Summary
Management options to consider in the high-risk patient for pulmonary resection include:
- 1
The use of EAA plus a postoperative pain management scheme to optimize pulmonary function in the critical two to four days after surgery.
- 2
The use of a “step-down” or intermediate care area,106 with a level of monitoring between that of the intensive care unit and the regular postoperative ward, for the initial three to four days.
- 3
Preoperative optimization of concurrent medical conditions with aggressive physical and medical therapy.
- 4
Careful titration of intra-operative fluids with early recourse to invasive monitoring, vasopressors and inotropes. Perioperative digitalization of patients with a history of cardiovasuclar disease for pneumonectomy.
- 5
Avoidance of N2O. Ventilate intraoperatively with an air/oxygen mixture, during both two- and one-lung ventilation, titrated against the arterial oxygen saturation. Avoidance of complete intraoperative atelectasis of the ND-lung with a low level of air/oxygen CPAP.
- 6
Surgical alternatives. The use of a median sternotomy or limited resection.
A simple cost/benefit analysis tells us that not every recent advance in thoracic anaesthesia is indicated for every patient. It is now part of the anaesthetist’s responsibility to identify the high-risk patient and to develop an appropriately stratified management plan.
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Crone, R.K., Sorensen, G.K. & Orr, R.J. Anesthésie chez le nouveau-né. Can J Anaesth 37 (Suppl 1), Sxv–Sxxiv (1990). https://doi.org/10.1007/BF03006269
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DOI: https://doi.org/10.1007/BF03006269