Anaesthetic management of volume controlled unilateral lung lavage.

Conventional means to facilitate clearance of inspissated material obstructing gas exchange in 
the alveoli and finer airways of patients with alveolar proteinosis, asthma, 
and mucoviscidosis, are often not very effective. The mechanical removal of 
such materials by volume controlled unilateral lung lavage with saline has 
been of benefit in selected patients refractory to conventional therapy (particularly 
those with alveolar proteinosis or accidentally inhaled radioactive particles). This report 
describes the anaesthetic and lavage techniques currently used in managing patients 
with alveolar proteinosis and mucoviscidosis and in whom lung lavage repeated 
at approximately six-month intervals has resulted in both subjective and objective 
improvements. In 14 lavages in four different patients (10 lavages in 
two patients with alveolar proteinosis and four lavages in two patients 
with mucoviscidosis) certain physiologic responses to lung lavage, particularly those related 
to oxygen transport, were measured quantitatively in an attempt to evaluate 
and to optimize anaesthetic and lavage techniques. The maintenance anaesthetic during 
lavage was selected randomly, so that each patient received light anaesthesia 
with ketamine/diazepam during one lavage and light halothane anaesthesia during lavage 
of the contralateral lung. 