Lung Volume Reduction Under Spontaneous Ventilation in a Patient with Severe Emphysema

Patient: Male, 71 Final Diagnosis: Left-side secondary spontaneous pneumothorax • chronic obstructive pulmonary disease Symptoms: Chest pain • shortness of breath • dyspnea • persistent bubbles extravasation Medication: Antibiotic drugs Clinical Procedure: Lung volume reduction surgery under spontaneous ventilation Specialty: Anesthesiology OBJECTIVE: Unusual setting of medical care BACKGROUND: One-lung ventilation under general anesthesia is necessary for most thoracic surgical procedures. However, adverse effects may derive from mechanical ventilation in emphysema patients. At present, lung volume reduction surgery under spontaneous ventilation may attenuate these adverse effects. CASE REPORT: We present a case of left-side secondary spontaneous pneumothorax in a 71-year-old male who had a history of chronic obstructive pulmonary disease for 12 years, combined with a contralateral giant bulla. After conservative therapies, bubble extravasation still persisited on the left side of the drainage tube. Lung volume reduction surgery under spontaneous ventilation was considered. The patient recovered fast though intraoperative critical respiratory management, effective pain control, and suitable sedation, and he was discharged from the hospital 3 days after the operation. CONCLUSIONS: Video-assisted thoracic surgery under spontaneous ventilation may be an alternative method for lung volume reduction surgery in emphysema patients who also have secondary spontaneous pneumothorax and a contra-lateral giant bulla.