
Contents
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General principles General principles
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General considerations General considerations
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Preoperative assessment Preoperative assessment
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Lung resection Lung resection
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Important scenarios encountered by thoracic anaesthetists Important scenarios encountered by thoracic anaesthetists
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Analgesia Analgesia
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Isolation of the lungs Isolation of the lungs
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Advantages of OLV Advantages of OLV
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Disadvantages of OLV Disadvantages of OLV
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Indications for isolation and separation of the two lungs Indications for isolation and separation of the two lungs
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Techniques Techniques
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Double lumen endobronchial tubes Double lumen endobronchial tubes
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Types of DLT Types of DLT
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Selection of DLT Selection of DLT
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Placement of DLT Placement of DLT
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Clinical confirmation of DLT position Clinical confirmation of DLT position
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Fibreoptic bronchoscope Fibreoptic bronchoscope
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Bronchial blocker technique Bronchial blocker technique
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Indications for using a bronchial blocker Indications for using a bronchial blocker
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Management of one lung ventilation Management of one lung ventilation
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Initiating OLV Initiating OLV
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Failure to achieve OLV Failure to achieve OLV
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Hypoxia on OLV Hypoxia on OLV
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Returning to two lung ventilation Returning to two lung ventilation
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Rigid bronchoscopy and stent insertion Rigid bronchoscopy and stent insertion
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Preoperative Preoperative
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Perioperative Perioperative
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Postoperative Postoperative
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Special considerations Special considerations
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Superior/cervical mediastinoscopy Superior/cervical mediastinoscopy
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Preoperative Preoperative
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Perioperative Perioperative
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Postoperative Postoperative
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Special considerations Special considerations
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Lung surgery: wedge resection, lobectomy, and pneumonectomy Lung surgery: wedge resection, lobectomy, and pneumonectomy
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Preoperative Preoperative
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Perioperative Perioperative
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Postoperative Postoperative
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Special considerations Special considerations
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Thoracoscopy and video-assisted thoracoscopic surgery (VATS) procedures Thoracoscopy and video-assisted thoracoscopic surgery (VATS) procedures
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Preoperative Preoperative
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Perioperative Perioperative
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Postoperative Postoperative
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Special considerations Special considerations
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Lung volume reduction surgery and bullectomy Lung volume reduction surgery and bullectomy
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Preoperative Preoperative
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Perioperative Perioperative
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Postoperative Postoperative
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Special considerations, Special considerations,
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Drainage of empyema and decortication Drainage of empyema and decortication
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Preoperative Preoperative
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Perioperative Perioperative
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Postoperative Postoperative
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Special considerations Special considerations
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Repair of bronchopleural fistula Repair of bronchopleural fistula
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Preoperative Preoperative
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Perioperative Perioperative
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Postoperative Postoperative
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Special considerations Special considerations
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Tips for controlling a massive air leak (i.e. unable to ventilate effectively) Tips for controlling a massive air leak (i.e. unable to ventilate effectively)
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Pleurectomy/pleurodesis Pleurectomy/pleurodesis
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Preoperative Preoperative
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Perioperative Perioperative
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Postoperative Postoperative
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Special considerations Special considerations
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Oesophagectomy Oesophagectomy
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Preoperative Preoperative
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Perioperative Perioperative
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Postoperative Postoperative
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Special considerations Special considerations
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Chest injury Chest injury
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General considerations General considerations
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Repair of ruptured diaphragm Repair of ruptured diaphragm
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Repair of ruptured oesophagus Repair of ruptured oesophagus
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Repair of tracheobronchial injury Repair of tracheobronchial injury
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Further reading Further reading
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Cite
Extract
General principles
Successful thoracic anaesthesia requires the ability to control ventilation of the patient's two lungs independently, skilful management of the shared lung and airway, and a clear understanding of planned surgery. Good communication between surgeon and anaesthetist is essential.
Patients undergoing thoracic surgery are commonly older and less fit than other patients (30% >70yr, 50% >ASA 3). Long-term smoking, bronchial carcinoma, pleural effusion, empyema, oesophageal obstruction, and cachexia are all common and can significantly reduce cardiorespiratory physiological reserve.
General considerations
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Preoperative assessment
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Lung resection1
Based on history, examination, and simple pulmonary function tests (PFTs), patients may be classified as:
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Pulmonary function (see p. 102 and p. 1264) tests are often used to determine suitability for lung resection surgery by estimating postoperative lung function. Always consider the results in context of patient's general health and proposed resection.
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Important scenarios encountered by thoracic anaesthetists
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Analgesia
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