Neuraxial Anesthesia and Intraoperative Bilevel Positive Airway Pressure in a Patient With Severe Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Undergoing Elective Sigmoid Resection

摘要: Objective: This case report describes the anesthetic management of a patient with severe chronic obstructive pulmonary disease (COPD) and sleep apnea (OSA) who underwent elective sigmoid resection under combined spinal-epidural anesthesia bilevel positive airway pressure (BiPAP). Case Report: A 63-year-old man diverticular presented for resection. His medical history included coronary artery bypass grafting, diabetes mellitus, gastroesophageal reflux, renal failure, COPD, paralyzed left hemidiaphragm, OSA treated nighttime BiPAP oxygen. Sigmoid was performed lumbar spinal-thoracic epidural without general and/or endotracheal intubation (intrathecal 3.5 mL isobaric bupivacaine 0.5% 100 μg epinephrine 200 morphine [Epimorph], 60 mg bupivacaine, lidocaine). Intravenous ketamine administered at rate between 30 50 mg/h. Intraoperative applied using setting 12.5/8mm Hg backup ventilation 10 breaths/min an oxygen flow 4 L/min. After surgery, (0.1%) infused over 3 days 10ml/hr supplemented oral acetaminophen, resulting in excellent pain relief. Postoperatively, continued to use when sleeping, no adverse respiratory events were observed. The discharged home 5 after surgery. Conclusion: Combined successfully used COPD undergoing Perioperative administration BiPAP, control by continuous infusion local anesthetic, avoidance may have contributed this patient9s uncomplicated postoperative course.