Anaesthetic management of a patient with a descending thoracic aortic aneurysm and severe bilateral bullous pulmonary parenchymal disease

Eagle, Chris; Tang, Tim

doi:10.1007/bf03028272

Cited by 7 publications

(5 citation statements)

References 6 publications

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“…Avoiding barotrauma is the key element of management; in the case of rupture, the use of bronchial blockers, jet ventilation strategies, or bulla ligation with chest tube insertion should be considered. 12 F I G U R E 3 A 2.5 × 2.5 cm aneurysm originating from the coarcted segment in the descending aorta was observed. Histopathological examination of the aortic tissue indicated the area of the aneurysm (A), coarctation formation (B), and atherosclerotic areas (C-F).…”

Section: Discussionmentioning

confidence: 96%

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Coarctation of the aorta with aortic and subclavian artery aneurysms

et al. 2021

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Coarctation of the aorta discovered in adulthood is uncommon. The formation of aneurysms from the coarctation segment and in the low‐pressure area is even rarer. The surgical management of coarctations can be challenging due to calcifications and concomitant cardiovascular and lung disease. We present a case with coronary artery disease, bilateral bullae, left subclavian artery aneurysm, saccular aortic aneurysms originating proximal to the coarctation and from the coarctation itself, and a remnant of ductus arteriosus. The surgical management and possible histopathologic causes for aneurysm formation are discussed.

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Section: Discussionmentioning

confidence: 96%

“…The presence of bilateral bullae poses a challenge for anesthetic management in single lung ventilation. Avoiding barotrauma is the key element of management; in the case of rupture, the use of bronchial blockers, jet ventilation strategies, or bulla ligation with chest tube insertion should be considered 12 …”

Section: Discussionmentioning

confidence: 99%

Coarctation of the aorta with aortic and subclavian artery aneurysms

et al. 2021

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“…This can be accomplished by avoiding positive-pressure ventilation. If this is not possible then peak pressures should be limited in order to avoid rupture of bullae [5]. Also, the size of the ET, which represents the internal diameter in millimeters, will affect peak pressures.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous hemothorax during general anesthesia

Parikh

Sattari

Shariati³

et al. 2009

J Anesth

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We report a case of spontaneous hemothorax in a healthy 27-year-old man undergoing elective reconstruction of the right anterior cruciate ligament (ACL) under general anesthesia. In the postanesthesia care unit (PACU), the patient became hypotensive and tachycardic with mid-sternal chest discomfort. A chest roentgenogram revealed an almost complete opacification of the right hemithorax. A diagnostic thoracentesis was positive for frank blood, confirming a right hemothorax. The patient was emergently taken back to the operating room. A chest tube was inserted, and 3.3 l of dark blood was drained. Once the patient improved hemodynamically, we proceeded with a right video-assisted thoracoscopic surgery (VATS). A bleeding vessel incorporated in a bleb was identified at the apex of the right lung. The bleeding vessel was clipped. A wedge resection of the apical bleb was performed and the associated torn vascular adhesion was stapled. The patient was found to have bullous disease at the apical region of the right lung. These bullae can undergo neovascularization and form vascularized bullae. Rupture of these vascularized bullae can cause a spontaneous hemopneumothorax. In our patient it is possible that an apical vascularized bulla ruptured causing a massive intrapleural bleed.

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“…The pursuit of normocapnia is a prerogative that can be sacrificed to a moderate degree ( 2 CO a P ഛ12 kPa). 5 9 10 53 65 82 Cannulation of a bulla, either accidental or therapeutic 44 to pre-empt the development of a tension pneumothorax, 20 may lead to the development of an air leak, requiring specialist surgical management and should not be undertaken lightly.…”

Section: Lessons For the Non-specialistmentioning

confidence: 99%

“…5 Deliberate decompression of bullae with intercostal drains remains an option, particularly to pre-empt the development of tension pneumothorax during anaesthesia. 20…”

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confidence: 99%

Anaesthesia for the surgery of emphysema

Conacher¹

1997

British Journal of Anaesthesia

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Thoracic anaesthesia is now established in a third age. The first age related to surgery for infective conditions, predominantly tuberculosis, the second was defined by surgery for bronchogenic cancer and the third is surgery for respiratory failure. The anaesthetic imperatives of this latest age are epitomized by emphysema, with some variants treated with lung transplantation and, recently, surgery for the oxymoron, lung volume reduction. Small areas of emphysematous changes are common in the general population, occasionally resulting in pneumothoraces; a significant number of these patients require surgical intervention. The presence of large cystic areas or bullae, and bilateral, widespread diffuse areas of enlarged air spaces distal to terminal bronchioles 32 are much rarer and their management fraught with risk. Until the advent of lung volume reduction surgery, the anaesthetic literature was sparse, with mostly case reports and series involving small numbers. Personal experience of managing cases with moderate to severe respiratory failure, as a result of end-stage emphysematous disease, serves as an illustrative framework (table 1) and has much to teach about the dangers, how anaesthesia may contribute to morbidity and mortality, and where risks can be reduced. An early specimen of emphysema, purportedly the lung of Dr Samuel Johnson, is illustrated in Mathew Baillie's The Morbid Anatomy of Some of the Most Important Parts of the Human Body (London, Bulmer, 1812). 47 Laennec 42 described the clinical condition of dyspnoea, cyanosis, dry cough, over-inflated chest, cardiac hypertrophy and quiet respiratory sounds on auscultation. He recognized the continuum from the small areas of enlarged air cells, illustrated in his book, to the giant cyst or bulla. He foresaw pathognomonic features now so often seen on chest x-rays and CT scans, 74 noting that: "When this disease occupies only one side, or exists much more in one lung than the other, this side is evidently enlarged, and the intercostal spaces wider...........and instead of its natural compressed shape it (the chest)

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Anaesthetic management of a patient with a descending thoracic aortic aneurysm and severe bilateral bullous pulmonary parenchymal disease

Abstract: The anaesthetic management of the surgical repair of a descending aortic aneurysm in a patient

Cited by 7 publications

References 6 publications

Coarctation of the aorta with aortic and subclavian artery aneurysms

Coarctation of the aorta with aortic and subclavian artery aneurysms

Spontaneous hemothorax during general anesthesia

Anaesthesia for the surgery of emphysema

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