Published online Jun 26, 2023. doi: 10.12998/wjcc.v11.i18.4368
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
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.
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 After surgical treatment, the patient was successfully withdrawn from ECMO on postoperative Day 1.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.
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.
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.