Pleural surgery in patients with cystic fibrosis A review of anasthetic management

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Abstract
Summary: Eighteen patients with advanced cystic fibrosis complicated by pneumothorax required either pleurectomy or abrasion pleurodesis. Anasthesia with nitrous oxide and oxygen was combined with controlled ventilation to both lungs, usually through a double lumen endobronchial tube. Spontaneous ventilation was restored at the end of operation in all but a minority of cases. Ten of 25 procedures were uncomplicated and a further five were followed by non‐respiratory events. Respiratory complications developed after the remaining ten procedures which were carried out on six patients, of whom only one survived for more than 6 months. All five fatal cases suffered a recurrence of pneumothorax within 6 months whereas three patients requiring re‐operation 2–6 years later survived. The principles of management are discussed and it is concluded that the operative and anasthetic hazards of thoracic surgery in this group of high‐risk cases can be avoided successfully, except when re‐operation is required within 6 months.

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