ArticleCureus2025
Perioperative Management of One-Lung Ventilation in an Adolescent With Metastatic Osteosarcoma Complicated by Bilateral Pneumothoraces.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
5 authors.
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Abstract
Thoracic anesthesia in pediatric patients is challenging due to anatomical and physiological factors that increase susceptibility to hypoxemia during one-lung ventilation (OLV). These complexities are further magnified in children with underlying oncological disease and poor pulmonary reserve. We report anesthetic management of a 16-year-old, 32 kg boy with metastatic osteosarcoma presenting with recurrent bilateral pneumothoraces scheduled for right video-assisted thoracoscopic surgery (VATS) and pleurodesis. The coexistence of bilateral pneumothoraces with compromised pulmonary reserve, with a potential risk of tension pneumothorax, posed significant anesthetic challenges, particularly for OLV. We describe perioperative considerations, anesthetic technique, and strategies to maintain oxygenation and hemodynamic stability. This case highlights the importance of careful planning, lung-protective ventilation, and multidisciplinary coordination in managing pediatric thoracic cases. Anesthetic management included standard American Society of Anesthesiologists (ASA) monitoring with invasive arterial pressure, induction with remifentanil, propofol, and rocuronium, and placement of a left-sided double-lumen tube, confirmed with fiberoptic bronchoscopy. A lung-protective strategy was applied with low tidal volumes, titration of fraction of inspired oxygen (FiO
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