Asploro Journal of Biomedical and Clinical Case Reports

Asploro Journal of Biomedical and Clinical Case Reports

Liu Qian^1,2, Haibei Liu^1,2iD, Yujun Zhang^1,2*
1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
²The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China

Corresponding Author: Yujun Zhang
Address: No. 37^th Guoxue Alley, Wuhou District, Chengdu, Sichuan, Chin Sichuan, Province 610041, China.
Received date: 10 December 2023; Accepted date: 19 December 2023; Published date: 26 December 2023

Citation: Qian L, Liu H, Zhang Y. Anesthesia Management of Severe Hypoxemia During Total Arch Replacement for Acute Aortic Dissection: A Case Report. Asp Biomed Clin Case Rep. 2023 Dec 26;7(1):24-29.

Copyright © 2023 Qian L, Liu H, Zhang Y. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.

Keywords: Aortic Dissection, Total Arch Replacement, Hypoxemia, General Anesthesia, Case Report

Abbreviations: AD: Aortic Dissection; ARDS: Acute Respiratory Distress Syndrome; CPB: Cardiopulmonary Bypass; CTA: Computed Tomography Angiography; ABG: Arterial Blood Gas Analysis; TEE: Transesophageal Echocardiography; ICU: Intensive Care Unit; MODS: Multiple Organ Dysfunction Syndrome; PEEP: Positive End-Expiratory Pressure

Abstract

Background: Acute aortic dissection poses a life-threatening condition that typically necessitates immediate surgical intervention, such as total arch replacement. However, hypoxemia is a severe complication in such surgeries, potentially resulting in organ dysfunction, prolonged hospital stays, and even mortality. Hypoxemia presents significant challenges to anesthesiologists. Through this case, we can enhance our comprehension of anesthetic management for total arch replacement.
Case presentation: A 43-year-old man with acute type A aortic dissection underwent total arch replacement. After a smooth surgery, severe hypoxemia occurred during weaning off cardiopulmonary bypass. Initial interventions, including airway suction and recruitment maneuvers, failed to improve oxygenation. Further investigations found left lung atelectasis and pleural effusion on transesophageal echocardiography, with minimal improvement after drainage. Fiberoptic bronchoscopy revealed extensive tenacious secretions occluding the airways. Conventional suctioning was ineffective due to high sputum viscosity. Ultimately, techniques including pulmonary lavage, bronchoscopic suctioning, and repeated lung recruitment controlled the refractory hypoxemia. The patient recovered after treatment in the intensive care unit.
Conclusions: It is worth noting that our case highlights the challenges posed by severe hypoxemia during total arch replacement surgery. The successful management of this complication underscores the importance of a multidisciplinary approach and close monitoring during the perioperative period. Individualized anesthetic management plays a critical role in addressing severe hypoxemia during total arch replacement surgery.