Review Note
Last Update: 02/20/2025 03:00 AM
Current Deck: ACG Part 2::Thoracic SSU
New Card (Unpublished)Currently Published Content
Front
Back
No published tags.
Pending Suggestions
Field Change Suggestions:
Front
Commit #286291
SS_TS 1.14 Outline the anaesthetic management of the following procedures :
Basic Thoracic Case
Basic Thoracic Case
Back
Commit #286291Basic thoracic case
- Preoperative assessment (see preop section)
- Monitoring and access:
- Standard monitoring
- Large IV cannula + art line in operative side if possible (side up)
- +/- asleep CVL Quad if lung volume reduction surgery or comorbidities
- Induction :
- Airway plan as per examination; lung isolation using DLT +/- alternatives
- Induction - TCI prop +/- remi, relaxant
- VL as DLT bulky; insertion, confirmation of placement with fibreoptic
- Position and pressure aread :
- Positioning lateral vs supine (posterolateral or anterior approach)
- Pressure cares for arms in lateral, axillary roll
- Ventilation
- Confirm DLT/bronch blocker position with fibreoptic once lateral
- Initiate OLV once lateral position (as soon as possible to ensure adequate isolation)
- Two lung ventilation once surgically appropriate
- Lobectomy → air leak test with saline and manual inflation to 20-30cmH20
- Bronchial cuff down when able to decrease risk of bronchial wall pressure injury
- +/- Regional anaesthesia when still lateral position
- Extubation :
- Extubate on own bed, awake and upright, analgesed for adequate cough
- HFNPO postoperatively
- PCA +/- regional catheter script
- CXR postoperatively