Four Hours Postoperative Mobilization is Feasible After Thoracoscopic Anatomical Pulmonary Resection

Abstract

Background We aimed to analyze the feasibility and risk factors associated with early mobilization (EM) within 4 h after thoracoscopic lobectomy and segmentectomy. Methods This study retrospectively evaluated 214 consecutive patients who underwent thoracoscopic anatomical pulmonary resection using our EM protocol between October 2017 and February 2019. We compared the correlations of the patients’ characteristics including the total number of drugs and perioperative parameters such as air leak, and orthostatic hypotension (OH) between the EM (E group) and failed EM (F group) groups. Second, we evaluated risk factors for OH, which often causes critical complications. Results A total of 198 patients (92.5%: E group) completed the EM protocol, whereas 16 patients did not (7.5%: F group). The primary causes of failure were severe pain, air leak, postoperative nausea and vomiting, and OH (n = 1, 3, 8, and 4). Upon univariate analysis, air leakage, OH, and non‐hypertension were identified as risk factors for failed EM (all p <0.05). EM was associated with a shortened chest tube drainage period (p <0.01). Thirty patients (14%) experienced OH, and 20% of them failed EM. A total number of drugs ≥5 (p = 0.015) was an independent risk factor for OH. Operative and anesthetic variables were not associated with EM or OH. Conclusions The EM protocol was safe and useful for tubeless management. Surgeons should be advised to actively prevent air leak. Our EM protocol achieved a low frequency of OH in mobilization. Due to its versatility, our mobilization protocol may be promising, especially in patients without severe comorbidities. Clinical registration number: The study protocol was approved by the Review Board of Aichi Cancer Center (approval number: 2020‐1‐067).

Effect of posture on pulmonary function and oxygenation after fast-tracking video-assisted thoracoscopic surgery (VATS) lobectomy: a prospective pilot study

“…In this context, reasons for not being mobilised should be analysed with regard to organisational vs. patient-related factors. Importantly, early mobilisation may be hindered by early orthostatic intolerance (Jans and Kehlet 2017 , Nakada et al 2021 ) calling for further studies on the pathogenic mechanisms and prevention (Jans and Kehlet 2017 ; Kehlet 2020 ).…”

Intraoperative Multimodal Approach for Pain After Thoracoscopic Pulmonary Resection

“…Other postoperative evaluations included postoperative nausea and vomiting, early mobilization, orthostatic hypotension (OH) at the first mobilization, chest tube duration, and length of postoperative hospitalization. In this study we defined OH as a decrease of ≥20 mmHg in systolic blood pressure (SBP) within 3 min of standing up at the first mobilization, compared to the sitting SBP 6 …”

“…In this study we defined OH as a decrease of ≥20 mmHg in systolic blood pressure (SBP) within 3 min of standing up at the first mobilization, compared to the sitting SBP. 6…”

Risk factors for postoperative nausea and vomiting after thoracoscopic pulmonary wedge resection: pitfalls of an increased fentanyl dose

“…Anesthetic parameters were as follows: dose of fentanyl per kg per hour, remifentanil, dexamethasone, droperidol, ketamine acid, prochlorperazine maleate, inhalation anesthesia (including temporary usage), and intraoperative infusion index (IOII). The IOII was calculated as follows: [amount of infusion (mL) -intraoperative total output (mL)]/(operative time (hour) × body weight (kg)) (12). We had developed the protocol of early postoperative mobilization and chest drain removal within 4 hours after the operation since January 2017 (13).…”