2024 FSA Podium and Poster Abstracts
P001: NAVIGATING CHALLENGES IN SINGLE LUNG VENTILATION: A CASE OF DIAPHRAGMATIC PACEMAKER PLACEMENT.
Madina Akhmetkaliyeva1; Kylie Schmitt2; Raul Bermudez-Velez1; Alejandra Figueroa1; 1HCA Florida Kendall Hospital; 2Nova Southeastern University
Intro: Single-lung ventilation is a specialized technique used in thoracic surgeries aimed at isolating one lung to optimize the surgical field, enhance visualization, and minimize surgical complications. Various single-lung ventilation techniques are available to offer flexibility to the anesthesiologist based on the patient’s anatomy, procedure requirements, and individual preferences. This case exemplifies the ability to utilize various techniques to fit the patients’ needs like starting with endotracheal intubation and switching to EZ blocker when needed.
Methods: A 50-year-old male with no past medical history arrived via EMS following a motor vehicle accident that led to a complete cord syndrome and C4-5 fracture s/p tracheostomy presented for thoracoscopic diaphragmatic pacemaker placement. The surgeon required single lung ventilation to access the diaphragm for placement of the electrodes, which was complicated by the patient’s diseased lungs after traumatic injury. The patient was intubated and mechanically ventilated with a tracheostomy. We attempted to facilitate single lung ventilation by removing the tracheostomy and intubating with a 39 French Endotracheal Double Lumen tube. However, fiberoptic bronchoscopy showed thick mucus plugs in both lungs and required larger diameter fiberoptic for intermittent suction throughout the procedure. The decision was made to place back a tracheostomy and isolate the lungs with an EZ blocker through tracheostomy.
The procedure commenced with the isolation of the more diseased right lung first to assess the patient’s tolerance to one-lung ventilation. The patient was able to tolerate single-lung ventilation, although, he required intermittent recruitment breaths and ventilation of both lungs to avoid significant desaturation while placing the electrodes on the diaphragm. Given that the patient tolerated single lung ventilation of the right lung, we proceeded with the left lung, which was better tolerated by the patient allowing for a quicker second part of the surgery.
Results: Following the procedure, the patient was transferred back to the ICU in stable condition. One week after the procedure patient showed significant improvement and required minimal ventilatory support. He was discharged to LTACH to continue long-term recovery after devastating injuries he sustained during a motor vehicle accident.
Discussion/Conclusion: In conclusion, the successful anesthetic management of this complex case underscores the critical importance of adaptability, innovation, and seamless communication between the anesthesiologist and surgeon in navigating challenging surgical scenarios. This case exemplifies the challenges encountered during the anesthetic management of a patient with complex neurologic and pulmonary pathology thus requiring adaptability with our intubation and ventilation techniques. The utilization of various single lung ventilation techniques, including transitioning from endotracheal intubation to EZ blocker, proved instrumental in optimizing the surgical field and facilitating the placement of diaphragmatic pacemaker electrodes. The strategic approach of isolating the more diseased lung first allowed for careful assessment of the patient's tolerance to single lung ventilation and ensured a smoother progression of the procedure.