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Korean J Anesthesiol > Volume 40(1); 2001 > Article
Korean Journal of Anesthesiology 2001;40(1):100-105.
DOI: https://doi.org/10.4097/kjae.2001.40.1.100   
Anesthetic Management for Resection of a Pulmonary Arteriovenous Malformation.
Woon Seok Roh, Seok Young Song, Chan Hong Park, Bong Il Kim, Soung Kyung Cho, Sang Hwa Lee, Sub Lee, Wook Su Ahn
1Department of Anesthesiology, School of Medicine, Taegu Catholic University, Taegu, Korea.
2Department of Thoracic and Cardiovascular Surgery, School of Medicine, Taegu Catholic University, Taegu, Korea.
Abstract
Pulmonary arteriovenous malformation (PAVM) is an uncommon congenital anomaly. As PAVM is a direct communication between branches of the pulmonary artery and vein, severe hypoxemia, paradoxical embolism, and massive hemorrhage can result. We present a 39-year-old woman with severe hypoxemia after the induction of one lung ventilation (OLV) for resection of a PAVM in her right lower lobe. We analyzed the cause of hypoxemia by an arterial blood gas analysis and estimated shunt equation. The preoperative value of an intrapulmonary shunt (Qs/Qt) was 15%. However, after the OLV, the values of Qs/Qt increased to 48% with 92.1% arterial oxygen saturation (SaO2). After the resection of PAVM, the value of Qs/Qt decreased to 36% during the OLV, and postoperative value of Qs/Qt and SaO2 were in the normal range. These findings represent that PAVM patients are prone to severe hypoxemia and an abnormally high Qs/Qt, which might be induced by the increase of pulmonary vascular resistance during OLV.
Key Words: Lung: pulmonary arteriovenous malformation; Ventilation: one lung; hypoxemia; intra pulmonary shunt
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