Anesthesia for Special Situations

High-frequency ventilation techniques are often appropriate.
Bronchopleural fistula and empyema are more likely to occur after a pneumonectomy than after other types of lung resection. Management of anesthesia in such patients includes several considerations (Table 37-10: Anesthetic Considerations in Management of a Patient with Bronchopleural Fistula).
1. An alternative to tracheal intubation in awake patients is placement of a DLT under general anesthesia with the patient breathing spontaneously.
2. Rapid sequence induction of anesthesia plus a muscle relaxant followed by placement of a single-lumen tracheal tube may be acceptable if the air leak is small and an empyema is not present.
3. For a large bronchopleural fistula, high-frequency jet ventilation may be the nonsurgical treatment of choice.
Lung Cysts and Bullae
1. These disorders usually represent end-stage emphysematous destruction of the lungs associated with severe obstructive pulmonary disease and carbon dioxide retention.
2. Positive-pressure ventilation or nitrous oxide may cause bullae to expand or rupture (tension pneumothorax).
3. Ideally, a DLT is inserted with a patient breathing spontaneously while awake or during general anesthesia.
4. Gentle positive-pressure ventilation with rapid, small tidal volumes and pressures not to exceed 10 cm H₂O may be used during the induction and maintenance of anesthesia, especially if the bullae have been shown to have no or only poor bronchial communication.
Anesthesia for resection of the trachea may be necessary to relieve stenosis that may occur after prolonged tracheal intubation or tracheotomy (Table 37-11: Anesthetic Considerations for Tracheal Resection).
Bronchopulmonary lavage is performed under general anesthesia using a DLT, most often for the treatment of cystic fibrosis.

section name header

Information ⬇

Outline ⬆