Timing of extubation after oesophagectomy

Caldwell, M. T. P.; Murphy, Paul; Page, Robert E.; Walsh, T. N.; Hennessy, T. P. J.

doi:10.1002/bjs.1800801214

Cited by 58 publications

(26 citation statements)

References 30 publications

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“…mediastinalen Raumforderung durch das Interpositionsorgan [7]. Die genannten Verä nderungen treten bei Oesophagusresektionen zwangslä ufig auf und sind nur schwer oder gar nicht therapeutisch beeinflußbar [15,55]. Prozentual ist die Funktionseinbuße bei Patienten mit prä operativer normaler oder eingeschrä nkter Lungenfunktion nicht unterschiedlich.…”

Section: Methoden Der Prä Operativen Risikoerfassungunclassified

Risikoerfassung

Bartels¹,

Stein²,

Schömig³

et al. 1997

Chirurg

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The aim of preoperative risk analysis is to reduce postoperative morbidity and mortality by identification of compromised organ function which can be improved by targeted preoperative measures and problem-oriented postoperative therapy. Ideally, therefore, preoperative risk assessment, influences the timing of the surgical procedure, the choice of the surgical approach, and the postoperative management. Identification of preexisting relevant disorders that may influence the postoperative course is an essential prerequisite of risk analysis. While preoperative risk analysis today gains in importance with the increasing extent of elective surgical procedures, preoperative risk evaluation still plays a minor role in the emergency situation when the given patient-dependent risk usually has to be accepted. Objective risk evaluation depends on the general and nutritional status, the pulmonary, cardio-vascular, hepatic, and renal function, and the cooperation of the patient. These factors, however, clearly have to be seen in relation to the type and extent of the planned surgical procedure. The selection of additional tests of organ function, exceeding the standard tests required prior to any surgical intervention, must be guided by the extent of the planned surgical procedure, the physiologic alterations associated with the surgical procedure, and the suspected underlying organ dysfunction. Generally accepted multi-factorial classification systems to identify patients at risk for a wide spectrum of surgical procedures are currently not available. Using the model of esophagectomy in patients with esophageal cancer we could, however, demonstrate that a quantitative assessment of the peri- and postoperative risk based on preoperatively available physiologic parameters is possible and markedly reduces postoperative mortality when applied prospectively. The development and validation of similar risk-score systems for other surgical procedures should be considered.

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Section: Methoden Der Prä Operativen Risikoerfassungunclassified

Risikoerfassung

Bartels¹,

Stein²,

Schömig³

et al. 1997

Chirurg

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“…18 F-Fluorodeoxyglucose-positron emission tomography (FDG-PET) was also used for some of the patients.…”

Section: Preoperative Assessment and Managementmentioning

confidence: 99%

“…Recently, some surgical teams have demonstrated the effi cacy of postoperative immediate extubation (IE) following an esophageal resection, most of which are Ivor-Lewis, transhiatal, or left thoracoabdominal esophagectomies with limited lymph node dissection [18][19][20][21][22]. However, very few reports have showed the feasibility and safety of this practice for patients with thoracic esophageal cancers who underwent transthoracic esophagectomy with extended radical 3FLND.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the feasibility and safety of immediate extubation after esophagectomy with extended radical three-field lymph node dissection for thoracic esophageal cancers

et al. 2009

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Evaluation of the feasibility and safety of immediate extubation after esophagectomy with extended radical three-fi eld lymph node dissection for thoracic esophageal cancers Abstract Background. No standard procedure exists in respiratory management, including mechanical ventilation, which is commonly administered, after thoracic esophagectomy for esophageal cancer. Methods. Various perioperative clinical parameters and complications were retrospectively compared between the patients who underwent mechanical ventilation (MV group, n = 38) and those who were extubated immediately (immediate extubation: IE group, n = 75), following transthoracic esophagectomy with three-fi eld lymph node dissection (3FLND) for thoracic esophageal cancers. Results. There were no signifi cant differences between the two groups in the early postoperative clinical course. The frequencies of postoperative complications were 39% and 47% in the IE and MV groups, respectively, and pulmonary complications tended to occur more frequently in the MV group (23.7%) than in the IE group (12.0%). Mobilization of the patients was signifi cantly earlier in the IE group than in the MV group (P < 0.0001). Conclusions. IE is feasible and safe even after transthoracic esophagectomy with 3FLND. To avoid the possible disadvantages of MV after surgery, IE can be a standard protocol for postoperative management after transthoracic esophagectomy with radical lymph node dissection.

