53. Thoracic surgery Flashcards
Eaton lambert syndrome and cancer
Associated with small cell carcinoma
Cancer not related to smoking and characteristics
Carcinoid. Survival 90% (5Y)
No responsive to usual vasopressors. Tx Octreotide
Increase risk of desaturation in chest surgery if
Poor PaO2 during 2LV
Right thoracotomy
Normal spirometry o RLD
Supine
V/Q high
Adjustments in OLV
TV 5 - 6 mk/kg (IBW)
Peak p < 35, plateau > 25
PEEP 5 - 10 mmHg
RR 12 rpm
Best test for pulmonary mechanics
Predicated post op FEV1
Segments in lungs
Right. 6 - 4 - 12
Left 10 -10
Pre anesthesia in thoracic surgery
If METs > 2 spirometry (ppo FEV1, DLCO)
If METs < 2 Consultation + optimization
Post op predicted FEV1
> 60 ok
30 - 60 simple exercise test
< 30 cardiopulmonary testing
< 20 unacceptable
Arrhythmias after thoracic surgery (lung resection)
60 - 70 % afib
incidence 30 - 50%
Innominate artery characteristics
Brachiocephalic artery
Blood supply to the right arm. Pressure can cause desaturation and flat wave if pulsometer is in the right
Cardiac herniation carac.
50% death
Rupture of pericardium
< 24 h
Bronchopleural fistula carac.
Sudden onset of dyspnea
Subcutaneous emphysema
Contralateral deviation of trachea
Decrease fluid levels
Increase risk for thoracic surgery if
FEV1 (ppo) < 40. high < 30
DLCO < 40
O2 consumption < 15 ml/kg/min. < 10 very high
Double lung tube sizes
female < 160 35
>160 37
Male < 170 39
> 170 41
Absolute C.I lung transplant
Malignancy < 2y
Chronic d. HB…
Spinal chest deformity
Non adherence
Substance addiction
Psychotic disorder
Toxicity of chemo
Cisplatin Renal
Bleomycin Lung
Doxorubicin Cardiac
Massive hemoptysis if blood loss
> 200 ml
Complication in thoracic surgery
15 - 20% resp
10 - 15 cardiac
4 death
Pulmonary Hypertension carac
Avoid hypotensive drugs
Ketamine ok (doesn’t exacerbate)
Ephedrine, Vaso, phenilep, OK
Use inhaled vasodilators
Thoracic epidural with caution
DLCO FEV1 and chemo
Chemo affects DLCO, no FEV1
Lower limit in FEV1 or DLCO for surgery
Patient with < 20 not candidate
HyperK and HyperNa, cancer
Squamous CC
Perioperative risk in thoracic surgery by test
< 15 l/kg/min high risk , 10 very high
6MWT 450 = 15
Shuttle WT 250 = 10
Increase risk if SPO2 in exercise spirometry increase more than 4%
Extubation criteria after thoracic surgery
FEV1 > 40%
FEV1 > 30% and exercise tolerance good (6MWT > 450m)
FEV1 > 20 in VATS and good tolerance
