양측 폐에 거대 큰 공기집을 가진 환자에서 큰 공기집 파열로 인한 일측성 큰 기관지 흉막루

Abstract

A patient with a large bronchopleural fistula presents severalintraoperative challenges for the anesthesiologist, particularly ifbullae coexist bilaterally. Ideally, a double lumen tube is insertedwhile the patient is conscious or breathing spontaneously undergeneral anesthesia to prevent possible tension pneumothorax in thecontralateral lung due to positive-pressure ventilation and thepossibility of inadequate ventilation due to an air leak from the fistula. However, we inserted a single lumen tube instead of a double lumentube, because this patient had multiple giant bullae bilaterally andthe contralateral lung tissue was almost completely compressed anddestroyed. We report the use of a single lumen tube under volatilegeneral anesthesia with synchronized intermittent mandatoryventilation with small tidal volume. In addition, we used permissivehypercapnia to further minimize barotraumas. Due to permissivehypercapnia, there were no cardiovascular consequences.