Name of the Procedure:

Anesthesia for Closed Chest Procedures; Mediastinoscopy and Diagnostic Thoracoscopy without One-Lung Ventilation

Summary

This procedure involves the administration of anesthesia for chest diagnostic procedures, specifically mediastinoscopy and thoracoscopy, without the need for isolating and ventilating only one lung. It ensures the patient is unconscious and pain-free during the surgery.

Purpose

The primary goal is to provide a safe and controlled environment for surgeons to examine and diagnose conditions within the chest cavity without causing pain or distress to the patient.

Indications

• Suspected lung disease or infection
• Lymph node biopsies for cancer staging
• Diagnosing chest tumors, cysts, or other abnormalities
• Unexplained chest pain or respiratory symptoms

Preparation

• Patients need to fast (no food or drink) typically 6-8 hours before the procedure.
• Adjust or discontinue certain medications as instructed by the physician.
• Preoperative assessments, including blood tests, imaging studies (CT scan or X-ray), and a thorough review of medical history.

Procedure Description

1. The patient is taken to the operating room and positioned appropriately on the surgical table.
2. Vital signs and oxygen levels are continuously monitored.
3. An intravenous (IV) line is placed to administer anesthesia drugs.
4. General anesthesia is induced, ensuring the patient is fully asleep and pain-free.
5. During mediastinoscopy, a scope is inserted through a small incision above the sternum to view and biopsy structures between the lungs.
6. During thoracoscopy, a camera-equipped scope is inserted through small incisions in the chest to visualize and diagnose lung and pleural conditions.
7. The patient is kept on a mechanical ventilator to assist with breathing throughout the procedure.

Duration

The procedure typically lasts between 1 to 2 hours, depending on the complexity of the diagnostic evaluation.

Setting

This procedure is performed in a hospital operating room equipped for thoracic surgeries.

Personnel

• Anesthesiologist or nurse anesthetist
• Thoracic surgeon
• Surgical nurses
• Operating room technician

Risks and Complications

• Allergic reaction to anesthesia
• Post-operative nausea and vomiting
• Infection at the incision site
• Bleeding or injury to surrounding organs and tissues
• Respiratory complications, such as pneumonia or atelectasis

Benefits

• Accurate diagnosis of chest conditions
• Minimally invasive compared to open surgery, resulting in fewer complications and quicker recovery
• Direct visual access to problematic areas, assisting in biopsy and diagnosis

Recovery

• Close monitoring in a recovery room post-procedure
• Pain management, usually with medications prescribed by the doctor
• Typically, a brief hospital stay is required, with gradual return to normal activities within a few days to a week.
• Follow-up appointments to discuss biopsy results and further treatment if needed

Alternatives

• Non-invasive imaging like CT or MRI scans
• Needle biopsy guided by imaging techniques
• Open surgical biopsy or thoracotomy, which is more invasive and requires a longer recovery period

Patient Experience

• Patients are unconscious during the procedure and will not experience pain.
• Post-operative discomfort around incision sites, manageable with pain medications.
• Temporary sore throat or hoarse voice from the breathing tube used during anesthesia.
• Gradual return to normal activities with some restrictions on heavy lifting and strenuous activities until fully healed.