Department of Anesthesiology, Shiga University of Medical Science, Otsu, Shiga, Japan.
Department of Anesthesiology, Kanazawa Medical University, Uchinada, Ishikawa, Japan.
Am J Case Rep. 2020 Dec 4;21:e925979. doi: 10.12659/AJCR.925979.
BACKGROUND Pneumonectomy is associated with various anatomical changes and potential complications involving the respiratory and cardiovascular systems. How laparoscopic surgery affects cardiorespiratory status in postpneumonectomy patients is yet to be ascertained. Here, we describe the use of the FloTrac™ sensor for the anesthetic management of laparoscopic adrenalectomy in a postpneumonectomy patient. CASE REPORT A 35-year-old woman underwent an extended hysterectomy and right pneumonectomy for retroperitoneal angiosarcoma and lung metastases, respectively. The metastasis was found in her left adrenal gland; therefore, laparoscopic adrenalectomy was scheduled. Spirometry demonstrated the following: forced vital capacity (FVC), 1.90 L (55.6% of predicted value); vital capacity, 53.6%; forced expiratory volume (FEV₁), 1.38 L (47.3% of predicted value); and FEV₁/FVC, 72.4%. The heart and mediastinal structures had shifted into the right hemithorax. Hugh-Jones classification was grade 2. The induction of general anesthesia was planned. The patient was orotracheally intubated and managed with the pressure control ventilation-volume guaranteed mode of ventilation, targeting an expired tidal volume of 6-7 ml/kg, without using PEEP. We evaluated cardiac output (CO), cardiac index (CI), stroke volume (SV), and stroke volume variation (SVV) using a FloTrac™ sensor. After the establishment of pneumoperitoneum, SVV increased. CO and SV decreased slightly; however, the patient's hemodynamic status was stable. After surgery, we extubated the patient in the operating room; she demonstrated good progress and was discharged home on postoperative day 5. CONCLUSIONS We found changes in the values of SVV after pneumoperitoneum in a postpneumonectomy patient. The FloTrac™ sensor may be a minimally invasive and promising monitor for detecting hemodynamic changes associated with laparoscopic surgery in postpneumonectomy patients.
肺切除术与涉及呼吸和心血管系统的各种解剖结构变化和潜在并发症相关。腹腔镜手术如何影响肺切除术后患者的心肺状态尚待确定。在这里，我们描述了使用 FloTrac™传感器对肺切除术后患者行腹腔镜肾上腺切除术的麻醉管理。
一名 35 岁女性因腹膜后血管肉瘤和肺转移瘤分别行广泛子宫切除术和右肺切除术。转移瘤位于其左侧肾上腺，因此计划行腹腔镜肾上腺切除术。肺量计检查显示：用力肺活量（FVC）1.90 L（预测值的 55.6%）；肺活量 53.6%；用力呼气量（FEV₁）1.38 L（预测值的 47.3%）；FEV₁/FVC 为 72.4%。心脏和纵隔结构已转移到右侧胸腔。Hugh-Jones 分级为 2 级。计划全身麻醉诱导。患者经口气管插管，采用压力控制通气-容量保证通气模式，目标呼气末潮气量为 6-7 ml/kg，不使用 PEEP。我们使用 FloTrac™传感器评估心输出量（CO）、心指数（CI）、每搏量（SV）和每搏量变异度（SVV）。建立气腹后，SVV 增加。CO 和 SV 略有下降，但患者血流动力学状态稳定。手术后，我们在手术室为患者拔管；她恢复良好，术后第 5 天出院回家。
我们发现肺切除术后患者气腹后 SVV 值发生变化。FloTrac™传感器可能是一种微创且有前途的监测器，可用于检测肺切除术后患者腹腔镜手术相关的血流动力学变化。
