Tolga Karaçay, Suat Yılmaz Oğur, Başak Altıparmak, Ferhat Özdemir, Melike Korkmaz Toker
Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society - 2025;31(4):183-186
Refractory hypoxemia during one-lung ventilation is uncommon in healthy patients. When standard measures fail, intracardiac shunts should be considered. A healthy 15-year-old girl underwent bilateral thoracic sympathectomy. Profound desaturation occurred during one-lung ventilation despite 100% oxygen. The tube position was correct, and oxygenation returned to normal with two-lung ventilation. Switching from sevoflurane to propofol- based total intravenous anesthesia provided partial improvement. Intraoperative transesophageal echocardiography revealed an atrial septal defect, which was later confirmed postoperatively. Refractory hypoxemia during one-lung ventilation may suggest hidden intracardiac shunting. Prompt intraoperative echocardiography is essential for diagnosis and safety.
