An Experience of Right Pneumonectomy in a Lung Cancer Patient with Poor Pulmonary Function Test within the Conventional Criteria of Contraindication to Surgery: Intraoperative Re-evaluation of Pulmonary Function: A case report.
- Author:
Jin Young CHON
1
;
Sung Jin HONG
;
Ung JIN
;
Hae Jin LEE
;
Yong Woo CHOI
;
Se Ho MOON
;
Sun Hee LEE
;
Man Seok BAE
Author Information
1. Department of Anesthesiology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- Publication Type:Case Report
- Keywords:
Anesthesia;
thoracic;
Surgery;
pneumonectomy;
Lung;
pulmonary function test;
intraoperative evaluation
- MeSH:
Anesthesia;
Follow-Up Studies;
Hemodynamics;
Humans;
Ligation;
Lung Neoplasms*;
Lung*;
Oxygen;
Pneumonectomy*;
Postoperative Period;
Pulmonary Artery;
Respiratory Function Tests*;
Ventilation
- From:The Korean Journal of Critical Care Medicine
1999;14(2):167-175
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Usually FEV1 lower than 1 liter is considered as a contraindication to pneumonectomy. Therefore sometimes, the curative operations of the resectable lung cancer can not be performed in case of poor pulmonary functions. The usual criteria on the performance of pneumonectomy on high risk patients based on the preoperative assessment of pulmonary function may not predict the operative outcome with accuracy in the postoperative period. Nowadays, there are some arguing points about applying the values of preoperative PFTs to pulmonary resection surgery. We performed a right pneumonectomy for stage IIIb lung cancer in a patient with poor lung function test; FVC 2.17 L, FEV1 0.97 L, FEV1/FVC 44%, FEF 25~75% 0.42 L/sec, MVV 28 L/min, TLC 5.18 L, RV 2.99, DLCO 13.46. After the temporary ligation of right main pulmonary artery during 30 minutes, arterial blood gas and percutaneous oxygen saturation with the controlled ventilation with room air (FiO2=0.21) confirmed the hemodynamic and oxygenation stabilities, twice. After successful surgery, the patient was tolerated for 4 months. And the follow up PFTs at postoperative 3 months and 18 days showed as follows; FVC 1.20 L, FEV1 0.63 L, FEV1/FVC 53%, FEF 25~75% 0.31 L/sec, MVV 25 L/min, TLC 3.80 L, RV 2.33 L, DLCO 8.04. Through the intraoperative re-evaluation of pulmonary function in a patient with poor preoperative PFTs,had been conventionally considered as a contraindication to pneumonectomy, we report a successful surgery and anesthetic management with the literatures reviewed.
