Anaesthesia for lung resection.
Management options to consider in the high-risk patient for pulmonary resection include: 1. The use of EAA plus a postoperative pain management scheme to optimize pulmonary function in the critical two to four days after surgery. 2. The use of a "step-down" or intermediate care area, with a level of monitoring between that of the intensive care unit and the regular postoperative ward, for the initial three to four days. 3. Preoperative optimization of concurrent medical conditions with aggressive physical and medical therapy. 4. Careful titration of intra-operative fluids with early recourse to invasive monitoring, vasopressors and inotropes. Perioperative digitalization of patients with a history of cardiovascular disease for pneumonectomy. 5. Avoidance of N2O. Ventilate intraoperatively with an air/oxygen mixture, during both two- and one-lung ventilation, titrated against the arterial oxygen saturation. Avoidance of complete intraoperative atelectasis of the ND-lung with a low level of air/oxygen CPAP. 6. Surgical alternatives. The use of a median sternotomy or limited resection. A simple cost/benefit analysis tells us that not every recent advance in thoracic anaesthesia is indicated for every patient. It is now part of the anaesthetist's responsibility to identify the high-risk patient and to develop an appropriately stratified management plan.
Department of Anaesthesia, Montreal General Hospital, McGill University, P.Q.
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Slinger
D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods; D000767:Anesthesia, Epidural / Q000379:methods; D000768:Anesthesia, General / Q000379:methods*; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000401:mortality; D008175:Lung Neoplasms / Q000601:surgery*; D010149:Postoperative Pain / Q000628:therapy; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors