Preoperative Lung - Preoperative Evaluation of Patients...

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Preoperative Evaluation of Patients Undergoing Lung Resection Surgery DR BASANTA HAZARIKA DEPARTMENT OF PULMONARY MEDICINE PGIMER,CHANDIGARH
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Introduction z Advances in surgical and anesthetic techniques have resulted in a marked reduction in postoperative complication z Preoperative PFT evaluation is an integral part z About 30,000 lung resections are performed annually in the USA
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Commonly performed surgeries for lung cancer z Pneumonectomy z Lobectomy z Wedge Resection z Segmentectomy
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Indications for Pulmonary Resection z Neoplastic Disease •Pr imary • Metastatic z Bullous Lung Disease: LVRS z conditions • Granulomas • Pulmonary infiltrates • Resection of segments destroyed by bronchiectasis ebapriya et al CHEST 2003;123:2096
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Complications after thoracic surgery Most Common z Pneumonia z Atelectasis z Arrhythmias (AF) z CCF Less common z MI z Prolonged air leak z Empyema z Bronchopleural fistula
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Mortality Rates z Pneumonectomy: 6.8% z Bi-lobectomy: 4.4 % z Lobectomy: 3.9% z Lesser Resection: 1.4% ( Damhuis et al., Eur Respir J 1996; 9:7–10)
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Postoperative complication of pulmonary resection z Pneumonectomy-39% z Lobectomy-19% z Wedge resection-6%
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Changes in Lung Volume Pneumonectomy: * FEV1 reduced by 34- 36% * FVC reduced by 36 - 40% * VO2 max reduced by 20 - 28% Lobectomy: * FEV1 reduced by 9 - 17% * FVC reduced by 7 - 11% * VO2 max reduced by 0 -13% ( Mazzone PJ et al., Am J Med 2005; 118:578-583)
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Risk assessment for pulmonary surgery High risk z Age >70 z Higher extent of resection (Pneumonectomy>lobectomy>resection) z Poor exercise performance z Low PPO FEV1 z Low PPO DLco z High Pco2 (controversial) z Prolong operative time
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Risk assessment for pulmonary surgery Low risk z FEV1 >2 L for pneumonectomy,>1 L for lobectomy,>0.6 L for segmentectomy z PPO FEV1 >30-40% predicted z Stair climbing >5 floor for pneumonectomy, 3 floor for lobectomy z PPO DLco >40% predicted z Vo2max uptake >15-20 ml/kg/min
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Indications for pre-operative assessment z To make a decision whether patient can tolerate surgery “pulmonary clearance” z To predict the occurrence of post operative respiratory complications z To assess the postoperative respiratory disability ( Pulmonary function tests in health and disease by Prof S K Jindal)
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Minimal respiratory evaluation z Good history taking z Physical examination z Chest roentgenography z PFT
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Important components of history in preoperative evaluation z Presenting symptoms z Prior diagnosis of pulmonary or cardiac disease z Co-morbid conditions: DM,LD,RD z Prior experiences with GA/Surgery z Cigarette smoking: never/current/ex z Medication/allergies z Alcohol use, history of withdrawal syndrome
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Who should be evaluated? The general answer
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Preoperative Lung - Preoperative Evaluation of Patients...

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