Thoracic surgery – perioperative considerations

 

(needs work)

 

Assessment:

Goal

·      Should this operation go ahead

·      Should the patient go to ICU?

Predictions

·      Correct for age, sex, height

·      Correct for amount of lung being removed

o  Left lung: 10+10 = 20 segments

o  Right lung: 6 + 4 + 12 = 22 segments

Mechanics

ppoFEV1:

·      <40%: moderate risk

·      <30%: high risk

(others: FVC, MVV, RV/TLC)

Gas exchange

ppoDLCO:

·      >40% high risk

(old way: PaO2 and PaCO2)s

Global function

VO2max:

·      <15: high risk

·      <10: very high risk

·      (two flights of stairs = VO2 12)

VE/VCO2 slope:

·      >35: high risk of respiratory complications and death

·      Strongest predictor

6MWT:

·      Desat >4%: high risk

·      (6MWT / 30 VO2max)

 

Complications:

Cardiovascular:

RV dysfunction

·      Amount of lung (hence vasculature) removed

·      Worse with high output (exercise, SIRS)

Arrhythmias

·      High incidence: 30-50%

·      Mostly atrial fibrillation

·      Risk factors: elderly, major surgery

·      Causes: ↑PVR, ↑SNS

Ischaemia

·      Moderate incidence: 5%

·      Risk factors: the usual, and common

·      Especially day 2-3 post-op

 

Respiratory:

Respiratory failure

·      Lung removal

·      Atelectasis

·      Pain

Pneumonia

 

 

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