Refractory Hypoxemia During One-lung Ventilation Indicating an Undiagnosed Atrial Septal Defect
Tolga Karaçay1, Suat Yılmaz Oğur2, Başak Altıparmak2, Ferhat Özdemir2, Melike Korkmaz Toker21Department of Anesthesiology and Reanimation, Şanlıurfa Training and Research Hospital, Şanlıurfa, Türkiye2Department of Anesthesiology and Reanimation, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Türkiye
Hypoxemia during one-lung ventilation is uncommon in healthy patients. When standard measures fail, intracardiac shunts should be considered. A healthy 15-year-old girl underwent bilateral thoracic sympathectomy. Profound desaturation occurred during one-lung ventilation despite 100% oxygen. The tube position was correct, and oxygenation returned to normal with two-lung ventilation. Switching from sevoflurane to propofol-based total intravenous anesthesia provided partial improvement. Intraoperative transesophageal echocardiography revealed an atrial septal defect, which was later confirmed postoperatively. Refractory hypoxemia during one-lung ventilation may suggest hidden intracardiac shunting. Prompt intraoperative echocardiography is essential for diagnosis and safety.
Keywords: Atrial septal defect, hypoxic pulmonary vasoconstriction, one-lung ventilation, refractory hypoxemia, sevoflurane
Manuscript Language: English