Thoracotomy








I Thoracotomy




1. Introduction

    Thoracotomy is usually performed in an attempt to resect malignant lung tissue, but it may also be performed for trauma; infections; and parenchymal abnormalities, such as recurrent blebs. Because thoracotomy involves incising the pleura, all patients require a chest tube postoperatively. Most patients are older than 40 years and have a history of smoking. Many also have associated cardiovascular disease.

2. Preoperative assessment
a) Preoperative evaluation of patients for pulmonary surgery (see the table below).

Initial Preanesthetic Assessment for Thoracic Surgery





















Patient Type Assessments
All patients Assess exercise tolerance, estimate PPO FEV1%,* discuss postoperative analgesia, consider discontinuation of smoking
Patients with PPO FEV1 <40% Dlco, V./Q. scan, Vo2 max
Patients with cancer Consider the “4 Ms”: mass effects, metabolic effects, metastases, medications
Patients with COPD ABG analysis, physiotherapy, bronchodilators
Patients with increased renal risk Measure creatinine and BUN

ABG, Arterial blood gas; BUN, blood urea nitrogen; COPD, chronic obstructive pulmonary disease; Dlco, diffusing capacity for carbon monoxide; FEV1, forced expiratory volume in 1 second; PPO, predicted postoperative; Vo2 max, maximum oxygen consumption; V/Q, ventilation–perfusion ratio.


*PPO FEV1% = Preoperative FEV1 % × (1% of functioning lung tissue removed/100). For values above 40%, postoperative complications are rare; for values between 30% and 40%, postoperative problems are possible; for values below 30%, postoperative ventilation is likely to be required.


Modified from Slinger PP, Johnston MR. Preoperative assessment and management. In Kaplan JA, Slinger PD, eds. Thoracic Anesthesia. 3rd ed. Philadelphia: Churchill Livingstone; 2003.

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Dec 2, 2016 | Posted by in ANESTHESIA | Comments Off on Thoracotomy

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