00541 Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); utilizing 1 lung ventilation

Name of the Procedure

Common name: Anesthesia for thoracotomy procedures

Medical terms: Thoracic anesthesia, one-lung ventilation (OLV)

Summary

Anesthesia for thoracotomy procedures ensures that patients undergoing major chest surgery involving the lungs, pleura, diaphragm, or mediastinum are pain-free and unconscious. During the procedure, one lung is temporarily collapsed to provide a better surgical view and access.

Purpose

Medical condition:

Used for thoracic surgeries involving the lungs, pleura, diaphragm, thymus, or mediastinum.

Goals:

• Facilitate complex chest surgeries by providing a clear view and access.
• Ensure patient comfort and safety during surgery.

Indications

• Lung resections (lobectomy or pneumonectomy)
• Mediastinal tumor removal
• Thymectomy
• Diaphragm repair
• Conditions like lung cancer, mediastinal masses, or pleural diseases

Preparation

Pre-procedure instructions:

• Fasting (usually 8 hours before surgery)
• Medication adjustments as directed by the anesthesiologist ##### Diagnostic tests:
• Pre-operative blood tests
• Chest X-ray or CT scan
• Pulmonary function tests
• ECG (electrocardiogram) to assess heart function

Procedure Description

• Step 1: Patient is positioned and prepped in the operating room.
• Step 2: An intravenous (IV) line is placed for medications and fluids.
• Step 3: General anesthesia is administered, and the patient is intubated with a double-lumen endotracheal tube for one-lung ventilation.
• Step 4: The unaffected lung is ventilated while the other lung is collapsed to allow the surgeon clear access.
• Step 5: Vital signs and oxygen levels are continuously monitored. ##### Tools and equipment:
• Double-lumen endotracheal tube
• Anesthesia machine and ventilator
• Monitoring equipment (e.g., ECG, pulse oximeter, capnograph)

Duration

Typically ranges from 2 to 6 hours, depending on the complexity of the surgery.

Setting

Performed in a hospital operating room equipped for thoracic surgeries.

Personnel

• Anesthesiologist
• Thoracic surgeon
• Surgical nurses
• Anesthesia technicians

Risks and Complications

Common:

• Sore throat from intubation
• Nausea and vomiting post-surgery ##### Rare:
• Lung injury or collapse of the ventilated lung
• Blood clots
• Infection
• Adverse reactions to anesthesia

Benefits

• Enables the safe and effective completion of thoracic surgeries.
• Improved surgical outcomes with clear exposure of the surgical site.
• Minimized post-operative pain and complications with proper anesthesia management.

Recovery

Post-procedure care:

• Monitoring in the recovery room or ICU
• Pain management with medications
• Incentive spirometer exercises to improve lung function ##### Recovery time:
• Initial recovery in hospital for a few days
• Full recovery and return to usual activities may take several weeks ##### Follow-up:
• Scheduled post-operative visits to assess recovery and manage any complications

Alternatives

Treatment options:

• Non-surgical treatments like chemotherapy or radiation (for cancer)
• Less invasive surgical options, if appropriate ##### Pros and cons: Non-surgical methods may have fewer immediate risks but might not be as effective for certain conditions.

Patient Experience

• During procedure: Patient will be unconscious and will not feel pain.
• After procedure: Some pain and discomfort in the chest area, managed with pain relief medications.
• Pain management: IV pain medications initially, followed by oral medications as recovery progresses.
• Comfort measures: Breathing exercises, physical therapy, and gradual resumption of activities.