Successful management of perilous perioperative hypoxia in a total arch replacement procedure: a case report

Abstract Background: Profound hypoxemia during total arch replacement surgery demands prompt intervention. Aortic dissection patients are susceptible to serious pulmonary complications. Case presentation: We report a critical case of intraoperative hypoxemia in this context. Despite no existing pulmonary issues, oxygenation difficulties during cardiopulmonary bypass weaning led to challenging procedural halts. Strategies such as airway suction, lung recruitment, and protective ventilation proved inadequate to rectify the hypoxic state. Transesophageal echocardiography indicated left pleural effusion and atelectasis, with minimal improvement after drainage. Fiberoptic bronchoscopy identified significant tenacious secretions obstructing the airway and left main bronchus, with conventional suction ineffective. Ultimately, pulmonary lavage and bronchoscopic suction, combined with repeated lung recruitment, led to enhanced oxygenation. Conclusions: It is crucial to conduct dynamic preoperative respiratory evaluations, particularly in patients with aortic dissection. Such assessments can effectively anticipate and prevent postoperative lung complications.