Review Note
Last Update: 02/27/2025 04:19 AM
Current Deck: ACG Part 2::Thoracic SSU
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Commit #291077
SS_TS 1.14 Outline the anaesthetic management of the following procedures:
- Lung volume reduction surgery
- Lung volume reduction surgery
Back
Commit #291077Lung volume reduction surgery/bullectomy
Surgery for improvement of respiratory function in severe emphysema
Reduction in total lung volume, resection of most diseased segments
High risk surgery, high relative mortality 18%
Patients typically have advanced respiratory disease
Preop
- MDT involvement; patient selection, counselling, preoperative investigations
- Respiratory optimisation, prehabilitation, no active respiratory problems
- Nutritional optimisation, carbohydrate loading
Periop
- Surgery performed via sternotomy vs thoracotomy vs VATS
- Lines: arterial line, CVL
- Thorough preoxygenation
- High risk of bullae rupture with aggressive IPPV → leak and tension PTX
- N2O contraindicated
- Limit risk of dynamic hyperinflation and gas trapping with deliberate hypoventilation, permissive hypercapnia
- Recommended Vt 5-6ml/kg, RR 10-12, IE ratio 1:4, Paw <30cmH20
- Treat bronchospasm +/- sputum retention
- Delayed operative lung collapse → external pressure, endobronchial suctioning
- Cautious fluid adminisaration
- Aim to extubate following procedure, ICU/HDU cares postoperatively