Anaesthesia for telescopic procedures in the thorax

Abstract

Over the past decade, there has been an increase in endoscopic procedures within the thorax for diagnostic and therapeutic purposes. Each has its indications, techniques and complications. However, the one common denominator is that there is always the possibility that thoracotomy may be necessary. Occasionally, particularly if considerable haemorrhage occurs, thoracotomy may be required immediately. Consequently, the clinical examination and investigations should be orientated to this possibility. The medical and theatre staff should be prepared for, and trained to deal with, such an eventuality. GENERAL PREOPERATIVE CONSIDERATIONS Patients should undergo a complete evaluation for a full posterolateral thoracotomy. The goal is to define all of the problems and to ascertain if the patient is in the best possible condition. Factors known to increase the risk for patients undergoing thoracic surgery include cigarette smoking, advanced age, coronary artery disease, preoperative weight loss, obesity, poor pulmonary function and duration of anaesthesia. 47 Cardiac risk is determined by the severity of coronary artery disease, presence of cardiac arrhythmias, left ventricular dysfunction, age and associated medical conditions such as hypoxaemia, diabetes and renal insufficiency. 28 An exercise stress test should be performed as patients with ischaemia are at a higher risk of perioperative cardiac complications and death when undergoing major operations such as pneumonectomy. 22 Consideration should be given to cardiac catheterization and, if appropriate, coronary artery bypass grafting before major lung resection. However, it is not known if this is true for patients undergoing thoracoscopic pulmonary resection. The preoperative evaluation of the respiratory system involves taking a history, physical examination, exercise tolerance, routine laboratory tests, including arterial blood-gas tensions, radiography and pulmonary function tests. Patients who show an increase in peak expiratory flow rate by 15% or more after administration of bronchodilators should receive perioperative bronchodilators. A forced vital capacity (FVC) of at least three times the tidal volume is necessary for an effective cough and a value of less than 50% of predicted is an indicator of increased risk of

The Physiological Consequences of Bronchoscopy : A Study of the Haemodynamic Changes During Bronchoscopy

“…lignocaine or Esmolol. 5 Though the disease process may affect the haemodynamic consequences -Our study included random allocation of patients to each group. Therefore it was not possible to ascertain the effects of the disease perse in individual groups.…”

Rigid Bronchoscopy

“…Concern for most complications is related to general anesthesia (GA). RB can be accomplished in the absence of GA, but without a high level of sedation the experience of the procedure will certainly be different, both for the bronchoscopist as well as the patient; therefore, most are performed with deep sedation or GA. 46 Patients with comorbid diseases making them a concern for GA should be fully evaluated with a risk assessment to determine if and when to proceed. Any preprocedural optimization should be addressed as early as possible, particularly if the indication for RB is related to an airway obstruction or FB.…”

“…During this mode, appropriate ventilation is assessed by adequate chest rise. 46,51 HFJV differs in that the respiratory rate can be set between 60 and 300 breaths/minute with 12 to 18 psi while maintaining the peak pressures < 35 cm H 2 O. 52 The advantage of HFJV is a motionless operative field.…”

Diagnostic Bronchoscopy in Children

“…Удаление бронхиального секрета с использованием отсоса в этих условиях дополнительно снижает функциональную остаточную емкость легких и дыхательные объемы, что препятствует эффективной кислородотерапии. Гипоксию, обусловленную этим механизмом, можно предотвратить, ограничив время санации и подачей вдыхаемой газовой смеси с повышенным содержанием увлажненного кислорода [2].…”

“…Первую фибробронхоскопию выполнил Шигето Икеда в 1968 г. [1,2]. В последнее время преобладающее число обследований проводится с помощью гибких бронхоскопов.…”