Year : 2021  |  Volume : 15  |  Issue : 4  |  Page : 424-427

When to abandon single-lung anesthesia during video-assisted thoracoscopic surgery (VATS) in infants and young children: A case-based review

Department of Anesthetics, King's College Hospital NHS Trust, Denmark Hill, London, United Kingdom

Correspondence Address:
Chulananda Goonasekera
Consultant Anesthetist, Department of Anesthetics, King's College Hospital NHS Trust, Denmark Hill, London SE5 9RS
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sja.sja_171_21

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Video-assisted thoracoscopic surgery (VATS) in infants and young children increasingly require one-lung anesthesia. However, the maintenance of norms of gas exchange is difficult during one-lung anesthesia in some infants. A combination of factors including added dead space of HME and the circle Y piece, intrathoracic inflation of CO2 and its pressure, airway resistance and bilateral lung disease contribute. Seeping blood from the operating lung soiling the endobronchial tube causes airway narrowing and obstruction adding to this difficulty especially during prolonged thoracoscopy. We report two cases: hypoxemia in one and hypercapnia in the other. Guidance on safe limits of permissive hypoxemia or hypercarbia in this scenario is vague. Therefore, irreversible hypoxemia and hypercarbia with changes in acid–base status should be considered as indications for swift conversion to open thoracotomy and abandon one-lung ventilation.

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