DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Pulmonary alveolar proteinosis.
2. History of smoking.
3. Dyspnea.
4. Hypoxemia.
POSTOPERATIVE DIAGNOSES:
1. Pulmonary alveolar proteinosis.
2. History of smoking.
3. Dyspnea.
4. Hypoxemia.
PROCEDURES PERFORMED:
1. Right total lung lavage.
2. Bronchoscopy with therapeutic aspiration of the airways.
SURGEON: John Doe, MD
ASSISTANT: None.
ANESTHESIA: General endotracheal anesthesia.
BLOOD LOSS: None.
COMPLICATIONS: None.
TOTAL LAVAGE FLUID: 18 liters in, 16.6 liters returned.
DISPOSITION: To postanesthesia care unit.
CONDITION: Satisfactory condition.
INDICATIONS FOR PROCEDURE: This is a patient with known pulmonary alveolar proteinosis. The patient previously underwent a left total lung lavage and returns today for the right total lung lavage. The patient has had some modest improvement in symptoms with the left total lung lavage. The risks, benefits, and alternatives to right total lung lavage and bronchoscopy with therapeutic aspiration of the airways were discussed with the patient, and informed consent was obtained and placed on the chart.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the supine position. Following smooth induction of general anesthesia, a left-sided double-lumen endotracheal tube was placed. Position was confirmed. A compression device was applied to the chest. ICU mechanical ventilation was performed. The right lung was isolated. Lung lavage was performed with 500 to 1000 mL aliquots sequentially. A total of 18 liters was lavaged in and 16.6 liters returned by gravity drainage.
Next, the double-lumen endotracheal tube was exchanged for a single-lumen tube, and bronchoscopy was performed to aspirate another 100 mL of saline from the right tracheobronchial tree. The left airway was visualized. Small amount of secretions were returned.
Of note, the typical salmon-colored fluid returned on the first several bags, which cleared throughout the course and the last seventeenth and eighteenth bags returned with clear fluid.
The patient tolerated the procedure well without incident or complications and was extubated and transported to the postanesthesia care unit in satisfactory condition.
