JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS
AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
A&A International Anesthesia Research Society
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ng, J.-M.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Ng, J.-M.

Anesth Analg 2006;103:497
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000227139.05281.EA

LETTER TO THE EDITOR

Preventing Hypoxemia During Pulmonary Sleeve Resections

Ju-Mei Ng, FANZCA

Department of Anaesthesia &, Surgical Intensive Care, Singapore General Hospital, Singapore, ng.ju.mei{at}sgh.com.sg

In Response:

Dr. Trytko (1) comments on our case report (2) describing the use of jet ventilation of the middle and lower lobes during right upper lobe sleeve resection to manage hypoxemia during one-lung ventilation. There are various means of managing hypoxemia on one-lung ventilation (3). High-frequency ventilation has been effective for providing adequate oxygenation and good surgical access in various reports, although it may not be easily accessible or widely available. Each clinical situation is unique. Depending on resources available and the anesthesiologist’s experience, it would be advantageous to incorporate this technique in the armamentarium for the management of hypoxemia. Early clamping of the pulmonary artery of the operative lung during pneumonectomy has also been advocated (3). Placing a vascular clamp on the main pulmonary artery, as Dr. Trytko suggests, would reduce the shunt and improve oxygenation. However, some patients may not tolerate such abrupt diversion of the entire blood flow into the nonoperative lung and may develop pulmonary hypertension and hemodynamic instability. This must be borne in mind, particularly when the patient is undergoing lobectomy (2) rather than a pneumonectomy. Perhaps early clamping of the pulmonary arterial supply of the right upper lobe would be more appropriate and less invasive. Communication with the surgeon would be crucial, as the feasibility of this technique would depend on stage of surgery and access.

References

  1. Trytko RL. Preventing hypoxemia during pulmonary sleeve resections. Anesth Analg 2006;103:497.[Free Full Text]
  2. Ng JM. Hypoxemia during one-lung ventilation: jet ventilation of the middle and lower lobes during right upper lobe sleeve resection. Anesth Analg 2005;101:1554–5.[Abstract/Free Full Text]
  3. Benumof JL. Anesthesia for thoracic surgery, 2nd ed. Philadelphia: WB Saunders, 1995.




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ng, J.-M.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Ng, J.-M.

Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press