Perioperative management in thoracic surgery

Abstract

Thoracic surgery has undergone significant advances in recent years related to anesthetic and surgical techniques and the prevention and management of complications related to the procedure. This has allowed improvements in patient clinical outcomes in surgeries of this kind. Despite the above, thoracic surgery, especially related to pulmonary resection, is not without risk, and is associated to considerable morbidity and mortality. Fast track or enhanced recovery after anesthesia protocols, minimally invasive surgery, and intraoperative anesthetic management improve the prognosis and safety of thoracic surgery. Patients in the postoperative period of major thoracic surgery require intensive surveillance, especially the first 24-72 h after surgery. Admission to the ICU is especially recommended in those patients with comorbidities, a reduced cardiopulmonary reserve, extensive lung resections, and those requiring support due to life-threatening organ failure. During the postoperative period, intensive cardiorespiratory monitoring, proper management of thoracic drainage, aggressive pain control (multimodal analgesia and regional anesthetic techniques), nausea and multimodal rehabilitation are key elements for avoiding adverse events. Medical complications include respiratory failure, arrhythmias, respiratory infections, atelectasis and thromboembolic lung disease. The most frequent surgical complications are hemothorax, chylothorax, bronchopleural fistula and prolonged air leakage. The multidisciplinary management of these patients throughout the perioperative period is essential in order to ensure the best surgical outcomes.

A Real-Time Artificial Intelligence-Assisted System to Predict Weaning from Ventilator Immediately after Lung Resection Surgery

“…Lung resection is one of the riskiest major surgeries and must be performed under general anesthesia with advanced anesthetic monitoring [ 3 ]. Patients undergoing lung resection surgery must receive endotracheal tube intubation, which provides access to mechanical ventilation via a machine called a ventilator.…”

Evaluating the impact of personalized rehabilitation nursing intervention on postoperative recovery of respiratory function among thoracic surgery patients

“…Since the characteristics create numerous complications that adversely impact the prognosis of patients, surgeons and anaesthesiologists have increasingly studied PPCs of thoracic operations. [3,4] In addition, prolonged hospitalizations and admissions to the intensive therapy unit are other significant medical and financial strains caused by PPCs. Risk factors associated with PPCs in the follow-up of pulmonary resection have been recognized in several clinical researches adopting various research designs and definitions.…”

“…Thoracic surgical intervention can involve prolonged surgical durations, increased trauma, 1-lung ventilation, nerve injury, acute or chronic pain, and sternum or rib incision. Since the characteristics create numerous complications that adversely impact the prognosis of patients, surgeons and anaesthesiologists have increasingly studied PPCs of thoracic operations [3,4] . In addition, prolonged hospitalizations and admissions to the intensive therapy unit are other significant medical and financial strains caused by PPCs.…”

Development and validation of a nomogram to predict postoperative pulmonary complications following thoracoscopic surgery

“…Thoracic surgery tends to involve one-lung ventilation, long operation times, increased trauma, sternum or rib incision, nerve injury, and acute or chronic pain. As these characteristics lead to many complications and seriously affect the prognosis of patients, PPCs of thoracic surgery have been widely studied by surgeons and anesthesiologists ( Hoshikawa & Tochii, 2017 ; Khaitan & D’Amico, 2018 ; Medbery & Force, 2017 ; Munoz De Cabo et al., 2020 ). The incidence of PPCs after thoracic surgery is 19–59% ( Agostini et al, 2010 ; Garcia-Miguel, Serrano-Aguilar & Lopez-Bastida, 2003 ).…”