A singular use of PEEP during Thermal Ablation of a Lung Lesion Adjacent to the Aorta: A Case Report

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Silvia Noli https://orcid.org/0009-0004-9880-5807
Ivan Silvestri https://orcid.org/0000-0002-7650-5326
Fabio Melchiorre https://orcid.org/0000-0001-9067-2895
Davide Vailati https://orcid.org/0000-0001-9883-2902

Keywords

non-operating room anesthesia, mono pulmonary ventilation, PEEP, thermal ablation

Abstract

Background: Thermal ablation is a minimally invasive procedure commonly performed for treating pulmonary lesions. However, its application near critical structures such as the aorta poses significant challenges, requiring precise anesthetic and procedural management. This report describes the anesthetic and procedural management of a 58-year-old woman with a pulmonary lesion near the aorta, who underwent thermal ablation under one-lung ventilation (OLV).


Methods: The patient, with a prior history of moderately differentiated adenocarcinoma and Takotsubo syndrome, was scheduled for thermal ablation of a 6 mm nodule in the left lower lung lobe. Preoperative evaluation revealed no significant coronary lesions. Under general anesthesia, OLV was established, and the left lung was excluded from ventilation to immobilize the lung. After needle for thermal ablation positioning, the aorta resulted into the thermo ablation area. Critical positive pressure application to the left lung was used to displace the aorta away from the ablation field.


Results: The application of continuous positive airway pressure of 5 cmH₂O was applied to the non-ventilated left lung resulted in an 8.19 mm displacement of the aorta, enabling safe thermal ablation without damaging critical structures. Intraoperatively, the patient remained stable, and postoperatively, she was discharged uneventfully after 3 days.


Conclusions: This case highlights the importance of multidisciplinary collaboration and tailored anesthetic management in high-risk procedures involving pulmonary lesions near critical vascular structures. OLV with selective intubation, combined with careful positive pressure application, played a crucial role in ensuring procedural safety.

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