Anesthetic considerations for tracheobronchial resection in oncologic surgery.

PURPOSE OF REVIEW: Anesthesia for the resection and reconstruction of the tracheobronchial tree for neoplastic disease is challenging, both from surgical as well as anesthetic points of view. There are no published recommendations or guidelines addressing anesthetic and airway management dilemmas that arise during these surgical interventions. This review presents key aspects of preoperative imaging evaluation, surgical planning, as well as anesthesia and airway management during these complex cases. RECENT FINDINGS: Newly published articles highlight both the surgical and anesthetic challenges encountered during tracheobronchial resections and emphasize the importance of creating specialized, high-volume centers for good patient outcomes. Of great importance is the development of a preoperative joint anesthetic-surgical plan which includes a patient-specific airway management strategy. This review presents newer and less commonly employed anesthetic management strategies which have been recently described in the literature to allow expansion of care to patients who were previously deemed too high risk for surgery. SUMMARY: With advances in technology, the use of classical ventilation methods in conjunction with newer alternatives, such as extracorporeal membrane oxygenation, creates the premise for a more individualized, safer and controlled approach to tracheobronchial resections for oncologic purposes.

Post-Pneumonectomy ARDS and Ogilvie Syndrome - A Case Report.

INTRODUCTION: The Acute Respiratory Distress Syndrome (ARDS) is a severe hypoxemic acute lung injury that may complicate lung resections. Reported mortality is very high, up to 50%. This report covers an ARDS case occurring post left pneumonectomy, with a favorable outcome, despite association with an acute colonic pseudo-obstruction syndrome (Ogilvie syndrome) that required abdominal surgery for decompression. CASE REPORT: A 60-year old Caucasian male, diagnosed with a stage IIIA left lung tumor underwent a left pneumonectomy. On the second postoperative day, the patient developed ARDS, requiring ventilatory support. Two days later, as the multiple organ dysfunction worsened, a bowel obstruction occurred. With an acute colonic pseudo-obstruction diagnosis, the decision was to perform laparotomy and a temporary cecostomy. A subsequent improvement in the respiratory parameters and vital functions resulted in weaning from ventilator 8 days after the onset of the ARDS and transfer to the surgery ward 14 days after pneumonectomy.

[Sedation of patients with respiratory failure in ICU]. / Sedarea pacientilor cu insuficienta respiratorie în Terapia Intensiva.

Sedation in patients with acute or chronic respiratory disease needing ventilatory support is provocative. Agitation, anxiety and pain interfere with the measures to alleviate respiratory failure and to improve gas exchanges (invasive or non-invasive ventilation), while most sedatives and analgetics are respiratory depressants. Benzodiazepines, propofol and opioids are widely used, but it does not exist a consensus in medication selection, sedation and pain score scales recommended, implementation of protocols of sedation and recovery from the drugs administrated. The use of old and new sedative/analgesic medication, frequently combined, generates the need for understanding pharmacological interferences and for a strategy in preventing oversedation. Creating a specific protocol and guidelines in each respiratory ICU for sedation/analgesia in mechanically ventilated patients can improve outcome and reduce the ICU and hospital stay.

[Preoperative evaluation for pulmonary resections in COPD patients]. / Evaluarea preoperatorie a pacientilor cu BPOC în vederea interventiilor chirurgicale toracice de rezectie pulmonara.

Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies in the world, an important number of such patients can necessitate, at a certain moment, a thoracic surgical intervention, especially pulmonary resections for pulmonary carcinoma. In these cases, the removing of a certain volume of pulmonary tissue from a patient who already has a respiratory malfunction necessitates a judicious preoperative evaluation to establish the correct indication, risk factors and postoperative prognosis (at least regarding the pulmonary function). Although the preoperative evaluation for pulmonary resections has been studied for many years, a parameter has not been found yet, simple or combined, to accurately predict the outcome. The majority of the candidates for pulmonary resections can be operated without previous complicated tests like CPET (cardio-pulmonary exercise testing) and regional pulmonary function, which are expensive and sometimes non accessible. In the past years, CPET gained more and more field in the appreciation of the surgical risk; combined with the split measurement of the function of the two lungs, it can even predict the postoperative effort capacity. In the complex preoperative evaluation of the chronic pulmonary patients we must not forget other, not so obvious aspects, so that the patient could benefit by the optimum moment and health status for his or her operation, for the purpose of a better prognosis.