Platypnea-Orthodeoxia syndrome (POS), an exceptionally uncommon condition, is characterized by decreased oxygen saturation in an upright posture with corresponding improvement in the supine position. Recently, an 85-year-old female patient presented for surgery due to a left femoral neck fracture. Following successful tracheal intubation and anesthesia induction, the ventilator indicated an airway pressure of 15mmHg. While in the right lateral decubitus position, the patient developed hypoxia despite normal arterial blood pressure and symmetrical breath sounds. Attempts to alleviate the hypoxia through pure oxygen ventilation, tympanic lung ventilation, and high-frequency ventilation were unsuccessful. Subsequently, there was a notable decrease in both blood pressure and heart rate, prompting an immediate halt to the surgery and repositioning the patient to the supine position. This resulted in the normalization of the patient's heart rate, oxygen saturation, and blood pressure. To investigate the etiology, a TEE probe was inserted, revealing the presence of a patent foramen ovale (PFO) and a significant right-to-left shunt while the patient was in the lateral position. The procedure was performed in a specific right lateral decubitus position. This case may represent a unique manifestation of POS syndrome, expanding the differential diagnosis for intraoperative position-related hypoxemia. Given the severe hypoxemia observed with intraoperative positional changes, a strong suspicion of POS syndrome is warranted.
| Published in | International Journal of Anesthesia and Clinical Medicine (Volume 12, Issue 1) |
| DOI | 10.11648/j.ijacm.20241201.17 |
| Page(s) | 33-37 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Platypnea-Orthodeoxia, Intraoperative Hypoxemia, Right Lateral Position, Artificial Femoral Head Replacement, Patent Foramen Ovale, Transesophageal Echocardiography
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APA Style
Wu, G., Xu, H. (2024). Intraoperative Hypoxemia in the Right Lateral Decubitus Position: A Case Report. International Journal of Anesthesia and Clinical Medicine, 12(1), 33-37. https://doi.org/10.11648/j.ijacm.20241201.17
ACS Style
Wu, G.; Xu, H. Intraoperative Hypoxemia in the Right Lateral Decubitus Position: A Case Report. Int. J. Anesth. Clin. Med. 2024, 12(1), 33-37. doi: 10.11648/j.ijacm.20241201.17
AMA Style
Wu G, Xu H. Intraoperative Hypoxemia in the Right Lateral Decubitus Position: A Case Report. Int J Anesth Clin Med. 2024;12(1):33-37. doi: 10.11648/j.ijacm.20241201.17
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Download@article{10.11648/j.ijacm.20241201.17,
author = {Guowei Wu and Hongwei Xu},
title = {Intraoperative Hypoxemia in the Right Lateral Decubitus Position: A Case Report
},
journal = {International Journal of Anesthesia and Clinical Medicine},
volume = {12},
number = {1},
pages = {33-37},
doi = {10.11648/j.ijacm.20241201.17},
url = {https://doi.org/10.11648/j.ijacm.20241201.17},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20241201.17},
abstract = {Platypnea-Orthodeoxia syndrome (POS), an exceptionally uncommon condition, is characterized by decreased oxygen saturation in an upright posture with corresponding improvement in the supine position. Recently, an 85-year-old female patient presented for surgery due to a left femoral neck fracture. Following successful tracheal intubation and anesthesia induction, the ventilator indicated an airway pressure of 15mmHg. While in the right lateral decubitus position, the patient developed hypoxia despite normal arterial blood pressure and symmetrical breath sounds. Attempts to alleviate the hypoxia through pure oxygen ventilation, tympanic lung ventilation, and high-frequency ventilation were unsuccessful. Subsequently, there was a notable decrease in both blood pressure and heart rate, prompting an immediate halt to the surgery and repositioning the patient to the supine position. This resulted in the normalization of the patient's heart rate, oxygen saturation, and blood pressure. To investigate the etiology, a TEE probe was inserted, revealing the presence of a patent foramen ovale (PFO) and a significant right-to-left shunt while the patient was in the lateral position. The procedure was performed in a specific right lateral decubitus position. This case may represent a unique manifestation of POS syndrome, expanding the differential diagnosis for intraoperative position-related hypoxemia. Given the severe hypoxemia observed with intraoperative positional changes, a strong suspicion of POS syndrome is warranted.
},
year = {2024}
}
TY - JOUR T1 - Intraoperative Hypoxemia in the Right Lateral Decubitus Position: A Case Report AU - Guowei Wu AU - Hongwei Xu Y1 - 2024/04/28 PY - 2024 N1 - https://doi.org/10.11648/j.ijacm.20241201.17 DO - 10.11648/j.ijacm.20241201.17 T2 - International Journal of Anesthesia and Clinical Medicine JF - International Journal of Anesthesia and Clinical Medicine JO - International Journal of Anesthesia and Clinical Medicine SP - 33 EP - 37 PB - Science Publishing Group SN - 2997-2698 UR - https://doi.org/10.11648/j.ijacm.20241201.17 AB - Platypnea-Orthodeoxia syndrome (POS), an exceptionally uncommon condition, is characterized by decreased oxygen saturation in an upright posture with corresponding improvement in the supine position. Recently, an 85-year-old female patient presented for surgery due to a left femoral neck fracture. Following successful tracheal intubation and anesthesia induction, the ventilator indicated an airway pressure of 15mmHg. While in the right lateral decubitus position, the patient developed hypoxia despite normal arterial blood pressure and symmetrical breath sounds. Attempts to alleviate the hypoxia through pure oxygen ventilation, tympanic lung ventilation, and high-frequency ventilation were unsuccessful. Subsequently, there was a notable decrease in both blood pressure and heart rate, prompting an immediate halt to the surgery and repositioning the patient to the supine position. This resulted in the normalization of the patient's heart rate, oxygen saturation, and blood pressure. To investigate the etiology, a TEE probe was inserted, revealing the presence of a patent foramen ovale (PFO) and a significant right-to-left shunt while the patient was in the lateral position. The procedure was performed in a specific right lateral decubitus position. This case may represent a unique manifestation of POS syndrome, expanding the differential diagnosis for intraoperative position-related hypoxemia. Given the severe hypoxemia observed with intraoperative positional changes, a strong suspicion of POS syndrome is warranted. VL - 12 IS - 1 ER -
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
