IntroductionAdequate blood oxygenation and ventilation/perfusion matching should be main goal of anaesthetic and intensive care management. At present, one of the methods of improving gas exchange restricted by ventilation/perfusion mismatching is independent ventilation with two ventilators. Recently, however, a unique device has been developed, enabling ventilation of independent lungs in 1:1, 2:1, 3:1, and 5:1 proportions. The main goal of the study was to evaluate the device’s utility, precision and impact on pulmonary mechanics. Secondly- to measure the gas distribution in supine and lateral decubitus position.Materials and methods69 patients who underwent elective thoracic surgery were eligible for the study. During general anaesthesia, after double lumen tube intubation, the aforementioned control system was placed between the anaesthetic machine and the patient. In the supine and lateral decubitus (left/right) positions, measurements of conventional and independent (1:1 proportion) ventilation were performed separately for each lung, including the following: tidal volume, peak pressure and dynamic compliance.ResultsOur results show that conventional ventilation using Robertshaw tube in the supine position directs 47% of the tidal volume to the left lung and 53% to the right lung. Furthermore, in the left lateral position, 44% is directed to the dependent lung and 56% to the non-dependent lung. In the right lateral position, 49% is directed to the dependent lung and 51% to the non-dependent lung. The control system positively affected non-dependent and dependent lung ventilation by delivering equal tidal volumes into both lungs with no adverse effects, regardless of patient's position.ConclusionsWe report that gas distribution is uneven during conventional ventilation using Robertshaw tube in the supine and lateral decubitus positions. However, this recently released control system enables precise and safe independent ventilation in the supine and the left and right lateral decubitus positions.

An unexpected prolonged neuromuscular block and respiratory distress, although infrequent, is a very serious anesthetic complication in patients undergoing general anesthesia.Suxamethonium is a neuromuscular blocker agent of choice for a rapid effect and of short duration (3 to 5 min), which is due to its rapid degradation with plasma pseudocholinesterase (1). This agent is used for intratracheal intubation, especially when rapid intubation is necessary.Sometimes suxamethonium may induce some side effects, such as cardiac arrhythmia or bradycardia, increase in intraocular pressure, allergy reaction and allergic shock or malignant hyperthermia. Inconvenience of its use is the lack of antagonistic agent. Although embryotoxic and teratogenic effect have not been revealed, its use in the first trimester of pregnancy is contraindicated. However, the placental transfer of this agent is not significant and does not affect the fetus in full term pregnancy. SUMMARYThe purpose of this study was a presentation of the young woman at delivery, who underwent a caesarean section under general anesthesia with suxamethonium as a neuromuscular relaxant. Prolonged neuromuscular block and respiratory distress requiring assisted respiration took place after the operation was completed. This condition was the result of a decreased plasma pseudocholinesterase activity. The most important goal after the delivery was providing an intensive care of patient and assisted respiration. The patient was ventilated until neuromuscular function and respiratory function returned to normal.Indukowany suksametonium przedłużony blok nerwowo-mięśniowy po cięciu cesarskim. Opis przypadkuCelem pracy było przedstawienie przypadku młodej kobiety, która urodziła cięciem cesarskim w znieczuleniu ogólnym z zastosowaniem suksametonium jako s'rodka zwiotczającego miçs'nie. Po zabiegu operacyjnym wystąpił przedłużony blok nerwowo-miçs'niowy. Pacjentka wymagała zastoso wania oddechu wspomaganego. Sytuacja ta była wynikiem obniżonej aktywności esterazy cholinowej. Najważniejszym zadaniem było zapewnienie pacjentce intensywnej opieki medycznej i utrzy manie oddechu wspomaganego do czasu powrotu prawidłowych funkcji życiowych.