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Minerva Pneumologica 2017 December;56(4):254-7

DOI: 10.23736/S0026-4954.17.01796-5


language: English

Mustard lung anesthesia: general anesthesia in patients with chronic obstructive pulmonary disease due to sulphur mustard exposure

Mehdi D. FIROOZABADI 1, Alireza SHAHRIARY 2, Hossein RAHMANI 3

1 Department of Anesthesiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 2 Laboratory of Proteomics, Chemical Injuries Research Center, Department of Physiology and Biophysics, Baqiyatallah University of Medical Sciences, Tehran, Iran; 3 Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran


Sulphur mustard is a powerful blistering and alkylating chemical weapon which has been used in many wars. Pulmonary complications have the highest prevalence and result in a wide range of chronic side effects. A particular kind of chronic obstructive pulmonary disease (COPD) is defined for these patients and it is known as mustard lung. Another important issue that has become essentially important over the years is interference of this disease with other invasive and non-invasive treatment procedures. An anesthesiologist and a surgeon must have a thorough understanding of local and systemic comorbidities and a general understanding of extra pulmonary side effects. This article studies important diseases and clinical manifestations affecting the process of anesthesia in these patients. This review article attempted to summarize the contents, to offer practical notes, to express necessary indications and to review preoperative evaluation and proper intraoperative and postoperative management. To reach this aims we search on valuable academic data base such as Google Scholar, PubMed, Scopus, and Web of Knowledge, and use our experience from management of this patients. In addition to X-ray and spirometry, these patients may require high-resolution CT of lungs. Since systemic inflammation is possible in these patients like other COPD cases, checking inflammatory blood tests (such as the C-reactive protein test) is also necessary. Venipuncture site for IV is vital in skin lesions and for the health of blood vessels. In order to prevent acidosis-alkalosis changes, ABG test must be performed. Respiratory monitoring and O2 saturation monitoring are also very important. Using protective eye goggle is crucially important in these patients - who have eye problems and, specifically, corneal problems - during anesthesia and then in the ICU. It should be noted that medications and blood products should be administered for these patients by considering extra pulmonary complications and above mentioned diseases. In addition, blood tests and pulmonary tests should be conducted after the surgery and before patient’s discharge to control possible complications.

KEY WORDS: Mustard gas - Anesthesia - Chronic obstructive pulmonary disease - Respiratory tract diseases

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