Flashcards in [AC] Thoracic Surgery Deck (23):
Insertion of an intercostal catheter (chest drain) enables
Drainage of air or fluid from the pleural space, allowing negative intra-thoracic pressures to be re-established leading to lung re-expansion
Bubbling in the underwater seal chamber of a chest drain can indicate
An air leak from the lung and should be evaluated critically
Lung cancer makes up over 90% of thoracic surgical procedures. What is the most aggressive kind of lung cancer?
Small cell (2 to 4 months prognosis)
Some information on lung cancer in New Zealand?
- NZ Maori; lung cancer is 2.5 to 3 x higher than that in the NZ european population
- Five year prognosis in NZ is POOR compared with the rest of the developed countries
- 8% of lung cancers in NZ occur amongst never smokers
Causes of lung cancer?
- Smoking/passive smoking
- Cannabis consumption
- Occupational hazards/materials (i.e. toxic chemicals)
- Atmospheric pollutants/gases
- Genetic predisposition
- Metastatic disease
Talk about NMT staging of lung cancer and is there any other way lung cancer is staged?
N - represents the lymph NODES involved by metastasis from the lung tumour
M - describes whether spread to other organs has occurred (METASTASIS)
T - represents the size of the TUMOUR and whether it has invaded into surrounding structures such as the ribs or heart
There is also the stage 1 to 5 for lung cancer; in which stage one is a local tumour with no metastasis with high 5 year survival rate to stage 5 which is distal metastasis, inoperable
Thoracotomy is an incision into the pleural space of the chest to gain access to the thoracic organs. The muscles transected may include:
Post op care following thoracic surgery in brief:
Shoulder and thoracic cage function
Inspiratory muscle training is an actual program in which you
load your inspiratory muscles via sucking on a device, increases your work of breathing. Patient builds up to it, i.e. up to 30 minutes twice a day.
If a patients Hb is low, we might need to give them blood, why is this relevant for us in terms of ambulation?
The may not have as much oxygen carrying capacity (check Sao2). Exercise uses oxygen, therefore we would like the patient to have a blood transfusion prior to surgery.
A type of surgery that enables surgeons to view the inside of a chest cavity with only small incisions is
Video-assisted thoracic surgery (VATS)
What is the incision and indications for a Pneumonectomy?
Indications: Carcinoma (cancers that begin in the epithelial tissues)
What is the pre-op management for a pneumonectomy?
Patient must be able to tolerate one lung removal, assessed via:
Exercise (SAO2 monitoring)
Pulmonary Function Tests (i.e. FEV/FVC ratio >50%; FEV >2L)
What is the post op management for a pneumonectomy?
Patients MUST NOT lie on good side. This is to ensure bronchial stump remains intact. Chest drain clamped and released one minute every hour to control mediastinal shift. No suction. Chest drain removed after about 24 hours and mediastinal space allowed to slowly fibrose
Incision & Indications for a Lobectomy?
Incision: Thoracotomy; some do VATS
Indications: Usually Carcinoma, bronchiectasis, lung abscess
Resection of one or more lobes. On the right lung the middle and lower lobes are often removed together due to their common lymph drainage. Insertion of apical and basal chest drains usual
Post-op care Lobectomy?
02, chest drains on low grade suction. Basal chest drain removed 1-2 days post-op, apical chest drain removed when air leak ceases, approx 4-5 days postop. May lie on either side, but should not lie on thoracotomy side unless necessary
Segmental resection incision?
Thoractomy or VATS
Post-op care same as Lobectomy
Incision: Thoractomy or VATS
Parietal pleura stripped off the chest wall. As the lung expands adhesions form between the visceral pleura and the chest wall preventing recurrence of a pneumothorax. The patient has one or two chest drains which are removed when air leaks stop.
Many thoracic surgical procedures require intercostal drainage. What are the two systems of chest drains?
Open chest drainage system
Closed chest drainage system
Apical chest drain vs Basal chest drain in terms of drainage needed?
Apical = Air
Basal = blood (fluids)