Anesth Pain Med.  2014 Jan;9(1):54-57.

A unilateral large bronchopleural fistula caused by rupture of bulla with coexisting bilateral giant bullae: A case report

• Kim YO
• Yeom JH
• Lee JM
• Byun JW
• Shin WJ

Abstract

A patient with a large bronchopleural fistula presents several intraoperative challenges for the anesthesiologist, particularly if bullae coexist bilaterally. Ideally, a double lumen tube is inserted while the patient is conscious or breathing spontaneously under general anesthesia to prevent possible tension pneumothorax in the contralateral lung due to positive-pressure ventilation and the possibility of inadequate ventilation due to an air leak from the fistula. However, we inserted a single lumen tube instead of a double lumen tube, because this patient had multiple giant bullae bilaterally and the contralateral lung tissue was almost completely compressed and destroyed. We report the use of a single lumen tube under volatile general anesthesia with synchronized intermittent mandatory ventilation with small tidal volume. In addition, we used permissive hypercapnia to further minimize barotraumas. Due to permissive hypercapnia, there were no cardiovascular consequences.

Keyword

Bronchial fistula; Bullae; Hypercapnia; Synchronized intermittent mandatory ventilation

MeSH Terms

Anesthesia, General
Barotrauma
Bronchial Fistula
Fistula*
Humans
Hypercapnia
Lung
Pneumothorax
Positive-Pressure Respiration
Respiration
Rupture*
Tidal Volume
Ventilation