Evaluación preoperatoria del paciente candidato a resección pulmonar
Preoperative evaluation of the lung resection candidate.
Mazzone P.
Critical Care Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Cleve Clin J Med. 2012 May;79 Electronic Suppl 1:eS17-22.
Abstract
Lung resection provides the greatest likelihood of cure for patients with localized lung cancer, but is associated with a risk of mortality, decreased postoperative lung function, and other complications. Lung function testing using spirometry, diffusing capacity of the lung for carbon monoxide, and peak oxygen consumption helps predict the risk of postoperative complications including mortality. Predicting postoperative lung function using the proportion of lung segments to be resected, radionuclide scanning, or other methods is important for assessing surgical risk. The American College of Chest Physicians, the European Respiratory Society/European Society of Thoracic Surgeons and the British Thoracic Society guidelines provide detailed algorithms for preoperative risk assessment, but their recommended approaches differ somewhat. Smoking cessation and pulmonary rehabilitation are perioperative measures that can improve patients' the short- and long-term outcomes.
http://www.ccjm.org/content/79/e-Suppl_1/e-S17.full.pdf
Fisiología pulmonar y obesidad: implicaciones para procedimientos torácicos
Lung physiology and obesity: anesthetic implications for thoracic procedures.
Pedoto A.
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Rm M301, New York, NY 10065, USA.
Anesthesiol Res Pract. 2012;2012:154208. Epub 2012 Feb 26.
Abstract
Obesity is a worldwide health problem affecting 34% of the American population. As a result, more patients requiring anesthesia for thoracic surgery will be overweight or obese. Changes in static and dynamic respiratory mechanics, upper airway anatomy, as well as multiple preoperative comorbidities and altered drug metabolism, characterize obese patients and affect the anesthetic plan at multiple levels. During the preoperative evaluation, patients should be assessed to identify who is at risk for difficult ventilation and intubation, and postoperative complications. The analgesia plan should be executed starting in the preoperative area, to increase the success of extubation at the end of the case and prevent reintubation. Intraoperative ventilatory settings should be customized to the changes in respiratory mechanics for the specific patient and procedure, to minimize the risk of lung damage. Several non invasive ventilatory modalities are available to increase the success rate of extubation at the end of the case and to prevent reintubation. The goal of this review is to evaluate the physiological and anatomical changes associated with obesity and how they affect the multiple components of the anesthetic management for thoracic procedures.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353144/pdf/ARP2012-154208.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Preoperative evaluation of the lung resection candidate.
Mazzone P.
Critical Care Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Cleve Clin J Med. 2012 May;79 Electronic Suppl 1:eS17-22.
Abstract
Lung resection provides the greatest likelihood of cure for patients with localized lung cancer, but is associated with a risk of mortality, decreased postoperative lung function, and other complications. Lung function testing using spirometry, diffusing capacity of the lung for carbon monoxide, and peak oxygen consumption helps predict the risk of postoperative complications including mortality. Predicting postoperative lung function using the proportion of lung segments to be resected, radionuclide scanning, or other methods is important for assessing surgical risk. The American College of Chest Physicians, the European Respiratory Society/European Society of Thoracic Surgeons and the British Thoracic Society guidelines provide detailed algorithms for preoperative risk assessment, but their recommended approaches differ somewhat. Smoking cessation and pulmonary rehabilitation are perioperative measures that can improve patients' the short- and long-term outcomes.
http://www.ccjm.org/content/79/e-Suppl_1/e-S17.full.pdf
Fisiología pulmonar y obesidad: implicaciones para procedimientos torácicos
Lung physiology and obesity: anesthetic implications for thoracic procedures.
Pedoto A.
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Rm M301, New York, NY 10065, USA.
Anesthesiol Res Pract. 2012;2012:154208. Epub 2012 Feb 26.
Abstract
Obesity is a worldwide health problem affecting 34% of the American population. As a result, more patients requiring anesthesia for thoracic surgery will be overweight or obese. Changes in static and dynamic respiratory mechanics, upper airway anatomy, as well as multiple preoperative comorbidities and altered drug metabolism, characterize obese patients and affect the anesthetic plan at multiple levels. During the preoperative evaluation, patients should be assessed to identify who is at risk for difficult ventilation and intubation, and postoperative complications. The analgesia plan should be executed starting in the preoperative area, to increase the success of extubation at the end of the case and prevent reintubation. Intraoperative ventilatory settings should be customized to the changes in respiratory mechanics for the specific patient and procedure, to minimize the risk of lung damage. Several non invasive ventilatory modalities are available to increase the success rate of extubation at the end of the case and to prevent reintubation. The goal of this review is to evaluate the physiological and anatomical changes associated with obesity and how they affect the multiple components of the anesthetic management for thoracic procedures.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353144/pdf/ARP2012-154208.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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