I Thoracotomy
Initial Preanesthetic Assessment for Thoracic Surgery
Patient Type | Assessments |
All patients | Assess exercise tolerance, estimate PPO FEV1%,* discuss postoperative analgesia, consider discontinuation of smoking |
Patients with PPO FEV1 <40% | Dlco, V./Q. scan, Vo2 max |
Patients with cancer | Consider the “4 Ms”: mass effects, metabolic effects, metastases, medications |
Patients with COPD | ABG analysis, physiotherapy, bronchodilators |
Patients with increased renal risk | Measure creatinine and BUN |
ABG, Arterial blood gas; BUN, blood urea nitrogen; COPD, chronic obstructive pulmonary disease; Dlco, diffusing capacity for carbon monoxide; FEV1, forced expiratory volume in 1 second; PPO, predicted postoperative; Vo2 max, maximum oxygen consumption; V/Q, ventilation–perfusion ratio.
*PPO FEV1% = Preoperative FEV1 % × (1% of functioning lung tissue removed/100). For values above 40%, postoperative complications are rare; for values between 30% and 40%, postoperative problems are possible; for values below 30%, postoperative ventilation is likely to be required.
Modified from Slinger PP, Johnston MR. Preoperative assessment and management. In Kaplan JA, Slinger PD, eds. Thoracic Anesthesia. 3rd ed. Philadelphia: Churchill Livingstone; 2003.