Expert: Dr Ian Jackson - please note UK based - 3/28/2011

Question
Back in 1994 I had major oral surgery to remove bilateral giant cell reparative graunlomas from both my upper and lower jaws. The surgery was done intraorally and had very heavy bleeding (2700 cc over 6 hours, could have been an ABC) being very short (under four feet) and underweight this was obviously a potentially dangerous situation.  Luckily all my vitals remained stable, however I had a partially collapsed lung and developed a mucus plug a couple days later.

No explication was given as to why my lung collapsed other than from heavy bleeding. I am guessing this was not the case and somehow my airway became compromised during the surgery. Because of this I was on a ventilator for 4 days, however this could have been to protect my airway from post op swelling as well.

My question is what can cause a collapsed lung to occur during oral surgery?

Thank You

Answer
Hi Luke
It is always difficult to look back at what has occurred and often there is no 'special reason'.
You were having major surgery and your lungs would have been protected from the bleeding by a special tube inserted probably via your nose and into your voicebox. This is called an endotracheal tube and it has a cuff that is inflated to stop anything getting down into your lungs.
Now it sounds like you did bleed a lot - esp given your height and so probable weight. It sounds like you lost just over 50% of your blood volume and this would have been replaced during the operation. Given that this was over 6 hours this is fairly easy for the anaesthetist to keep up with.
Now as to your lungs.
Everyone who is anaesthetised starts to lose the function of certain areas of their lungs. No matter wha clever things we do patients develop areas where the alveoli are closed off and lost to gas exchange until sometime in the Recovery period (they do come back) This is called atelectasis. So after a 6 hr operation you would have had some of this going on - however it seldom causes a serious issue in young fit people.
Given your lood loss you would have been transfused quite a bit of different blood products to 1. keep your haemoglobin level respectable and 2. keep the amount of clotting factors in your bloodstream respectable.
There is a condition called TRALI (Transfusion related acute lung injury) and this could have been the source of your problems (look it up in wikipedia)
However you have hit the nail on the head by the comment about concerns about airway obstruction due to swelling. I have to suspect that is the real reason you were kept on the ventilator.
I hope the above helps a bit.
Kind regards
Dr Ian Jackson