Ventilatory Dysfunction Resulting From Bilateral Anterolateral High Cervical Cordotomy

Because of metastatic pain resistant to medical treatment after left pneumonectomy for squamous cell carcinoma, a 46-year-old patient underwent a bilateral cervical cordotomy at the C1-C2 anterolateral level, in two phases. The second intervention was followed by severe ventilatory problems requiring mechanical ventilation, and at a later stage, the implantation of a phrenic pacemaker on the right side. Analysis of the ventilatory pattern during spontaneous breathing and during phrenic pacing and measurement of the transdiaphragmatic pressure during phrenic nerve stimulation revealed the existence of a beneficial effect of aminophylline on both the regulation of ventilation and diaphragmatic contractility.