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Online ISSN 1827-1596
Della Rocca G., Pompei L., Coccia C., Costa M. G., Di Marco P., Di Giacomo T. *, Pietropaoli P.
Università degli Studi di Roma «La Sapienza» - Roma Azienda Ospedaliera Policlinico Umberto I Istituto di Anestesia e Rianimazione
*Cattedra di Chirurgia Toracica (Direttore: Prof. G. F. Coloni)
Bacground. Lung volume reduction surgery (LVRS) has become a novel palliative procedure for a subgroup of patients with advanced non-bullous emphysema.
Methods. Seventy-six patients with severe emphysema were evaluated: ten patients were considered for lung transplantation and only 24 underwent LVRS. In all patients an epidural catheter was inserted between the T5-T9 space. During one lung ventilation (OLV), ventilatory setting was adjusted to avoid “air trapping” and/or dynamic hyperinflation and high frequency jet ventilation was used when PaO2/ FiO2 was lower than 60 mmHg in 5 patients. Permissive hypercapnia (PaCO2=53 mmHg) was allowed to avoid hyperinflation and reach hemodynamic stability.
Results. During OLV PaO2/FiO2 was 148±80 mmHg, PaCO2 53±11 mmHg, mPA 27±2 mmHg and Qsp/Qt was 38±6%. Although the high risk patients, there were no complications due to hypercapnia during surgery. Twenty-three patients were extubated successfully at the end of the surgery (PaO2/FiO2 179±34 mmHg and PaCO2 59±11 mmHg) and only one patient was not extubated because of air leakage and died for postoperative respiratory failure after 20 days. Another patient died because of sepsis after 15 days. Numeric Ordinal Verbal Scale (by Keele modified) was used for postoperative pain degree at 0, 12th and 24th hours. No patients had pain>2.
Conclusions. In conclusion, a careful anesthesia technique with an accurate intraop monitoring associated with thoracic epidural analgesia even in Video Assisted Thoracic Surgery is suggested in LVRS patients; 12 months postoperative data confirm the validity of the procedure (FEV1 24 → 36%, FVC 53 → 70%, RV 265 → 199% and 6MWT 213 → 330 m).