Anesthetic Management of Post-thoracotomy Complications

Abstract

The immediate postoperative period following thoracic surgery is a dynamic time characterized by rapidly changing physiology. Anesthetic and surgical complications may become evident and may require immediate intervention. Although most patients undergoing thoracic surgery are extubated immediately following surgery, preexisting lung disease may necessitate postoperative mechanical ventilation. Patients remaining intubated postoperatively should be weaned to ventilator modes that promote spontaneous ventilation and low airway pressures, and they should be assessed frequently for extubation criteria. Airway-related complications are not uncommon and may be due to anesthetic or surgical technique. The large caliber of double-lumen endotracheal tubes may increase the risk of airway injury. Glottic injury and airway bleeding may also occur. Intrathoracic complications range from relatively minor air leaks to life-threatening bronchopleural fistulas. Preoperative prophylaxis against deep vein thrombosis helps prevent pulmonary embolism. Other complications such as phrenic nerve injury may become evident immediately postoperatively or after a prolonged period of mechanical ventilation in the ICU. Atrial fibrillation is a very common complication following thoracic surgery. Its management depends on the patient’s hemodynamic status. New-onset postoperative atrial fibrillation should prompt a thorough review of the patient’s overall well-being. Other cardiac complications are less common, including cardiac herniation and interatrial shunting.