Anaesthesia for serial whole-lung lavage in a patient with severe pulmonary alveolar proteinosis: a case report

• Published in: Journal of medical case reports Vol. 2; no. 1; p. 360
• Main Authors: Webb, Stephen T, Evans, Adrian J R, Varley, A James, Klein, Andrew A
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27-11-2008; BioMed Central; BMC
• Subjects: Anesthesia; Care and treatment; Case Report; Case studies; Diagnosis; Health aspects; Patient outcomes; Pulmonary alveolar proteinosis; Risk factors; United Kingdom
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/1752-1947-2-360

Pulmonary alveolar proteinosis is a rare condition that requires treatment by whole-lung lavage. We report a case of severe pulmonary alveolar proteinosis and discuss a safe and effective strategy for the anaesthetic management of patients undergoing this complex procedure.
A 34-year-old Caucasian man was diagnosed with severe pulmonary alveolar proteinosis. He developed severe respiratory failure and subsequently underwent serial whole-lung lavage. Our anaesthetic technique included the use of pre-oxygenation, complete lung separation with a left-sided double-lumen endotracheal tube, one-lung ventilation with positive end-expiratory pressure, appropriate ventilatory monitoring, cautious use of positional manoeuvres and single-lumen endotracheal tube exchange for short-term postoperative ventilation.
Patients with pulmonary alveolar proteinosis may present with severe respiratory failure and require urgent whole-lung lavage. We have described a safe and effective strategy for anaesthesia for whole-lung lavage. We recommend our anaesthetic technique for patients undergoing this complex and uncommon procedure.