Goonasekera Chulananda, Mathew Malcolm, Kurup Meera, James Steve
Department of Anesthetics, King's College Hospital NHS Trust, Denmark Hill, London, United Kingdom.
Saudi J Anaesth. 2021 Oct-Dec;15(4):424-427. doi: 10.4103/sja.sja_171_21. Epub 2021 Sep 2.
Video-assisted thoracoscopic surgery (VATS) in infants and young children increasingly require one-lung anesthesia. However, the maintenance of norms of gas exchange is difficult during one-lung anesthesia in some infants. A combination of factors including added dead space of HME and the circle Y piece, intrathoracic inflation of CO and its pressure, airway resistance and bilateral lung disease contribute. Seeping blood from the operating lung soiling the endobronchial tube causes airway narrowing and obstruction adding to this difficulty especially during prolonged thoracoscopy. We report two cases: hypoxemia in one and hypercapnia in the other. Guidance on safe limits of permissive hypoxemia or hypercarbia in this scenario is vague. Therefore, irreversible hypoxemia and hypercarbia with changes in acid-base status should be considered as indications for swift conversion to open thoracotomy and abandon one-lung ventilation.
婴幼儿的电视辅助胸腔镜手术（VATS）越来越需要单肺麻醉。然而，在一些婴幼儿的单肺麻醉期间，维持气体交换的正常标准很困难。包括热湿交换器（HME）和环路Y形管增加的死腔、二氧化碳在胸腔内的充盈及其压力、气道阻力以及双侧肺部疾病等多种因素都有影响。术侧肺渗血污染支气管内导管会导致气道狭窄和阻塞，进而增加这种困难，尤其是在长时间胸腔镜检查期间。我们报告两例病例：一例为低氧血症，另一例为高碳酸血症。在这种情况下，关于允许性低氧血症或高碳酸血症安全限度的指导并不明确。因此，应将伴有酸碱状态改变的不可逆性低氧血症和高碳酸血症视为迅速转为开胸手术并放弃单肺通气的指征。
