Pneumonectomy
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Revision as of 13:58, 24 October 2022 by Olivia Sutton (talk | contribs) (Created page with "{{Infobox surgical procedure | anesthesia_type = | airway = | lines_access = | monitors = | considerations_preoperative = | considerations_intraoperative = | considerations_postoperative = }} A pneumonectomy is the surgical removal of an entire lung. It can be performed via VATS or thoracotomy. == Overview == === Indications<!-- List and/or describe the indications for this surgical procedure. --> === * Lung cancer * TB * Severe COPD * Bronchiectasis * Lung a...")
Pneumonectomy
| Anesthesia type | |
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| Airway | |
| Lines and access | |
| Monitors | |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
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A pneumonectomy is the surgical removal of an entire lung. It can be performed via VATS or thoracotomy.
Overview
Indications
- Lung cancer
- TB
- Severe COPD
- Bronchiectasis
- Lung abscess
Surgical procedure
- After a pneumonectomy, air fills the space previously occupied by the lung. This postpneumonectomy space (PPS) will change over time, as the body compensates with elevation of the hemidiaphragm, mediastinal shift towards the PPS, and hyperinflation of the remaining lung. At the same time, there is progressive resorption of the air in the PPS which is replaced with fluid.
- Postoperatively, a chest tube is NOT always inserted, and the air is not always evacuated.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | May have poor reserve to begin.
Many patients are smokers with COPD |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
- Have DLT (39F for males, 37F for females typically) available, as well as equipment to place it (video scope, fiberoptic bronchoscope to confirm placement)
- Have large hemostat or Kelly clamp to clamp DLT and drop or deflate the operative lung
Patient preparation and premedication
Regional and neuraxial techniques
- Thoracic epidurals are common. Bolusing prior to incision helps with intraoperative and postoperative pain. (consider 5-8cc of 0.25% bupivacaine)
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Indications | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |