Apneic oxygenation in thoracic surgery in patients with previous pneumonectomy

Anesthetic management of patients undergoing thoracic surgical procedures for lung cancer poses unique challenges to the anesthesiologist, including patients' comorbidities, lateral decubitus position, the need for lung isolation, and the associated pathophysiology during and after these procedures. Anesthetic management is even more challenging in patients with previous pneumonectomy. In this case report we present two patients (patients Α and B), who had a previous history of left pneumonectomy and were scheduled for surgical resection of a tumor in the remaining right lung. Apneic oxygenation was used in both patients intraoperatively, initially by oxygen insufflation via a thin catheter advanced to the level of the carina. For a significant period of time, oxygenation was preserved in both patients. Patients Α and Bshowed time to oxygen desaturation of 30min and 25min respectively. Hypoxemia was recognized immediately by SpO2 decline below 90% and was confirmed via blood gas samples. Apneic oxygenation via a Mapleson-C circuit was applied successfully for hypoxemia management in both patients. Oxygen levels improved immediately and remained stable until the end of apneic oxygenation. Total duration of apneic oxygenation was 90min and 50min in patients A and B, respectively. Increaseof arterialcarbon dioxidetension (PaCO2) and subsequent respiratory acidosis were predictable results of apneic oxygenation thatwere corrected quickly by mechanical ventilation (MV). After the end of surgery, both patients were admitted intubated to the ICU, where weaning from MV was successful after 2hrs. Patients A and B were discharged from the ICU on first postoperativeday after an uncomplicated postoperative course.