A 30-year-old woman in the 20th gestational week developed right-sided spontaneous pneumothorax. Chest tube drainage was performed, but air leakage continued. At the 24th gestation, video-assisted thoracoscopic bullectomy was performed. General anesthesia was induced with thiopental, vecuronium and fentanyl and, maintained with sevoflurane. Endobronchial intubation with a 32Fr double-lumen tube was successful. After changing to the left lateral position, epidural catheter was placed and mepivacaine 2% was administered. During one-lung ventilation, SpO 2 remained 100% but end-tidal CO 2 was elevated to 66 mmHg. Ephedrine 15 mg was required to maintain systolic blood pressure above 100 mmHg. After the surgery, continuous injection of levobupivacaine 0.18% was started through the catheter. When patient complained of pain, 3 ml bolus injection was administered. In our case, one-lung ventilation led to hypercapnia, but avoided prolonged fetal acidosis by returning to bilateral lung ventilation.
We obtained satisfactory results for circulatory and respiratory perioperative stability in anesthetic management of patients who underwent right ventricular exclusion procedures.
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