Core Topics in Thoracic Anesthesia
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Providing an easily readable source of information about the current spectrum of anesthesia and critical care management of patients undergoing thoracic surgery, this book forms part of the successful Core Topics brand. The book provides practical assistance to those commencing careers in thoracic anesthesia and will also to be a useful aide-memoire to those already working in the field. The comprehensive content includes discussion of some of the more contentious issues in the management of thoracic patients as well as giving a flavour of the rapid evolution of new techniques that are of increasing importance in the field, such as lung-assist devices, different modes of ventilation and VAT surgery. Both editors are practising cardiothoracic anesthetists/intensivists at an internationally recognized centre for thoracic surgery, particularly lung transplantation. The contributors are chosen for their clinical expertise and to give a spectrum of opinion across the range of thoracic anesthesia.
anesthetic implications of bronchoscopy Jet systems can be relatively uncontrolled; not uncommonly close to direct pipeline pressure. Overinﬂation of lungs, barotrauma and air trapping are potential dangers to be alert to. End-tidal CO2 monitoring is difﬁcult and all things withstanding generally is dispensed with. In an emergency the suction port can be used for jet ventilation. If all else fails, a standard tracheal tube can be jammed into the top of an RB and the patient oxygenated from a
development of surgery in general. The use of these early tracheal tubes resulted in some cases to damage of the trachea and its subsequent stenosis; once the complications of endotracheal tubes were appreciated there was not only a rapid development of tracheal surgery but also of the design of tracheal tubes. The other factor that limited the development of tracheal surgery was the belief by surgeons that only two to three tracheal rings could be excised. Although tracheal surgery is only
These patients should have pulmonary function tests. A chest X-ray will show retro-cardiac air-ﬂuid level and a barium swallow will show an intrathoracic stomach. Surgical considerations Hiatus hernia is present in a large number of patients with GERD. Two types of hiatus hernia can occur. r Type 1 or sliding hernia. This constitutes the majority of cases. The gastro-esophageal junction and fundus of the stomach herniate through the esophageal hiatus into the thorax. r Type 2 or para-esophageal
population, which are discussed below. r Children’s ribs are relatively more horizontal, limiting increases in tidal volume. The diaphragm is therefore the most important muscle of respiration in a spontaneously breathing child. r Children exhibit relatively higher basal oxygen consumption (6–8 ml/kg per min compared with 3 ml/kg per min in adults). Hypoxia develops relatively more rapidly under conditions of apnea or hypoventilation. r Gas exchange and ventilation rapidly deteriorate during
environmental changes and consequent prevalence of underlying smokingrelated and occupational lung disease adds to the comorbidity. Chronic obstructive pulmonary disease (COPD) is the primary diagnosis in 18% of all hospital admissions in patients older than 65 years. The death rate for COPD has increased by 70% over the last three decades. With early diagnosis and aggressive pre-operative pulmonary treatment, complication rates in the elderly with COPD can be minimized. 140 Cambridge Books