Preanesthetic Assessment for Thoracic Surgery

  • Peter Slinger
  • Gail Darling
Chapter

Abstract

All patients having pulmonary resections should have a ­preoperative assessment of their respiratory function in three areas: lung mechanical function, pulmonary ­parenchymal function, and cardiopulmonary reserve (the “three-legged stool” of respiratory assessment). Following pulmonary resection surgery, it is usually ­possible to wean and extubate patients with adequate ­predicted post-operative respiratory function in the operating room provided they are “AWaC” (alert, warm and comfortable). Preoperative investigation and therapy of patients with coronary artery disease for noncardiac thoracic surgery is becoming a complex issue. An individualized strategy in consultation with the surgeon, cardiologist, and patient is required. Myocardial perfusion, CT coronary angiography, and other advances in imaging are used increasingly in these patients. Geriatric patients are at a high risk for cardiac complications, particularly arrhythmias, following large pulmonary resections. Preoperative exercise capacity is the best predictor of post-thoracotomy outcome in the elderly. In the assessment of patients with malignancies, the “four M’s” associated with cancer must be considered: mass effects, metabolic effects, metastases, and medications.Perioperative interventions which have been shown to decrease the incidence of respiratory complications in high-risk patients undergoing thoracic surgery include: cessation of smoking, physiotherapy, and thoracic epidural analgesia.

Keywords

Catheter Ischemia Corticosteroid Uranium Aspirin 

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Peter Slinger
    • 1
  • Gail Darling
    • 2
  1. 1.Department of AnesthesiaToronto General HospitalTorontoCanada
  2. 2.Department of Surgery, Division of Thoracic SurgeryToronto General Hospital, University Health NetworkTorontoCanada

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