Version October 2024
| Pleural procedure | Anesthetic considerations |
| Catheter drainage of pleural effusion | Surgical approach: VATS or open thoracotomy. Transthoracic ultrasound may be used to localize effusion and guide drainage. |
| Pleurodesis | Surgical approach: VATS. In the postoperative period, IV and/or oral opioids are usually necessary to manage pain. NSAIDs are avoided due to concerns regarding attenuation of the inflammatory response that is necessary for successful pleurodesis. |
| Open drainage or debridement of empyema | Surgical approach: Although VATS is typically used, preparations for possible conversion to open thoracotomy are made. If open thoracotomy is planned, a thoracic epidural catheter may be inserted before induction to provide supplemental intraoperative and postoperative analgesia. A double-lumen tube is typically selected for lung isolation (rather than a bronchial blocker) to provide an optimal seal and prevent potential cross-contamination from the affected to the unaffected lung. |
| Empyectomy, pleurectomy, or decortication | Surgical approach: VATS or open thoracotomy. Significant bleeding may occur due to injury of lung tissue during chest entry or dissection of the empyema peel adherent to the visceral pleura. Transfusion of red blood cells (RBCs) may be necessary. At the end of the procedure, full re-expansion of the lung is important to fill the pleural space and prevent development of postoperative fibrosis within this space. |
| Repair of bronchopleural or alveolopleural fistula | Surgical approach: VATS or open thoracotomy. Lung isolation is necessary to decrease pressure and air flow on the side of the pathology. Precise placement of an endobronchial blocker under direct bronchoscopic guidance can provide temporary occlusion of the fistula. After confirming proper placement of the lung isolation device, the bronchial cuff should be inflated to isolate the contralateral lung before initial or any subsequent repositioning of the patient to accomplish the surgical repair. Vigilance for development of tension pneumothorax is necessary throughout the perioperative period. |
Do you want to add Medilib to your home screen?
