Case conference

Differential Ventilation with Spontaneous Respiration for Bilateral Emphysema

“…A double-lumen tube allows complete and independent ventilatory control of each lung. 1 Immediate discontinuation of ventilation on the side of the pneumothorax would prevent development of tension pneumothorax and hemodynamic instability. The other advantages of a double-lumen tube include selective suctioning and testing of the suture or staple line for leaks, against a known high pressure without increasing lung volume on the non-resected side.…”

“…Bilateral emphysematous bullous disease can pose anesthetic problems such as hypoxemia, hypercarbia, bronchospasm, spontaneous rupture of the bulla, and pneumothorax. 1 In patients with bilateral bullous disease and additional empyema in one of the lungs, controlled ventilation may be hazardous because of the high risk of inducing pneumothorax on the healthy side, causing bilateral collapse of the lungs, resulting in severe hypoxia.…”