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Summary of the Day

Transversus Abdominal Plane Block

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Question of the Day

A 65-year-old woman with a 40-pack-year history of smoking presents to the emergency department with hemoptysis. Imaging reveals a mass in the right upper lobe and the patient is scheduled a video-assisted thoracoscopic wedge resection. Intraoperatively, a left-sided double-lumen endobronchial tube is placed. During the surgical procedure, the patient's oxygen saturation decreases from 100% to 84% despite use of 100% oxygen. She is otherwise hemodynamically stable. Which of the following treatment options would be LEAST likely to improve Sp02?

Question of the Day
A 65-year-old woman with a 40-pack-year history of smoking presents to the emergency department with hemoptysis. Imaging reveals a mass in the right upper lobe and the patient is scheduled a video-assisted thoracoscopic wedge resection. Intraoperatively, a left-sided double-lumen endobronchial tube is placed. During the surgical procedure, the patient's oxygen saturation decreases from 100% to 84% despite use of 100% oxygen. She is otherwise hemodynamically stable. Which of the following treatment options would be LEAST likely to improve Sp02?
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Correct Answer

Explanation

Assessing whether the ventilator is working appropriately, the endobronchial tube has not dislodged, and the circuit is still connected is paramount. Causes of oxygen desaturation including decreased cardiac output, changes in hemodynamic status, or increased oxygen consumption should always be considered. Treatment options for oxygen desaturation during one-lung ventilation with a double-lumen endobronchial tube include confirming appropriate placement using fiberoptic bronchoscopy as well as checking for secretions, increasing the FiO2, adding PEEP to the dependent lung, and adding CPAP to the non-dependent lung. The implementation of two-lung ventilation should always be considered. In emergent situations, clamping the pulmonary artery will divert blood flow from the non-dependent lung and improve oxygenation.

OA Series: June 2024

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