Review Note
Last Update: 02/27/2025 04:33 AM
Current Deck: ACG Part 2::Thoracic SSU
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Commit #291086
SS_TS 1.18 Compare the anaesthetic management of thoracoscopic and open approaches for thoracic surgery
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Commit #291086Video assisted thoracoscopic surgery (VATS) :
- Less invasive than thoracotomy
- diagnosis and management disease of pleura, undiagnosed peripheral pulmonary nodules, interstitial lung disease. First choice technique for lung biopsies, pleurectomies, sympathectomies.
Anaesthetic Management :
- Thoracoscopic surgery can be performed under local, regional (intercostal nerve block at level of incision +2 above and below) or GA. Open approaches done under GA +/- regional technique for pain management
- Ventilation : one or two lung for VATS
- Insufflation leads to partial collapse of the lung on side of surgery.
- If patient is awake, hazardous to insufflates gasses under pressure to increase visualization
- Patient usually left breathing spontaneously
- High FiO2 delivered over face mask to overcome shunt due to unavoidable pneumothorax.
- Likely OLV for Thoractomy
- Monitoring :
- For short cases in well patients, blood gases not usually monitored, even if OLV
- For prolonged VATs eg lobectomy or open procedure. Require arterial line for BP monitoring and frequent gases.
- May have large blood loss in open case.
- Positioning : often both lateral decubitus
- VATS often in extreme lateral flexion so more careful attention must be paid to secure patient to the table
For both :
- Careful fluid management
- Neither TIVA or volatile superior
Advantage of VATS, when compared to open thoracotomy, include:
- reduced hospital length of stay,
- Less blood loss if no mishaps occur,
- less pain
- improvement in pulmonary function when compared to open thoracotomy,
- early patient mobilization with early recovery and rapid return to work and daily activities
- less inflammatory reaction, as measured by cytokine response in patients undergoing VATS lobectomy compared to open thoracotomy
Millers Anaesthesia
Gold coast notes