2024-03-29T14:12:33Z
https://nagoya.repo.nii.ac.jp/oai
oai:nagoya.repo.nii.ac.jp:02003759
2023-01-17T06:10:19Z
499:508:509:1662337921058
Challenges in left sleeve pneumonectomy in the left lateral decubitus position
Nakamura, Shota
Fukui, Takayuki
Ito, Hideki
Goto, Masaki
Ozeki, Naoki
Chen-Yoshikawa, Toyofumi Fengshi
adenoid cystic carcinoma
sleeve pneumonectomy
carinal resection
We report the case of a 20-year-old woman with carinal adenoid cystic carcinoma who underwent left sleeve pneumonectomy in the left lateral decubitus position, during which severe desaturation was encountered. After transecting the left main bronchus, the left lung was selectively intubated and ventilated. However, oxygenation was inadequate. Hence, venoarterial extracorporeal membrane oxygenation (ECMO) was introduced. Initially, Barclay’s procedure was planned to preserve the left lung, but this plan was altered due to the extent of the tumor and unstable ventilation. After the lesion was removed, the trachea and right main bronchus were anastomosed end-to-end. During left pneumonectomy, the right lung was selectively ventilated, but oxygen saturation (SpO2) dropped to <70% despite ECMO. SpO2 improved on additionally ventilating the left lung using another breathing circuit. Temporary right chest closure was performed with ventilation of the left lung across the thoracotomy wound. The patient was turned to the semi-supine position, and tolerated selective right lung ventilation with ECMO. Subsequently, left thoracotomy and pneumonectomy were successfully performed. Careful management is required for desaturation in left sleeve pneumonectomy in the left lateral decubitus position.
departmental bulletin paper
Nagoya University Graduate School of Medicine, School of Medicine
2022-08
application/pdf
Nagoya Journal of Medical Science
3
84
673
677
0027-7622
2186-3326
https://nagoya.repo.nii.ac.jp/record/2003759/files/19_Nakamura.pdf
eng
https://www.med.nagoya-u.ac.jp/medlib/nagoya_j_med_sci/843.html
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