Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2023; 11(18): 4368-4376
Published online Jun 26, 2023. doi: 10.12998/wjcc.v11.i18.4368
Anesthesia for extracorporeal membrane oxygenation-assisted thoracoscopic lower lobe subsegmental resection in a patient with a single left lung: A case report
Xiang-Feng Wang, Zi-Yan Li, Lei Chen, Long-Xiang Chen, Fang Xie, Hui-Qin Luo
Xiang-Feng Wang, Zi-Yan Li, Lei Chen, Long-Xiang Chen, Fang Xie, Hui-Qin Luo, Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province, China
Author contributions: Wang XF and Chen L contributed to manuscript writing and editing; Chen LX contributed to data collection; Li ZY and Xie F contributed to photo collection; Luo HQ contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Supported by the Special Scientific Research Project of the National Traditional Chinese Medicine Clinical Research Base, No. JDZX201926.
Informed consent statement: The patient provided informed written consent prior to the operation.
Conflict-of-interest statement: There are no conflicts of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiang-Feng Wang, MM, Chief Physician, Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, No. 817 Road, Taijiang District, Fuzhou 350004, Fujian Province, China. 11375451@qq.com
Received: March 20, 2023
Peer-review started: March 20, 2023
First decision: April 20, 2023
Revised: May 3, 2023
Accepted: May 23, 2023
Article in press: May 23, 2023
Published online: June 26, 2023
Processing time: 98 Days and 5.8 Hours
Abstract
BACKGROUND

It is difficult and risky for patients with a single lung to undergo thoracoscopic segmental pneumonectomy, and previous reports of related cases are rare. We introduce anesthesia for Extracorporeal membrane oxygenation (ECMO)-assisted thoracoscopic lower lobe subsegmental resection in a patient with a single left lung.

CASE SUMMARY

The patient underwent comprehensive treatment for synovial sarcoma of the right lung and nodules in the lower lobe of the left lung. Examination showed pulmonary function that had severe restrictive ventilation disorder, forced expiratory volume in 1 second of 0.72 L (27.8%), forced vital capacity of 1.0 L (33%), and maximal voluntary ventilation of 33.9 L (35.5%). Lung computed tomography showed a nodular shadow in the lower lobe of the left lung, and lung metastasis was considered. After multidisciplinary consultation and adequate preoperative preparation, thoracoscopic left lower lung lobe S9bii+S10bii combined subsegmental resection was performed with the assistance of total intravenous anesthesia and ECMO intraoperative pulmonary protective ventilation. The patient received postoperative ICU supportive care. After surgical treatment, the patient was successfully withdrawn from ECMO on postoperative Day 1. The tracheal tube was removed on postoperative Day 4, and she was discharged from the hospital on postoperative Day 15.

CONCLUSION

The multi-disciplinary treatment provided maximum medical optimization for surgical anesthesia and veno-venous ECMO which provided adequate protection for the patient's perioperative treatment.

Keywords: Left single lung; Subpulmonary segmental resection; Extracorporeal membrane oxygenation; Thoracoscopic; Anesthesia; Case report

Core Tip: The patient was a 50-year-old woman with synovial sarcoma of the right lung. A left pulmonary nodule was found more than 6 mo after surgery. The pulmonary function tests showed that lung function was severely limited. Performing anesthesia and surgery in this patient was difficult. Multidisciplinary treatment provided maximum medical optimization for the surgical anesthesia in this case; the combined protocol of total intravenous anesthesia, veno-venous extracorporeal membrane pulmonary oxygenation, goal-directed fluid therapy, perioperative pulmonary protection and rehabilitation, and multimodal analgesia provided adequate protection for the patient's perioperative treatment. The patient recovered and was discharged from the hospital.