Anesthesia for Thoracic Surgery Part 2 Flashcards
explain a VATS (video assisted thoracoscopic surgery)
use of video camera and surgical instruments inserted through ports in the thoracic wall; usually 3-5 ports are used. staplers also used to resect the lung tissue and divide large blood vessels
indications for a VATS (6)
lung biopsy wedge resection biopsy of hilar and mediastinal masses esophageal and pleural biopsy pericardectomy pneumonectomy
advantages of thoracoscopic procedures over thoracotomy
smaller incision, no intraoperative rib spreading, less postoperative pain
less risk of postoperative hypoxemia
faster recovery and discharge from the hospital
thoracoscopic surgery can be performed under which types of anesthesia
local, regional, general
two lung ventilation or OLV
GA most common
pain management options for patient undergoing thoracoscopic procedures include
PCA for chest tube pain and NSAIDS usual after thoracoscopy
intraoperative considerations for thoracoscopic procedures
GA/OLV with DLT or bronchial blocker is common
infiltration with local anesthesia by surgeon prior to placement of potrs
lateral decubitus position with bean bag/axillary roll
routine monitors
minimum one large bore PIV (or 2)
arterial line usually placed
check ABG’s q30m iso
describe end of intraoperative part of thoracoscopy procedure events (3)
lung is suctioned and gently her inflated
change DLT to standard ETT if patient cannot be extubated. may want to valsalva up to 30mmHg
chest tube placed prior to closing
what type of ventilation do you do during a closed thoracoscopic procedure
one lung ventilation (deflate lung)
intraoperative complications during thoracoscopic procedures
CO2 insufflation used to improve surgical visualization in pleural cavity. this can create a gas embolism or hemodynamic compromise. do not allow them to insufflated >2LPM and anticipate increase in EtCO2
tension pneumothorax
hemorrhage
perforation of diaphragm or other organs
complications related to positioning and DLT
describe a mediastinoscopy
usually performed with lymph node or tissue biopsy to either establish a diagnosis (carcinoma of the lung, thymoma, or lymphoma) or to determine resectability of an intrathoracic tumor
performed through small transverse incision just above suprasternal notch. blunt dissection along pre tracheal fascia permits biopsy or paratracheal lymph nodes to the level of the carina.
shoulder roll and head extended
2 big things with patients undergoing mediastonoscopy
hemorrhage is possible related to vasculature. T&C and have 2U in OR and large bore IV’s
AW: do a good assessment! this includes looking at CT or MRI. if they lie flat and cough, maybe dont put those bitches to sleep ya feel.
mediastonoscopy anesthetic considerations related to artery compression
compression to innominate artery can cause poor flow to right carotid artery. therefore always put pulse ox and arterial line on the right
innominate artery supplies not only the right arm but also the right common carotid
poor cerebral perfusion results
mediastonoscopy anesthetic considerations related to airway obstruction
central airway obstruction due to compression of the trachea may occur during induction of anesthesia or during the manipulation of the mediastinoscope near the trachea
anesthetic technique for mediastonoscopy
GA with ETT and CV
placement of monitors on mediastinoscopy patient
monitor aline/pulse ox on right arm (if absent waveform, ask surgeon to reposition mediascinoscope because he is impeding blood flow to the head and arm
BP on left