Abstract Preoperative assessment of thoracic surgical patients is a multidisciplinary process designed to offer appropriate surgical treatment with acceptable risk. UK guidelines for pulmonary ...resection associated with malignant disease have reviewed available evidence concerning operative risk. Patients displaying cardiopulmonary physiological parameters above previously recommended threshold values remain classified as good risk. Less certainty exists about the utility of predicted postoperative pulmonary function values and preoperative performance status to confer unacceptable risk. Guidelines suggest a tri-partite risk assessment combining risks of operative mortality, perioperative adverse cardiac events and post-operative dyspnoea – to be discussed by the multidisciplinary team and with the patient.
Principles of cardiac anaesthesia Keogh, Brian F; Alexander, David
Anaesthesia and intensive care medicine,
October 2012, Volume:
13, Issue:
10
Journal Article
Peer reviewed
Abstract Cardiac surgical outcomes in the UK have consistently improved despite increasing procedure complexity and ‘sicker’ patients. Numerous anaesthetic techniques are employed with no definitive ...evidence clearly demonstrating superiority of one particular technique. Patient safety is paramount and various monitoring techniques used to enhance safety and ensure effective anaesthesia are outlined. Management of bleeding, particularly in complex cases, is a major component of cardiac anaesthesia and recent developments in this area are briefly described.
To assess the possibility that acute respiratory distress syndrome (ARDS) of pulmonary and nonpulmonary origins represent two distinct syndromes.
Analysis of data collected prospectively from an ...inception cohort of 117 patients with ARDS.
Adult intensive care unit (ICU), university/postgraduate hospital.
Differences were sought in mortality and 6-month functional outcome between patients developing ARDS due to pulmonary (group 1) and nonpulmonary (group 2) pathology. Group 1 patients displayed a trend toward increased ICU and in-hospital mortality (42.1% vs. 23.2%, p = .10, and 47.4% vs. 27.9%, p = .11, respectively). No difference was found in ICU length of stay (46.3 +/- 4.9 vs. 39.0 +/- 4.8 days for groups 1 and 2, respectively) nor in duration of positive-pressure ventilation (26.2 +/- 4.3 vs. 20.6 +/- 3.2 days). However, the need for pressure-controlled inverse ratio ventilation was significantly greater in group 1 (16.9 +/- 3.2 vs. 9.1 +/- 1.3 days; p = .033). In survivors, reductions in total lung capacity at 6 months (68.1 +/- 4.6 vs. 61.8 +/- 4.6% predicted for groups 1 and 2, respectively; p = .4), accessible lung volume (74.4 +/- 4.4 vs. 68.9 +/- 4.9% predicted; p = .56), and forced expiratory volume (77.8 +/- 2.9 vs. 80.3 +/- 2.4% predicted; p = .57) did not differ between groups. Gas transfer coefficient was well preserved (84.5 +/- 4.6 vs. 86.6 +/- 4.7% predicted; p = .80).
These data suggest a trend toward higher mortality and ventilatory requirements in ARDS of direct etiology, generating a hypothesis worthy of further exploration.
Abstract Preoperative assessment of thoracic surgical patients is a multidisciplinary process designed to offer appropriate surgical treatment with acceptable risk. Recently updated UK guidelines for ...pulmonary resection associated with malignant disease have reviewed available evidence concerning operative risk. Patients displaying cardiopulmonary physiological parameters above previously recommended threshold values remain classified as good risk. Less certainty now exists about the utility of predicted post-operative pulmonary function values and preoperative performance status to confer unacceptable risk. The new guidelines suggest a tripartite risk assessment combining risks of operative mortality, perioperative adverse cardiac events and postoperative dyspnoea – to be discussed by the multidisciplinary team and with the patient.
Preoperative assessment for thoracic anaesthesia Harte, Brian H.; Moran, Peter; Keogh, Brian F. ...
Anaesthesia and intensive care medicine,
February 2018, 2018-02-00, Volume:
19, Issue:
2
Journal Article
Peer reviewed
Preoperative assessment of patients for thoracic surgery is a multidisciplinary process designed to offer appropriate surgical treatment with acceptable risk. UK guidelines for pulmonary resection ...associated with malignant disease involved review of available evidence concerning operative risk. Patients displaying cardiopulmonary physiological parameters above previously recommended threshold values remain classified as acceptable risk. However, less certainty exists about the utility of predicted postoperative pulmonary function values and preoperative performance status to confer unacceptable risk. These guidelines suggest a tri-partite risk assessment combining risks of operative mortality, perioperative adverse cardiac events and postoperative dyspnoea, to be discussed by the multidisciplinary team and with the patient.
Many patients with respiratory disease present for anaesthesia. Clinical examination should elicit signs of respiratory pathology, especially airway obstruction and impaired gas exchange. A chest ...radiograph is mandatory in most patients. The authors give detailed advice on how to deal with smokers and patients who have chronic obstructive airway disease, asthma, upper respiratory tract infection, obstructive sleep apnoea, pulmonary hypertension or cystic fibrosis.
Patients presenting for thoracic surgery often have concomitant cardiac disease, and because many are smokers, they may have related complications. The authors explain how to predict and assess ...cardiac risk factors and how to assess the respiratory system in these patients. The most valid single test for predicting postoperative lung function is the predicted postoperative forced expiratory volume in one second.
There are a limited number of reports in the literature cocerning lung volume reduction surgery in patients receiving mechanical ventilation. We present a case in which a ventilator-dependent patient ...with apparent end-stage pulmonary emphysema underwent lung volume reduction with a successful outcome. Although the role of this procedure for selected nonventilated patients has been widely discussed its use in ventilated patients is still not clearly defined. We show that lung volume reduction surgery may facilitate ventilatory weaning in such cases and improve functional status.
PDF
