Anestesia para pleuroscopías

Objetivo . Describir nuestra experiencia en el manejo anestesiologico de las pleuroscopias. Pacientes y metodos. Se consulto nuestra base de datos en un periodo comprendido entre julio de 2000 y julio de 2002. Revisamos 70 procedimientos de pleuroscopias con cirugia videoasistida (CVA), realizados con anestesia general e intubacion con sonda de doble luz para ventilacion unipulmonar. Resultados. Las indicaciones mas frecuentes fueron derrames pleurales y neumotorax , los procedimientos mas frecuentes fueron pleurodesis y biopsias. El porcentaje de reconversion de la tecnica fue de 5.7%, en su mayoria por dificultades tecnicas. No hubo hemorragias importantes ni muertes atribuibles a la tecnica. De las complicaciones no quirurgicas 4 pacientes presentaron broncoespasmo que retrocedio con tratamiento habitual y 5 presentaron hipoxemia que obligo a suspender transitoriamente la ventilacion unipulmonar. En el postoperatorio un paciente presento un cuadro de edema pulmonar con buena evolucion en 24 horas. Los pacientes coordinados para aerostasis presentaron menos enfermedades asociadas y menor ASA, a diferencias de los que presentaban masas y tumores pulmonares. En 69 pacientes se logro una adecuada ventilacion unipulmonar. La complicacion mas frecuente fue el desplazamiento distal de la sonda. El numero de otras complicaciones fue bajo, facilmente controlable y atribuible al terreno del paciente y al tipo de sonda utilizado. Conclusion. Las pleuroscopias realizadas con anestesia general y ventilacion unipulmonar son procedimientos seguros, con complicaciones esperables y con buena respuesta al tratamiento. El diagnostico quirurgico y el tipo de procedimiento indicado, son datos importantes para evaluar el riesgo de enfermedades asociadas y de complicaciones.(AU) This article describes the authors´experience in the anesthetic management of pleuroscopies in a General Hospital in Montevideo, Uruguay. Patients and Methods Data were collected from Anesthesia Departament Database corresponding to a period of two years from july 2000 to july 2002. Seventy pleuroscopies were reviewed. All patients underwent general anesthesia and in all cases double lumen tubes were used for unipulmonar ventilation. Results Empyema and neumothorax were the most frequent preoperative diagnoses. Pleurodesis and pleural biopsies were the most frequently used procedures. Surgical technique was converted in 5.7% of all cases due to technical difficulties. No significant bleeding or deaths occurred during surgery or in the postoperative period in these serie of patients. Other incidents related to anesthesia were bronchospasm (4 patients, all of them fully recovered after usual treatment) and hypoxia (5 patients who required discontinuation of unipulmonar ventilation). In the postoperative period one patient suffered from pulmonar edema requiring admission in an intensive care unit. After 24 hours the patient fully recovered and was succesfully discharged from that Unit. All patients who underwent aerostatic procedures were in the preoperative period, in better physical conditions (lower ASA score) than those with lung tumors. Unipulmonar ventilation was succesfully performed in 60 of 70 total patients. Distal double lumen tube malposition was the most frequent complication. Other incidents were rare and in all cases easily solved. In most cases they were related to patients´ previous physical status or to characteristics or quality of double lumen tubes utilized. Conclusions In our experience Pleuroscopies under General Anesthesia and unipulmonar ventilation are safe procedures with well known complications and good response to usual treatment. Preoperative diagnose and procedure performed, are important data in order to assess the risk of associated illnesses and postoperative complications.(AU)