[Intraoperative risk management during thoracic procedures].
Risk management in clinical practice is an impor part of medical audit. Although, medical audit consists of monitoring, data collection, peer review and establishing standards, these four steps should be regarded as a series of cyclical process. As a general rule, this concept should be applied to any field of clinical medicine and will contribute to the development of sound quality control scheme. Several complications are known to occur in thoracic anesthesia, especially in one-lung ventilation. For example, malposition of double-lumen endotracheal tube, severe hypoxia and higher airway pressure are relatively common problems, and it would be better for us to prepare for these adverse events beforehand. Auscultation, fiber-optic visualization and proper ventilatory management (eg. lower tidal volume with dependent lung PEEP, alveolar recruitment maneuver, application of CPAP to non-dependent lung) are the recommended technique required to correct these abnormalities. When life-threatening hypoxia is imminent, we should convert to two-lung ventilation without any delay. In this regard, verbal communication between surgical teams should be kept on even ground, each playing key roles in the management of such a critical situation.
Tsuzaki
Koichi
K
Department of Anesthesiology, School of Medicine, Keio University, Tokyo 160-8582.
D000758:Anesthesia; D006801:Humans; D000860:Hypoxia / Q000517:prevention & control; D007431:Intraoperative Complications / Q000517:prevention & control; D008168:Lung / Q000601:surgery; D008482:Mediastinum / Q000601:surgery; D012121:Respiration, Artificial / Q000379:methods; D012308:Risk Management; D019616:Thoracic Surgical Procedures