Chest surgery clinics of North America
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Postoperative atelectasis is a common problem following any surgery. Limited atelectasis is usually well-tolerated and easily reversible. However, complete atelectasis of the remaining lung following partial lung resection may be poorly tolerated. ⋯ Prophylaxis includes preoperative and postoperative physiotherapy and medications, which should be graded in accordance to the individual patient's risk factors. Large atelectasis requires bronchoscopy to remove mucous plugs. Tracheostomy should be considered in patients with relapsing atelectasis or swallow disorders.
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Chest Surg. Clin. N. Am. · Aug 1998
ReviewPathogenesis and management of persistent postthoracotomy pain.
Persistent chest wall pain is common after thoracotomy and is usually caused by recurrence or progression of malignancy. It should prompt efforts to identify and treat the causative disease. A minority of patients experience persistent pain not related to neoplasm. ⋯ This suggests that strategies for avoiding PTPS may begin with aggressive perioperative anesthetic and analgesic techniques. More effective application of knowledge already available from laboratory studies awaits further clinical trials. New drugs such as NMDA inhibitors hold promise for more effective treatment in the future.
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Chest Surg. Clin. N. Am. · Aug 1998
ReviewMechanical ventilation for respiratory failure postthoracotomy.
Although the exact incidence of postthoracotomy respiratory failure is unknown, it can be estimated to lie between 5% and 15%, given that many of these patients suffer from comorbid cardiopulmonary disease. Preoperative assessment is essential to more accurately predict those patients at increased risk for the development of respiratory failure. Efforts to minimize these risks include the aggressive use of analgesics. ⋯ The twin goals of mechanical ventilation should be to provide inspiratory muscle assistance and rest while preventing the onset of muscle atrophy. To that extent, the limitations of the various modes of mechanical ventilation must be appreciated as to their impact on patient ventilatory performance. Weaning, which should be regarded simply as an extension of mechanical ventilation, should be approached with an appreciation of the pathophysiologic basis underlying ventilatory failure, the factors responsible, and a rational approach to their repair.
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This article discusses some of the routine as well as more specialized monitoring devices available. In thoracic surgery monitoring may be even more challenging because the surgery itself may involve manipulation of the airways, the pulmonary as well as cardiovascular systems. The anesthesiologist must have a full understanding of the required monitoring devices and decide which if any special techniques are needed depending on the surgical procedure and the patient's preoperative condition.
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Chest Surg. Clin. N. Am. · Nov 1997
ReviewPreoperative pulmonary evaluation of the thoracic surgical patient.
A test designed to separate those undergoing thoracic surgery without complications and those with complications must be both highly specific and sensitive. Clearly, the difference between patients at opposite ends of the population curves is easy to identify. Spirometry can be helpful for screening, although it is not a very discriminating test. ⋯ Functional indexes (PPP, PRQ) or exercise testing can aid further in the selection of those patients in whom a nonsurgical option should be considered. Flow decision chart for the preoperative evaluation of patients for pulmonary resection should continue to evolve as new information about outcome studies is gathered. Examination of outcome data will provide us with reduction of the size of the nonoperable population, so that we can deny only those patients who truly pose a prohibitive risk.