Anaesthetic approach to VATS in a patient with one lung

Abstract

Spontaneous pneumothorax after a contralateral pneumonectomy is a potentially fatal condition. It can be treated with pleurodesis via video-assisted thoracoscopic surgery. However, achieving sufficient lung deflation to perform this whilst maintaining good oxygenation in a patient with a single lung is challenging. We describe the anaesthetic management of a 47 year-old male who underwent left-sided video-assisted thoracoscopic pleurodesis for a lifethreatening pneumothorax with a previous right pneumonectomy. We used total intravenous anaesthesia for induction and maintenance of anaesthesia with intermittent apnoeic ventilation. Both adequate surgical field visualisation and oxygenation were achieved. He had an uneventful postoperative course.