Pivalizza E G, Tonnesen A S
Department of Anesthesiology, University of Texas Medical School at Houston 77030.
Can J Anaesth. 1994 Sep;41(9):857-60. doi: 10.1007/BF03011594.
A case is presented of acute intraoperative atelectasis causing profound hypoxaemia in a patient undergoing a combined epidural-general anaesthetic for hip surgery in the lateral position. The pathophysiology of the resultant ventilation-perfusion mismatch and the effects of applied positive end-expiratory pressure in the lateral position are explored. The emergency management is assessed, with emphasis on the role of bronchoscopy in diagnosis and treatment of this rare cause of life-threatening hypoxaemia in the operating room. This patient with risk factors for respiratory complications may have benefited from preoperative bronchoscopy to assist in lung expansion.
本文报告一例在侧卧位行髋关节手术并采用硬膜外-全身联合麻醉的患者，术中发生急性肺不张导致严重低氧血症。探讨了由此产生的通气-灌注不匹配的病理生理学以及侧卧位应用呼气末正压的影响。评估了紧急处理措施，重点强调了支气管镜检查在诊断和治疗手术室中这种罕见的危及生命的低氧血症原因方面的作用。这位有呼吸并发症危险因素的患者可能会从术前支气管镜检查以辅助肺扩张中获益。