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“…The decision to keep patients intubated and mechanically ventilated following major procedures is often made out of concern that the stress or pain of assuming the work of breathing might lead to adverse outcomes. The tradition of overnight ventilatory support in patients recovering from radical esophagectomy, for example, has clearly been shown not to be universally necessary [5,6].In several institutions in Japan, it is rather a routine procedure for a patient to be extubated immediately after radical esophagectomy and managed under spontaneous breathing. In the study of Murata and Kubota [2], the rate of unsuccessful weaning seems to be considerably high.…”

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confidence: 99%

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confidence: 99%

Is prophylactic mechanical ventilation really necessary after esophageal surgery?

Nishino

2001

Journal of Anesthesia

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unsuccessful weaning group. These findings suggest that an increase in respiratory energy expenditure due to the impairment of respiratory mechanics is the main cause of postoperative respiratory failure in patients undergoing radical operation for esophageal cancer.No doubt, there are beneficial effects of prophylactic mechanical ventilation after major surgery. For example, mechanical ventilation can reduce the metabolic demands on an often fragile circulatory system and allow for more aggressive pain control in patients recovering from major surgical insults. However, prolonged mechanical ventilation may not only alter the quality of life for a patient but also have several adverse effects, such as circulatory depression, barotraumas, and ventilator-induced lung injury. There is also a question whether prophylactic mechanical ventilation is really necessary after esophageal surgery.There is a substantial literature to suggest that postoperative mechanical ventilation as prophylaxis against adverse respiratory or cardiac outcomes is unnecessary in the absence of clear pulmonary pathology [3,4]. The decision to keep patients intubated and mechanically ventilated following major procedures is often made out of concern that the stress or pain of assuming the work of breathing might lead to adverse outcomes. The tradition of overnight ventilatory support in patients recovering from radical esophagectomy, for example, has clearly been shown not to be universally necessary [5,6].In several institutions in Japan, it is rather a routine procedure for a patient to be extubated immediately after radical esophagectomy and managed under spontaneous breathing. In the study of Murata and Kubota [2], the rate of unsuccessful weaning seems to be considerably high. However, to my knowledge, no prospective randomized study has been conducted to compare the rate of postoperative complications in patients breathing spontaneously and patients receiving mechanical ventilation after radical esophageal surgery. At this point, it is not clear whether prophylactic mechanical It is generally accepted that the characteristic postoperative mechanical respiratory abnormality following abdominal or thoracic surgery is a restrictive pattern with severely reduced inspiratory capacity and vital capacity, plus smaller, but more important, reductions in FRC. Thus, patients breathe rapidly with a small tidal volume and are unwilling or unable to inspire deeply. The reduced inspiratory capacity limits the patient's ability to cough effectively and causes atelectasis and hypoxemia. In view of these postoperative abnormalities, ventilatory support with mechanical ventilation after major surgery seems to be a reasonable procedure to minimize the number of respiratory complications.Radical surgery for esophageal cancer requires a combined thoracoabdominal procedure and is still associated with a high rate of postoperative pulmonary complications [1]. Although patients undergoing combined thoracoabdominal surgery seem to be particularly liable to change...

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Timing of extubation after oesophagectomy

Cited by 58 publications

References 30 publications

Risikoerfassung

Risikoerfassung

Evaluation of the feasibility and safety of immediate extubation after esophagectomy with extended radical three-field lymph node dissection for thoracic esophageal cancers

Is prophylactic mechanical ventilation really necessary after esophageal surgery?

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