Severe hypoxemia due to lung collapse on the operation side sometimes occurs during thoracotomy. It can usually be COUIlt.eracted with a high FlO,. But, we have experienced a patient who showed refractory hypoxemia even under intermittent positive pressure ventilation (IPPV) through a single lumen endotracheal tube at an Flo, of 1.0 during esophagcctorny, The collapsed lung was inflated and the bilateral lungs were ventilated manually or with mechanical ventilation (MV) to maintain Pao, at a physiologic range. However, the inflated hmg hid the operation field. When the lung was placed aside with a retractor for continuing the operation, the Pao, fell again below an acceptable level. Therefore, we superimposed high frequency jet ventilation (HF JV) on IPPV. Superimposed HF,lV resulted in good pulmonary oxygenation as well as providing satisfactory operative conditions,
Case ReportA 66-years-old male, with a past history of hypertension and cerebral apoplexy, underwent esophagectorny for esophageal carcinoma. He had worked as a miner for 15 ----------years since he was 31-years-old, and had smoked 20 cigarettes per day over 40 years. He received a pre-operative radiation therapy of a total of 30 Cy. Pulmonary fibrotic changes were seen on his chest X-rays. The lung function tests showed VC 2930 ml, %VC 94.2%, FEVl.O% 78.6%, RV% 27.2%, %DLCO 58.4%, and arterial blood gases (ABC) at spontaneous breathing of room air were pH 7.449, Po, 79,8 rnm.Hg, and Pe02 35.1 mmHg.The patient was premedicated with 0.5 mg of atropine sulfate and 50 mg of Pethilorfan®. Under spontaneous air breathing in a supine position in the operating room, his ABC showed pH 7.431, Po, 53.6 mmHg, and PC02 42.1 mmHg. The ABC at an FlO, of 1.0 showed pH 7.435, Po, 556.1 mmHg, and PC02 '12.9 mrnHg. He was anesthetized with thiamylal, and orotracheally intubated with a single lumen endotracheal tube after succinylcholine chloride injection. Anesthesia was maintained with 0.7-1.0% halothane in nitrous oxide and oxygen. He was placed in a left recumbent position. After the right chest cavity was opened and the right lung was placed aside with a retractor, the ABC remarkably aggravated to pH 7.354, Po, 44.5 mmHg, and Pea, 54.1 mmHg at an F102 of 0.6 under manual ventilation with a minute volume of 7-8l. Anesthesia was switched to morphine hydrochloride, diazepam, and low concentrations of halothane. The F102 was raised to
