|An 81-year-old man presents with left ventricular failure and surgical emphysema on chest X-ray. He has a history of vomiting and chest pain. His C-reactive protein is raised, his white cell count is raised, he has bibasal crepitations and bronchial breathing on the left side. His arterial blood gases show respiratory acidosis, with a CO2 level of 8.9 kPA and normal bicarbonate. His surgical emphysema resulted from a ruptured oesophagus and he required urgent thoracotomy.
1. Summarise the case.
2. Discuss the use of one-lung ventilation during thoracotomy.
3. What strategies would you use to improve oxygenation intraoperatively?
4. Would you site an epidural? Discuss the pros and cons.