Haloi Prajnananda, Biswas Rahul, Bora Ananta K
Department of Anesthesiology and Critical Care, GNRC Medical, North Guwahati, Assam, India.
Saudi J Anaesth. 2024 Jul-Sep;18(3):442-444. doi: 10.4103/sja.sja_43_24. Epub 2024 Jun 4.
Anesthesia in patients with emphysematous giant bulla undergoing non-thoracic surgery is challenging and can cause serious complications. We report a successful case of lip mass resection in a 65-year-old male with paraseptal emphysema and giant bullae under regional anesthesia using a mental nerve block. The patient presented with a slow-growing ulcerative mass on his lower lip and had a history of non-compliant COPD management. An excisional biopsy was planned. Preoperative workup revealed extensive lung pathology with giant bullae. General anesthesia with positive pressure ventilation in patients with emphysematous giant bullae can cause compression of lung parenchyma, vena cava kinking, circulatory collapse, and even death. To circumvent such risks, regional anesthesia was preferred and surgery was successfully done under ultrasound-guided bilateral mental nerve block. The procedure was uneventful, with stable hemodynamics throughout.
患有气肿性大疱的患者接受非胸科手术时的麻醉具有挑战性，且可能导致严重并发症。我们报告一例成功的病例，一名65岁男性患有间隔旁肺气肿和气肿性大疱，在区域麻醉下使用颏神经阻滞进行唇部肿物切除。患者下唇出现一个生长缓慢的溃疡性肿物，有慢性阻塞性肺疾病（COPD）管理不规范的病史。计划进行切除活检。术前检查发现广泛的肺部病变和气肿性大疱。气肿性大疱患者采用正压通气的全身麻醉可导致肺实质受压、腔静脉扭结、循环衰竭甚至死亡。为规避此类风险，首选区域麻醉，并在超声引导下双侧颏神经阻滞成功完成手术。手术过程顺利，血流动力学全程稳定。
