from Section 18 - Cardiothoracic Surgery
Published online by Cambridge University Press: 05 September 2013
Pulmonary lobectomy is most often performed for neoplasms of the lung, both benign and malignant. It may also be performed for residual bronchiectasis, pulmonary sequestration, refractory lung abscess, pulmonary tuberculosis, and other infectious processes.
Although a reasonable assessment of a patient's pulmonary function may be obtained by noting their exercise tolerance to commonly performed activities like climbing a flight of stairs, more objective assessment of their cardiac status is carried out as per the American College of Cardiology/American Heart Association guidelines. Evaluation of the pulmonary status includes pulmonary function tests, and in marginal cases quantitative ventilation/perfusion scans and cardiopulmonary exercise testing.
The use of Video-Assisted Thoracic Surgery (VATS) in recent years has produced similar or better results when compared with the traditional thoracotomy approach, along with a reduction in the mortality, morbidity, and in-hospital stay. The operation is performed under general anesthesia administered via a double-lumen endotracheal tube. The patient is placed in the lateral decubitus position with the operated side superior; the table is flexed maximally at the level of the patient’s hips; and contralateral single lung ventilation is started. Continuous intraoperative monitoring of vital parameters has increased the safety of these procedures. A second-generation cephalosporin is administered preoperatively and continued for two postoperative doses. Intraoperative intercostal blocks help in postoperative pain management. Almost all patients are extubated in the operating suite following surgery.
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