Thoracic surgery clinics
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Thoracic surgery clinics · Aug 2010
ReviewDigital and smart chest drainage systems to monitor air leaks: the birth of a new era?
Recently, several companies have manufactured and commercialized new pleural drainage units that incorporate electronic components for the digital quantification of air through chest tubes and, in some instances, pleural pressure assessment. The goal of these systems is to objectify this previously subjective bedside clinical parameter and allow for more objective, consistent measurement of air leaks. ⋯ These may afford earlier mobilization of patients because the pleural drainage chamber is attached to a battery-powered smart suction device. In this article we review the clinical experiences using these new devices.
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With the increasing use of MDCT, more solitary pulmonary nodules are being detected. Although the majority of these lesions are benign, lung cancer constitutes an important consideration in the differential diagnosis of solitary pulmonary nodules. The goal of management is to correctly differentiate malignant from benign nodules to ensure appropriate treatment. ⋯ These lesions are not suitable for CT enhancement studies and may show low metabolic activity on PET imaging. Due to their association with bronchioloalveolar carcinoma and adenocarcinoma, subsolid nodules require a more aggressive approach in terms of reassessing serial imaging and/or obtaining tissue diagnosis. As data from the low-dose CT lung cancer screening trials are analyzed and further studies with new imaging techniques are performed, management strategies for the imaging evaluation of the solitary pulmonary nodule will continue to evolve.
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Thoracic surgery clinics · Aug 2009
ReviewPostoperative pain management in the elderly undergoing thoracic surgery.
The management of postoperative pain in the elderly represents a considerable challenge because these patients are generally at higher risk for postoperative complications. There are several analgesic options, some of which may influence perioperative morbidity in this high-risk group of patients. Although use of regional analgesia, particularly epidural analgesia is associated with some benefits, including a decrease in perioperative morbidity, there are side effects and complications (eg, medication-related side effects, epidural hematoma, infection) from these and other techniques, and the clinician should evaluate the benefits and risks of each technique on an individual basis. Nevertheless, the available data suggest that use of regional analgesic techniques (ie, epidural and paravertebral catheters) is associated with a decrease in perioperative pulmonary complications.
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Thoracic surgery clinics · Aug 2009
ReviewPreoperative evaluation and risk assessment for elderly thoracic surgery patients.
Assessment for thoracic surgery in elderly patients should proceed on the basis of physiologic rather than chronologic age. Thoracic surgery has been shown to be safe in selected elderly patients, and age should not be a contraindication to a therapy that offers the best chance of cure for early stage cancer patients. ⋯ Specialized multidisciplinary care provided by primary care physicians, geriatric specialists, cardiologists, oncologists, surgeons, anesthesia personnel, nurses, physical therapists, and nutritionists will optimize care for the elderly thoracic surgery patient. Careful selection of patients for surgery has contributed to the improvement in operative mortality over time, and refinements in preoperative testing should continue this trend in the future.
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Thoracic surgery clinics · Aug 2009
Evaluation and management of the elderly patient at risk for postoperative delirium.
Geriatric patients are at a high risk for the development of postoperative delirium. By recognizing predisposing and precipitating risk factors, preventive measures can be undertaken to reduce this risk. Accurate and timely diagnosis is essential, and we offer therapeutic strategies to help reduce the high morbidity and mortality of this important condition.