Right-sided Decortication in a Patient with Left Pulmonary Artery Embolism – A Case Report

Authors

  • Tanvi Meshram All India Institute of Medical Sciences, Jodhpur, India
  • Darshana Rathod All India Institute of Medical Sciences, Jodhpur, India
  • Kamlesh K. Kumari All India Institute of Medical Sciences, Jodhpur, India
  • Arun Sahayraja M All India Institute of Medical Sciences, Jodhpur, India

DOI:

https://doi.org/10.3126/nmj.v5i1.44411

Keywords:

Anesthesia, Decortications, One lung ventilation, Pulmonary embolism, VATS, Thoracic surgery, V/Q mismatch

Abstract

This case is an anesthesia challenge and management of one-lung ventilation in a patient with pulmonary embolism of the ventilated lung. A 50 years old male with a history of pulmonary thromboembolism of segmental and subsegmental branches of the left pulmonary artery was posted for right decortication. He developed hypoxia (sp02~82-85% ) and PaC02-EtCO2 difference of ~30 mm Hg on initiation of one lung ventilation indicating significant shunting of blood and V/Q mismatch. We want to emphasize the importance of intraoperative arterial blood analysis to look for (PaCO2 –EtCO2) difference and periodic reinflation of the collapsed lung for management of patients in whom the blood supply to the dependent is compromised. The presence of pulmonary vascular compromise on the dependent side offers a great number of challenges during the management of one-lung ventilation.

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Author Biographies

Tanvi Meshram, All India Institute of Medical Sciences, Jodhpur, India

Department of Anaesthesia

Darshana Rathod, All India Institute of Medical Sciences, Jodhpur, India

Department of Anaesthesia

Kamlesh K. Kumari, All India Institute of Medical Sciences, Jodhpur, India

Department of Anaesthesia

Arun Sahayraja M, All India Institute of Medical Sciences, Jodhpur, India

Department of Anaesthesia

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Published

2022-06-30

How to Cite

Meshram, T., Rathod, D., Kumari, K. K., & Sahayraja M, A. (2022). Right-sided Decortication in a Patient with Left Pulmonary Artery Embolism – A Case Report. Nepalese Medical Journal, 5(1), 563–565. https://doi.org/10.3126/nmj.v5i1.44411

Issue

Section

Case Reports