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Non-invasive ventilation corrects alveolar hypoventilation during spinal anesthesia

[La ventilation non effractive corrige l’hypoventilation alvéolaire traduite par l’association bronchopneumopathie chronique obstructive, obésité, rachianesthésie et position de lithotomie]

Martine Ferrandière, MD^*, Eric Hazouard, MD, Jean Ayoub, MD PhD, Marc Laffon, MD PhD^*, John Gage, MD^*, Colette Mercier, MD^* and Jacques Fusciardi, MD^*

^* From the Departments of Anesthesia and Critical Care,
Pneumology; and the
Division of Nuclear Medicine and Ultrasound, Regional University Hospital Center of Tours, Tours, France.

Address correspondence to: Dr. Martine Ferrandière, Réanimation Chirurgicale, Hôpital Trousseau, CHU de Tours, 37044 Tours cedex, France. Phone: +33 2 47478551; Fax: +33 2 47474660; E-mail: ferrandiere{at}med.univ-tours.fr

Purpose: To document and explain the beneficial effects of non-invasive ventilation in correcting hypoxemia and hypoventilation in severe chronic obstructive pulmonary disease, during spinal anesthesia in the lithotomy position.

Clinical features: A morbidly obese patient with severe chronic obstructive pulmonary disease underwent prostate surgery in the lithotomy position under spinal anesthesia. Hypoxemia was encountered during surgery, and a profound decrease of forced vital capacity associated with alveolar hypoventilation and ventilation/perfusion mismatching were observed. In the operating room, an M-mode sonographic study of the right diaphragm was performed, which confirmed that after spinal anesthesia and assuming the lithotomy position, there was a large decrease (–30%) in diaphragmatic excursion. Hypoxemia and alveolar hypoventilation were successfully treated with non-invasive positive pressure ventilation.

Conclusions: Intraoperative application of non-invasive positive pressure ventilation improved diaphragmatic excursion and overall respiratory function, and reduced clinical discomfort in this patient.