Preoperative and postoperative care of the thoracic surgery patient

Abstract

Major pulmonary and esophageal procedures place tremendous physiological stress on patients. Over the past three decades, the morbidity and mortality associated with thoracic surgical procedures has dropped significantly. This increase in safety is attributable to a shift in disease process from infectious to malignant, and advances in anesthetic techniques, surgical precision, patient selection, and perioperative care. The process of patient selection includes better preoperative staging of malignancy and physiological assessment and evaluation of fitness for operation. Today, a grand majority of general thoracic operations are performed for malignancy; we treat far fewer infectious processes than our predecessors. Our patients in general are better fit for surgery and their expectation for full functional recovery is much higher. We review some significant points in perioperative care of thoracic surgery patients including preoperative cardiac and pulmonary assessment, perioperative antibiotic use, pain management, chest tube management, and the use of postoperative anticoagulants and antiarrhythmics. © 2008 Springer New York.