Abstract
Purpose
To document and explain the beneficial effects of non-invasive ventilation in correcting hypoxemia and hypoventilation in severe chronic obstructive pulmonary disease, during spinal anesthesia in the lithotomy position.
Clinical features
A morbidly obese patient with severe chronic obstructive pulmonary disease underwent prostate surgery in the lithotomy position under spinal anesthesia. Hypoxemia was encountered during surgery, and a profound decrease of forced vital capacity associated with alveolar hypoventilation and ventilation/ perfusion mismatching were observed. In the operating room, an M-mode sonographic study of the right diaphragm was performed, which confirmed that after spinal anesthesia and assuming the lithotomy position, there was a large decrease (-30%) in diaphragmatic excursion. Hypoxemia and alveolar hypoventilation were successfully treated with non-invasive positive pressure ventilation.
Conclusions
Intraoperative application of non-invasive positive pressure ventilation improved diaphragmatic excursion and overall respiratory function, and reduced clinical discomfort in this patient.
Résumé
Objectif
Mettre en évidence ľefficacité de la ventilation non effractive peropératoire pour corriger les effets délétères de ľassociation bronchopneumopathie chronique obstructive, obésité, rachianesthésie et position de lithotomie.
Eléments cliniques
Pendant une opération de la prostate réalisée sous rachianesthésie en position de lithotomie, nous avons observé : une hypoxémie liée à une majoration de ľhypoventilation alvéolaire et un effondrement de la capacité vitale forcée. Une étude échographique du diaphragme nous a permis de rattacher ces troubles à une réduction de plus de 30 % de la cinétique du diaphragme. Le traitement a consisté en la mise en place peropératoire ďune ventilation non effractive au masque facial.
Conclusion
La ventilation non effractive, en restaurant la cinétique diaphragmatique, a corrigé ľhypoxémie, rétablit la capacité vitale forcée et amélioré le confort respiratoire du patient.
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Ferrandière, M., Hazouard, E., Ayoub, J. et al. Non-invasive ventilation corrects alveolar hypoventilation during spinal anesthesia. Can J Anesth 53, 404–408 (2006). https://doi.org/10.1007/BF03022508
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DOI: https://doi.org/10.1007/BF03022508