emphysema: Anesthetic Management

Department of Anaesthesia & Critical Care Medicine, Royal Brompton Hospital, London, England, and the Department of Thoracic Medicine, National Heart and Lung Institute, London, England

Address correspondence to James Hillier, FRCA, Department of Anesthesia, Harefield Hospital, Hill End Road, Harefield Middlesex, UB9 6JH England. Address e-mail to thehilliers{at}clara.co.uk

Bronchoscopic lung volume reduction is a novel approach to the treatment of severe emphysema. Its objective is to achieve the same improvements in lung function and exercise tolerance as lung volume reduction surgery while avoiding the surgical morbidity and mortality. We describe the anesthetic experience in a series of seven patients who underwent a total of eight procedures (one patient underwent a second procedure on the contralateral side). The technique used was one of total IV anesthesia using remifentanil and propofol, with a ventilatory strategy aimed at avoiding gas trapping and dynamic hyperinflation. To achieve this pressure, limited ventilation with a prolonged expiratory phase was provided by a Draeger Evita 2 ventilator. This technique resulted in intraoperative hypercapnia (PaCO₂ 6.75 kPa) compared with baseline values (median PaCO₂ 5.1 kPa; P < 0.05), but 2 h postoperatively the arterial partial pressure of CO₂ was returning to baseline (median PaCO₂ 5.6 kPa; P < 0.01 compared with intraoperative data). There were no deaths or admissions to the intensive care unit after the procedure. One patient developed a pneumothorax that required drainage, three patients had acute exacerbations of chronic obstructive pulmonary disease, and one patient developed a cough that resolved spontaneously. Total hospital stay did not exceed 5 days for any of these patients.

IMPLICATIONS: Bronchoscopic lung volume reduction is a novel approach to the treatment of severe emphysema. We describe the anesthetic experience with this new procedure, highlighting the problems facing the anesthesiologist.

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