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Case Report

A Case of Empyema for Thoracotomy and Decortication-Anaesthesia Management

Ravi Madhusudhana, M. Sai Chandana, Ravi Madhusudhana, Siri Chandana, S. Manasa

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Indian Journal of Anesthesia and Analgesia 13(2):p 99-102, April-June 2026. | DOI: https://doi.org/10.21088/ijaa.2349.8471.13226.8

How Cite This Article:

M. Sai Chandana, Ravi Madhusudhana, Sri Chandana, et al. A case of Empyema for Thoracotomy and Decortication-Anaesthesia Management. Ind J Anesth Analg. 2026; 13(2): 99-102.

Timeline

Received : December 24, 2025         Accepted : January 25, 2026          Published : June 30, 2026

Abstract

Empyema requires careful planning and execution of anaesthesia management due to the complexity of the procedure and the patient’s underlying condition. A 6-year-old patient presented with cough and fever progressing to distress diagnosed as empyema. She was posted for right thoracotomy and decortication. Other investigations were optimal; except TLC which was 17,000 and INR of 1.36. Preoxygenated and premedicated with Inj Glycopyrrolate, induced with Inj Ketamine and Airway secured with 5 mm ID cuffed endotracheal tube under suxamethonium. Patient was put in lateral position and anaesthesia maintained with O 2 plus N2O with Isoflurane; IV paracetamol and Inj Fentanyl was given after 1 hour. Intraoperatively SpO2 was coming down to 85, so N2O was stopped for some time; Isoflurane with Intermittent Propofol was given till the Decortication was done. Smaller tidal volume (5 ml/kg) with higher respiratory rate (24 per minute) was given initially. The right lung expanded well after the procedure and O2 and N2O was restarted and PEEP of 5 cm of H 2O was given. After completion of surgery, the neuromuscular block was reversed with Inj Neostigmine and Inj Glycopyrrolate, O2 supplementation with face mask continued in the postoperative period for 6 hours then nasal prongs overnight. Post-operative period continued with incentive spirometry and was uneventful.In a case of empyema with respiratory distress in a paediatric patient, meticulous planning is required and lung Isolation is difficult and we planned for low tidal volume technique and case was managed with-out any adverse events.

References

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Data Sharing Statement

There are no additional data available. All raw data and code are available upon request.

Funding

This research received no funding.

Author Contributions

All authors contributed significantly to the work and approve its publication.

Ethics Declaration

This article does not involve any human or animal subjects, and therefore does not require ethics approval.

Acknowledgements

We would like to express our gratitude to the patients, their families, and all those who have contributed to this study.

Conflicts of Interest

No conflicts of interest in this work.

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Cite this article

M. Sai Chandana, Ravi Madhusudhana, Sri Chandana, et al. A case of Empyema for Thoracotomy and Decortication-Anaesthesia Management. Ind J Anesth Analg. 2026; 13(2): 99-102.

Licence:

Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)

This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.

Received Accepted Published
December 24, 2025 January 25, 2026 June 30, 2026
DOI: https://doi.org/10.21088/ijaa.2349.8471.13226.8

Keywords

DecorticationEmpyemaLow-tidal volume ventilationThoracotomyPaediatric

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Timeline

Received December 24, 2025
Accepted January 25, 2026
Published June 30, 2026

licence

Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)

This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.


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