Name of the Procedure:

Anesthesia for Closed Chest Procedures; Mediastinoscopy and Diagnostic Thoracoscopy Utilizing One Lung Ventilation

Summary

For certain chest surgeries, such as mediastinoscopy and diagnostic thoracoscopy, anesthesia is administered in a way that allows for one lung to be ventilated while the other lung is collapsed. This technique facilitates better surgical visibility and access for the surgeon.

Purpose

This type of anesthesia is used to facilitate procedures that examine and diagnose conditions within the mediastinum (area between the lungs) or thoracic cavity. The primary goal is to provide safe and effective anesthesia while enabling the surgeon to perform the required diagnostics or treatment efficiently.

Indications

• Suspicion of mediastinal tumors or masses.
• Unexplained lymphadenopathy (enlarged lymph nodes).
• Evaluation of lung cancer staging.
• Unexplained chest symptoms requiring visual examination inside the chest.

Preparation

• Patients need to fast for around 6-8 hours before the procedure.
• Adjustments in medication may be required, particularly blood thinners and other medications affecting anesthesia.
• Pre-operative assessments include blood tests, chest X-rays, and sometimes a CT scan of the chest.

Procedure Description

1. The procedure begins with the patient placed under general anesthesia.
2. A double-lumen endotracheal tube is inserted to allow for independent lung ventilation.
3. One lung is ventilated while the other lung is deflated to provide a clear view and operating space for the surgeon.
4. The surgeon performs a mediastinoscopy by making a small incision above the sternum and inserting a scope to view the mediastinum.
5. For diagnostic thoracoscopy, small incisions are made in the chest to insert a thoracoscope, allowing direct visualization of the thoracic structures and collection of tissue samples if needed.

Duration

The procedure typically lasts between 1 to 3 hours, depending on the complexity and findings during the surgery.

Setting

This procedure is performed in a hospital operating room equipped with specialized surgical and anesthesia tools.

Personnel

• Anesthesiologist
• Thoracic surgeon
• Surgical nurses
• Operating room technicians

Risks and Complications

• As with any surgery, there are risks of infection and bleeding.
• Complications specific to one lung ventilation include hypoxia (inadequate oxygen) and lung injury.
• Rare risks include adverse reactions to anesthesia and difficulty re-expanding the collapsed lung after surgery.

Benefits

• Provides critical diagnostic information that can guide treatment plans.
• Minimally invasive with relatively quick recovery time.
• Offers clear visualization for the surgeon, leading to potentially more accurate diagnoses and targeted treatments.

Recovery

• Post-procedure care includes monitoring in a recovery room to ensure stable breathing and pain control.
• Patients might experience mild soreness or discomfort at incision sites.
• Recovery time can vary but typically involves a few days of hospital stay with follow-up appointments to check on healing and lung function.

Alternatives

• Non-invasive imaging tests like CT scans or MRI, but they may not provide as detailed or direct visualization.
• Open surgical biopsy, which is more invasive with a longer recovery period.

Patient Experience

• Patients are under general anesthesia during the procedure and will not feel or remember it.
• Post-procedure, discomfort is managed with pain relief medications.
• Most patients return to normal activities within a few days, although full recovery varies individually.