Anesthesic management of whole lung lavage in pulmonary alveolar proteinosis (Case Report) Pulmoner Alveoler Proteinoziste Uygulanan Masif Bronkoalveoler Lavajda Anestezi (Olgu Sunumu)
Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi, cilt.9, sa.2, ss.77-81, 2003 (Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 9 Sayı: 2
- Basım Tarihi: 2003
- Dergi Adı: Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi
- Derginin Tarandığı İndeksler: Scopus
- Sayfa Sayıları: ss.77-81
- Anahtar Kelimeler: Pulmonary alveoler proteinosis, Whole lung lavage
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
In this case report; we presented anesthesic management of whole lung lavage (WLL) in pulmonary alveolar proteinosis (PAP). A 24-yr-old male was admitted for evaluation of progressive dyspnea. PAP was diagnosed by laboratory, roentgenologic data and with the result of open lung biopsy. Initially WLL for the left lung was planned. Anesthesia was induced with alfentanil 20 μg.kg-1, propofol 2.5 mg.kg-1 and vecuronium 0.1 mg.kg-1 IV in ASA III case. ECG, heart rate, peripheral oxygen saturation, invasive arterial pressure and arterial blood gases were monitored. The internal jugular vein and radial artery were both cannulated. Swan-Ganz catheter, oesophageal temperature probe and Foley catheter were also inserted. After left-sided double lumen tube was inserted the correct position was confirmed by intubating fiberoscope. Halothane 0.7-1 % in 100 % O2, alfentanil and vecuronium bolus doses were used in the maintenance. The lung was filled with warm saline (37°) with the case in the supine position. A Y-shaped set with the length of 150 cm between carina and reservoir was used during lavage. Saline was infused from a height of 50 cm above the carina. The lung was filled with 700-1000 mL in each session lasting 5-8 minutes. The left lavage last 6 hours, 30 L saline was used totally and total retention of fluid was 400 mL. The case was scheduled for the right WLL after a week. Monitorization, induction and protocol of WLL were the same as the left lavage. Cisatracurium and propofol (5-6 mg. kg-1. hr-1) were used at this time. In the right lavage lasting 4 hours and 30 min total saline used was 25 L with the retention of 500 mL. PaO2 values of the case were 58, 66 and 73 mmHg prior to, after the left and the right WLL respectively. Although WLL is an efficient method in the treatment of PAP, it is an uncommon and complicated procedure. Special preparation, equipment and experienced anesthetic team for thoracic anesthesia are needed. Actually we believe that when proper conditions are provided the procedure might be safe and beneficial.