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Title: Intraoperative oxygen challenge for toleration of single lung ventilation in a patient with severe obstructive airway disease: A case report.
Austin Authors: Weinberg, Laurence ;Cosic, Luka ;Louis, Maleck ;Garry, Tom ;Lloyd-Donald, Patryck ;Barnett, Stephen A ;Miles, Lachlan F 
Affiliation: Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
Department of Cardiothoracic Surgery, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Jan-2020
Date: 2019
Publication information: Annals of medicine and surgery 2020; 49: 28-32
Abstract: Perioperative risk assessment is complex in patients with chronic obstructive pulmonary disease who have undergone previous lung resection surgery. A 70-year-old female with severe chronic obstructive pulmonary disease and previous right middle and lower lobectomy, presented for left lower lobe superior segmentectomy. Respiratory function tests revealed a forced expiratory volume in 1 second of 0.72L, a forced vital capacity of 1.93L, and a carbon monoxide transfer factor of 10.0 ml/min/mmHg. A cardiopulmonary exercise test demonstrated little ventilatory reserve with profound arterial desaturation on peak exercise, however, a normal peak oxygen consumption (16.7 ml/min/kg) and a nadir minute ventilation/carbon dioxide slope of 24 implied a limited risk of perioperative cardiovascular morbidity. Given these conflicting results we performed an intraoperative oxygen challenge test under general anaesthesia with sequential ventilation of different lobes of the lung. We demonstrate the use of the oxygen challenge test as an effective intervention to further assess safety and tolerance of anaesthesia of patients with limited respiratory reserve being assessed for further complex redo lung resection surgery. Further, this test was a risk stratification tool that allowed informed decisions to be made by the patient about therapeutic options for treating their lung cancer. The prognostic value of traditional physiological parameters in patients with chronic obstructive pulmonary disease who have undergone previous lung resection surgery is uncertain. The intraoperative oxygen challenge test is another risk stratification tool to assist clinicians in assessment of safety and tolerance of anaesthesia for patients being considered for lung resection.
DOI: 10.1016/j.amsu.2019.10.032
ORCID: 0000-0001-7403-7680
Journal: Annals of medicine and surgery
PubMed URL: 31871680
ISSN: 2049-0801
Type: Journal Article
Subjects: Anaesthesia
Bronchial blocker
COPD, chronic obstructive pulmonary disease
CPET, cardiopulmonary exercise testing
CT, computed tomography
Case report
FEV1, forced expiratory volume in 1 second
FVC, forced vital capacity
Risk stratification
SABR, stereotactic ablative radiotherapy
SPECT, single photon emission computed tomography
TLCO, carbon monoxide transfer factor
Thoracic surgery
VE/VCO2, minute ventilation/carbon dioxide
VO2, maximum oxygen consumption
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