Bilateral bullectomy using a double-lumen tube and alternate one-lung ventilation

Abstract

A 37-years-old man (weight 50 kg, height 165 cm, BMI 20.2) diagnosed with spontaneous pneumothorax and scheduled for bilateral bullectomy through video-assisted thoracoscopic surgery (VATS) using a double-lumen tube (DLT) and alternate one-lung ventilation (OLV). The patient has no allergies, hereditary history /-/, does not use alcohol and has been smoking since 18. Contrast-enhanced CT revealed no focal or infiltrative changes in the two lung tissues, 1.2cm bullae in the right lung apex, 1.9 cm bullae in the left apex, no gas or fluid in the pleural cavity, 0.3cm diverticulum in the main bronchus of the right lung and the trachea and main bronchi are free. No significant changes in ECG, spirogram, general urinalysis, and coagulogram. Due to the patient was young and relatively healthy did not require prior medications. Dexamethasone 8mg, methylprednisolone 100mg were administered 15 minutes before surgery. For anesthesia, 150mcg of fentanyl, 300mg of thiopental sodium, and 30mg of trachium were used under general anesthesia. Because the requirement of OLV, a 37Fr DLT was inserted into the trachea and attached in 28cm. During surgery, the anesthesia apparatus was adjusted to IPrV mode with Fr 12, PEEP 0cm H2O, TV 420ml, and FiO2 60%; PEAK was 21-24 cm H2O for OLV. Isoflurane was used as evaporation. During anesthesia, administered at tidal V 7ml/kg to prevent rupture of the bullae, rupture of the surgical suture of the operated lung and other injuries of the lung. Firstly, operated right bullectomy with left lung ventilation for 40 minutes. Secondly, operated left lung bullectomy with right lung ventilation for 60 minutes. The patient was monitored for a day in the intensive care unit and transferred to the department of general surgery. He was discharged from the hospital after the 12 days.