What is the role of anesthesia in bullectomy?

Updated: Feb 21, 2019
  • Author: Neerja Gulati, MD; Chief Editor: Dale K Mueller, MD  more...
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Answer

Patients with lung bullae are at increased risk for perioperative complications due to underlying chronic lung disease. Bullectomy is typically performed with general anesthesia with single-lung ventilation. A double-lumen endotracheal tube is used to provide single-lung ventilation to the lung not being operated on. If single-lung ventilation cannot be achieved, low–tidal volume ventilation during surgery and apneic oxygenation during stapling may be provided. Single-incision thoracoscopic surgery (SITS) with two-lung ventilation has been described. [19]

Close intraoperative monitoring should be done with pulse oximetry, capnography, and measurement of arterial and central venous pressure. [8]

Use of short-acting anesthetic agents is preferred to enable early extubation. [8]  Inhalational agents may have unpredictable uptake and distribution as a consequence of the increased dead space. Use of nitrous oxide is avoided, because of the risk of bulla expansion.


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