one lung anaesthesia

47 Pages·2015·0.95 MB·English

ONE LUNG ANAESTHESIA
N R BURRI
DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF
ANAESTHETISTS FINAL EXAMINATION
Tuesday 12th March 2013 9:30 am to 12:30 pm
a) What are the indications for ‘one lung
ventilation’ (OLV)? (30%)
b) How can the risks associated with lung
resection be quantified preoperatively? (30%)
c) How would you manage the development of
hypoxaemia during OLV? (40%)
WHAT SURGERIES REQUIRE IT ?
• Lung
• Oesophageal
• Mediastinal
• Spinal
Absolute
INDICATIONS
Relative
ABSOLUTE INDICATIONS
ISOLATION VENTILATION LAVAGE

1. INFECTION
1. BRONCHOPLEURAL FISTULA PULMONARY
2. HAEMORRHAGE
2. TRACHEOBRONCHIAL TREE DISRUPTION ALVEOLAR
3. GIANT UNILATERAL LUNG CYST PROTEINOSIS
4. SURGERY ON MAIN BRONCHI
RELATIVE INDICATIONS
ACCESS NON THORACIC
1. THORACIC AORTIC ANEURYSM SPINE SURGERY
2. PNEUMONECTOMY
3. LOBECTOMY
4. OESOPHAGECTOMY
LUNG SURGERIES / CANCER
• Lobectomies: 2400/yr 2-4% mortality
• Pneumonectomies: 500/yr 6-8% mortality

3 PREREQUISITES FOR LUNG CANCER SURGERY:
1) Non small cell tumour (Squamous / Adeno).
2) Surgically resectable
•BRONCHOSCOPY
3) Patient consent •CT
•PET
•MEDIASTINOSCOPY

TESTS OF PULMONARY FUNCTION
• Basic Spirometry
• Diffusion Capacity
• V/Q scan
• Prediction of Post Op Function
• Exercise Capability
• SpO & ABGs
2
6 minute walk test
Shuttle walk test
CPET
BASIC SPIROMETRY:
• FEV
1
• FVC
• FEV / FVC ratio
1
• Flow rates: Peak, mid, end expiratory
• RV

FEV > 1.5L for Lobectomy & > 2L for Pneumonectomy
1
VITALOGRAPH: NORMAL

FEV = 4.5
1
FVC = 5.5
FEV % = 80%
1