Thoracic surgery – miscellaneous

Post-op complications:

Respiratory

· T1RF (lung removal, atelectasis, oedema, secretions)

· T2RF (as above, pain)

· Pneumonia

Cardiovascular

· Arrhythmias – AF in 30-50%

· Ischaemia

· PHTN / RV dysfunction (∝ lung removal)

(in the atrium system, a pop-off valve in the seal chamber performs the function of a safety bottle)

Problems:

No safety bottle	· Build up of positive pressure
No water in #2	· Air sucked into pleural space
No water in #3	· No suction – device open to ambient air

Problems with IPPV

· Ineffective ventilation

· Tension pneumothorax

· Contamination (?)

Overall goals

· Drainage

· Isolation

· Closure

Anaesthetic

· Spont vent induction

· Surgeon scrubbed and ready

· Alternative: awake intubation