CASE REPORT


Clinical Pearls in Anaesthesia for Pleurectomy/Decortication for Malignant Mesothelioma



Shagun Bhatia Shah*, Itee Chowdhury, Laleng Mawia Darlong, Priyanka Goyal, Anamica Kansal
* Rajiv Gandhi Cancer Institute and Research Centre, Department of Anesthesiology, New Delhi, India


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© 2017 Shah et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Rajiv Gandhi Cancer Institute and Research Centre, Department of Anesthesiology, New Delhi, India, Tel: 9891769779; E-mails: drshugun-2010@rediffmail.com, shah.shagun@rgcirc.org


Abstract

Background:

For most thoracic surgeries (lung resection, esophagectomy) the main purpose of inserting a double lumen tube for lung isolation is providing space for dissection and preventing lung motion by not ventilating (collapsing) the lung undergoing surgery.

Objective:

In addition, during pleurectomy/ decortication surgeries, the anaesthetist can indirectly perform the dissection of pleura from the lung without scrubbing, gloving or holding the scalpel.

Conclusion:

This is accomplished by ventilating the lung undergoing surgery, with large tidal volumes while the surgeon provides static traction to the visceral pleura. These phases alternate with one lung ventilation. A detailed account of anaesthesia for pleurectomy/ decortication follows.

Keywords: Anaesthesia, Double lumen tube, Pleurectomy / Decortication, Malignant mesothelioma.