Anaesthetic Considerations in the Video-assisted Thoracoscopic Excision of Pulmonary Aspergilloma: A Case Report

Abstract

Video-assisted Thoracoscopy (VATS) is often used for diverse chest and lung ailments, which requires one-lung ventilation utilising a double-lumen tube. It involves small incisions and real-time imaging, resulting in enhanced postoperative recovery. A dry field allows the surgeon better visualisation of the thoracic cavity. To ensure that the patient is fit for prolonged single-lung ventilation, preoperative assessment is vital. While there are advantages and disadvantages to minimally invasive procedures, anaesthesia management and single-lung ventilation are key steps in a successful VATS procedure. Care must be taken to avoid elevated peak pressures intraoperatively. Hereby, the authors present a case report of a 49-year-old smoker with cough, fever, a known treated case of pulmonary Koch’s, and chronic lung disease. After a thorough clinical examination and imaging, he was diagnosed to have a cavitary lesion in the lung, suggestive of Aspergilloma. Authors performed thorough preoperative evaluation prior to surgery, which included pulmonary function tests to help identify the performance of the residual lung. For this patient, VATS was employed to resect the cavitary lesion along with the fungal ball. Single-lung ventilation with a double-lumen endotracheal tube was utilised to collapse the right lung and provide a better operative field. The surgery was uneventful with minimal blood loss, and histopathology confirmed the diagnosis. Due to the minimal access route, the duration of ventilation and recovery is hastened. Appropriate antibiotic/antifungal support, along with aggressive chest physiotherapy and incentive spirometry, is initiated early in such patients, as the pain following VATS is bearable.