Pandit Anuja, Gupta Nishkarsh, Madan Karan, Bharti Sachidanand J, Kumar Vinod
Department of Onco-Anesthesiology and Palliative Medicine, DRBRAIRCH, AIIMS, New Delhi, India.
Department of Pulmonary Medicine and Sleep Disorders, AIIMS, New Delhi, India.
Ghana Med J. 2019 Sep;53(3):248-251. doi: 10.4314/gmj.v53i3.9.
Pulmonary alveolar proteinosis (PAP) is an uncommon lung disease characterized by excessive accumulation of pulmonary surfactant that usually requires treatment with whole-lung lavage. A 47-year-old female presented with history of dry cough and breathlessness for past 6months. Chest radiograph demonstrated bilateral alveolar shadows and high resolution computerized tomography thorax showed crazy paving pattern. Broncho-alveolar lavage (BAL) and transbronchial lung biopsy confirmed a diagnosis of PAP. Due to worsening hypoxemia and respiratory failure, wholelung lavage was planned and performed. Anaesthetic management involved integrated use of pre-oxygenation, complete lung isolation, one-lung ventilation with optimal positive end-expiratory pressure, vigilant use of positional manoeuvres, and use of recruitment manoeuvres for the lavaged lung. We have discussed valuable strategies for the anaesthetic management of patients undergoing this multifaceted procedure in a case of severe PAP.
None declared.
肺泡蛋白沉积症（PAP）是一种罕见的肺部疾病，其特征是肺表面活性物质过度积聚，通常需要进行全肺灌洗治疗。一名47岁女性，有干咳和气短病史6个月。胸部X线片显示双侧肺泡阴影，胸部高分辨率计算机断层扫描显示铺路石样改变。支气管肺泡灌洗（BAL）和经支气管肺活检确诊为PAP。由于低氧血症和呼吸衰竭加重，计划并实施了全肺灌洗。麻醉管理包括预给氧、完全肺隔离、采用最佳呼气末正压进行单肺通气、谨慎使用体位调整以及对灌洗肺使用肺复张手法。我们在一例严重PAP病例中讨论了对接受这一复杂手术患者进行麻醉管理的宝贵策略。
未声明。
