Manejo perioperatorio en cirugía torácica / Perioperative management in thoracic surgery

La cirugía torácica ha experimentado importantes avances en los últimos años relacionados con las técnicas anestésicas y quirúrgicas y la prevención y el manejo de las complicaciones relacionadas con el procedimiento. Esto ha permitido mejorar los resultados clínicos de los pacientes sometidos a este tipo de intervención. A pesar de ello, los procedimientos de cirugía torácica, especialmente los relacionados con la resección pulmonar, no están exentos de riesgo, con una morbimortalidad asociada considerable. Los protocolos Fast track o Enhanced recovery after anesthesia, la cirugía mínimamente invasiva y el manejo anestésico intraoperatorio mejoran el pronóstico y la seguridad de los procesos de cirugía torácica. Los pacientes postoperados de cirugía torácica mayor requieren una vigilancia intensiva, especialmente las primeras 24-72 h del postoperatorio inmediato. El ingreso en la UCI se recomienda especialmente en los pacientes con comorbilidad, con reserva cardiopulmonar reducida, con resecciones pulmonares extensas y en los que requieren soporte por fallo de algún órgano con riesgo vital. Durante el periodo postoperatorio la monitorización intensiva cardiorrespiratoria, el manejo adecuado de los drenajes torácicos, el control agresivo del dolor (analgesia multimodal y técnicas anestésicas regionales), las náuseas y la rehabilitación multimodal son elementos claves para evitar eventos adversos. Entre las complicaciones médicas destacan la insuficiencia respiratoria, las arritmias, las infecciones respiratorias, las atelectasias y la enfermedad pulmonar tromboembólica. Las complicaciones quirúrgicas más frecuentes son el hemotórax, el quilotórax, la fístula broncopleural y la fuga aérea prolongada. El manejo multidisciplinar de estos pacientes durante todo el periodo perioperatorio es esencial para asegurar los mejores resultados quirúrgicos

Thoracic surgery has undergone significant advances in recent years related to anesthetic and surgical techniques and the prevention and management of complications related to the procedure. This has allowed improvements in patient clinical outcomes in surgeries of this kind. Despite the above, thoracic surgery, especially related to pulmonary resection, is not without risk, and is associated to considerable morbidity and mortality. Fast track or enhanced recovery after anesthesia protocols, minimally invasive surgery, and intraoperative anesthetic management improve the prognosis and safety of thoracic surgery. Patients in the postoperative period of major thoracic surgery require intensive surveillance, especially the first 24-72 hours after surgery. Admission to the ICU is especially recommended in those patients with comorbidities, a reduced cardiopulmonary reserve, extensive lung resections, and those requiring support due to life-threatening organ failure. During the postoperative period, intensive cardiorespiratory monitoring, proper management of thoracic drainage, aggressive pain control (multimodal analgesia and regional anesthetic techniques), nausea and multimodal rehabilitation are key elements for avoiding adverse events. Medical complications include respiratory failure, arrhythmias, respiratory infections, atelectasis and thromboembolic lung disease. The most frequent surgical complications are hemothorax, chylothorax, bronchopleural fistula and prolonged air leakage. The multidisciplinary management of these patients throughout the perioperative period is essential in order to ensure the best surgical outcomes

Perioperative management in thoracic surgery. / Manejo perioperatorio en cirugía torácica.

Thoracic surgery has undergone significant advances in recent years related to anesthetic and surgical techniques and the prevention and management of complications related to the procedure. This has allowed improvements in patient clinical outcomes in surgeries of this kind. Despite the above, thoracic surgery, especially related to pulmonary resection, is not without risk, and is associated to considerable morbidity and mortality. Fast track or enhanced recovery after anesthesia protocols, minimally invasive surgery, and intraoperative anesthetic management improve the prognosis and safety of thoracic surgery. Patients in the postoperative period of major thoracic surgery require intensive surveillance, especially the first 24-72hours after surgery. Admission to the ICU is especially recommended in those patients with comorbidities, a reduced cardiopulmonary reserve, extensive lung resections, and those requiring support due to life-threatening organ failure. During the postoperative period, intensive cardiorespiratory monitoring, proper management of thoracic drainage, aggressive pain control (multimodal analgesia and regional anesthetic techniques), nausea and multimodal rehabilitation are key elements for avoiding adverse events. Medical complications include respiratory failure, arrhythmias, respiratory infections, atelectasis and thromboembolic lung disease. The most frequent surgical complications are hemothorax, chylothorax, bronchopleural fistula and prolonged air leakage. The multidisciplinary management of these patients throughout the perioperative period is essential in order to ensure the best surgical outcomes.