背景:使用电子可视化双腔支气管导管(E-visualDLT)可以在单肺通气期间实现出色的手术可视化。全位倒位(SIT)是一种罕见的常染色体隐性遗传病,其中与普通人群相比,个体左侧和右侧的支气管和肺叶结构相反。在SIT的情况下,将左侧电子视觉DLT置入右支气管可能提供更有利的单肺通气。然而,尚未报道使用E-visualDLT单肺通气麻醉技术进行SIT的实例.
方法:我们提供了一个病例报告,详细说明了在一名36岁男性诊断为SIT的全身麻醉下有效实施可视化单肺通气技术。该患者有纵隔肿块,并使用左侧入路对纵隔肿块进行了胸腔镜切除。
方法:根据对比增强胸部计算机断层扫描(CT)结果,患者被诊断为SIT并伴有纵隔肿块。建议进行手术干预以减轻由肿块引起的心脏压迫。然而,麻醉的管理和处理带来了显著的挑战,因为临床麻醉医师遇到了相互矛盾的数据和数量有限的循证指南.
方法:在麻醉开始前召开多学科会议,制定综合策略。在整个麻醉管理中,我们的团队确保了细致的监控,提供足够的氧合,建立了血流动力学平衡。麻醉小组审议并设计了一项计划,通过右支气管采用左侧电子视觉DLT放置,用于SIT患者的右侧单肺通气。对麻醉诱导过程进行重复模拟以保证患者安全。
结果:由于麻醉的细致有效管理和监督,手术按计划完成。随后,在没有任何并发症的情况下,进行了E-visualDLT的移除.
结论:关于SIT的数据和文献很少,需要彻底的预先规划和准备。
BACKGROUND: Using an electronic visualized double-lumen endobronchial tube (E-visual DLT) allows for excellent surgical visualization during one-lung ventilation. Situs inversus totalis (SIT) is a rare autosomal recessive genetic condition wherein the bronchial and pulmonary lobar structures on the left and right sides of individuals are reversed compared to those of the general population. In the case of SIT, placing a left-sided E-visual DLT into the right bronchus might offer more advantageous one-lung ventilation. However, there have been no reported instances of using E-visual DLT single-lung ventilation anesthesia techniques for SIT.
METHODS: We present a case report detailing the effective implementation of a visualized single-lung ventilation technique under general anesthesia in a 36-year-old male diagnosed with SIT. The patient had a mediastinal mass and underwent thoracoscopic resection of the mediastinal mass using a left-sided approach.
METHODS: Based on the findings from the contrast-enhanced chest computed tomography (CT) results, the patient was diagnosed with SIT along with a mediastinal mass. Surgical intervention was proposed to alleviate the cardiac compression caused by the mass. Nevertheless, the administration and handling of anesthesia posed a notable challenge since clinical anesthesiologists encounter contradictory data and a limited number of evidence-based guidelines.
METHODS: Convened a multidisciplinary meeting prior to the initiation of anesthesia to formulate a comprehensive strategy. Throughout the anesthetic management, our team ensured meticulous monitoring, delivered sufficient oxygenation, and established hemodynamic equilibrium. The anesthesia team deliberated and devised a plan to employ a left-sided E-visual DLT placement through the right bronchus for right-sided one-lung ventilation in the patient with SIT. The process of anesthesia induction was subjected to repeated simulations to guarantee patient safety.
RESULTS: Due to the meticulous and effective administration and supervision of anesthesia, the surgery was completed as planned. Subsequently, the removal of the E-visual DLT was executed without any complications.
CONCLUSIONS: Data and literature about SIT are scarce, necessitating thorough pre-planning and preparation.