| Spinal and Epidural Anesthesia in Two Severe Hypoxemia Patients: Two case reports. |
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Young Chul Shin, Jong Hun Jun, Woo Jae Jeon, Sang Yoon Cho |
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Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Korea. jhjun@hanyang.ac.kr |
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| Abstract |
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Severe hypoxemia is considered by many to contraindicate major surgery. Several studies have shown that dependency on oxygen, PaO2 < or = 60 mmHg, PaCO2 > or = 45 mmHg, FEV1 < or = 50%, and FVC < or = 75% are indicative of a high risk of morbidity and mortality following major surgical procedures.
Here, we report our experience of the use of regional anesthesia in such patients. One patient was a 82-year-old female patient who was scheduled for partial hip replacement due to a fracture of the right femur. Her pulmonary function test and preoperative arterial blood gas analysis results were as follows: FVC 1.23 L (49.1%), FEV1 1.11 L (61.3%), FEV1/FVC 90.2%, a room air pH 7.423, PaCO2 43.0 mmHg, PaO2 46.4 mmHg, SaO2 84.5% and base excess 2.7 mM/L. Another patient was a 79-year-old COPD male patient scheduled for appendectomy. His immediate preoperative arterial blood gas analysis results were; room air pH 7.368, PaCO2 62.1 mmHg, PaO2 43.8 mmHg, SaO2 77.4% and base excess 7.3 mM/L. Both patients underwent and tolerated surgery safely with regional anesthesia. No permanent sequela occured postoperatively in these cases. No severe changes in room air arterial blood gas levels were observed before and after surgery. We present a review of two cases of severe hypoxemia in which a regional block was used. |
| Key Words:
epidural anesthesia; severe hypoxemia; spinal anesthesia |
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