Bronchopleural fistula management during anaesthesia

Abstract

The anaesthetic management of operations for bronchopleural fistula in twenty-two patients is discussed. The fistulae followed pulmonary resection for tuberculosis or tuberculous empyema. A fistula may cause air leakage leading to spontaneous pneumothorax, collapse of the lung or mediastinal shift. Spillover of empyema fluid may lead to respiratory obstruction. Empyema fluid was aspirated before operation and the intercostal catheter under water seal was kept working during operation. In each case a cuffed endotracheal tube was passed under general anaesthesia, thiopentone and suxamethonium being administered to the patient in the head-up position. Frequent aspiration through the endotracheal tube was required. These patients were not considered suitable for intubation under local anaesthesia, nor was one-lung anaesthesia, or the use of bronchial blockers, considered necessary. © 1964 John Sherratt and Son.