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Thoracic Surgery Complications

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AIR. LEAK. AIR LEAK. What operation. Aetiology. Conservative. Talc. Tetracycline. Blood. Flutter bag. Sort out in Theatre saline, bagging and prolene. Atelectasis ... – PowerPoint PPT presentation

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Title: Thoracic Surgery Complications


1
Thoracic SurgeryComplications
2
Complications
  • ?

3
Complications
  • Air Leak
  • Atalectasis
  • Sputum Retention
  • Chest Infections
  • Atrial Fibrillation
  • Bleeding
  • Wound Infections
  • Recurrent Disease
  • Inadequate Resection
  • Medical Problems
  • MRSA
  • Bronchopleural Fistula
  • Post Pneumonectomy Problems
  • Post Pneumonectomy Empyema
  • Lobectomy Space Problems

4
AIR LEAK
5
AIR LEAK
  • What operation
  • Aetiology
  • Conservative
  • Talc
  • Tetracycline
  • Blood
  • Flutter bag
  • Sort out in Theatre saline, bagging and prolene

6
Atelectasis
  • Obstructive tumour, mucous or foreign
    body
  • Non obstructive effusion or mass
  • Pain
  • Double lumen tube malposition
  • Temperature
  • WCC
  • TNF alpha
  • Nebs
  • Physio
  • Bronch

7
Sputum Retention
  • Pain
  • Phrenic nerve block
  • Anatomical stenosis
  • Surgical,
  • Foreign body,
  • Tumour
  • Preoperative sputum and smoking
  • Physio, Nebs, stop smoking, pain relief-
    epidural, pre op admission for a week

8
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9
Chest Infections
  • Frequent
  • Pre op PFTs and performance predict
  • Medical and surgical causes
  • Pre op cultures from bronch
  • Pain relief, Nebs, Antibiotics and Physio

10
Atrial Fibrillation
  • pO2, K
  • Intrapericardail dissection
  • Pneumonectomy gt lobectomy gt wedge
  • Chest infection / Atelectasis
  • Role digoxin prophylaxis
  • Beta blockers
  • Oesophageal leak

11
Bleeding
  • Should be rare unless on anticoagulants
  • Usually massive or from chest wall
  • Probably little role for platelets, FFP or
    Aprotinin
  • CXR most helpful, if collecting TAKE BACK

12
Wound Infections
  • Rare with thoracotomies
  • Empyema not unusual
  • MRSA
  • Surgical technique
  • Haemostasis
  • Suture tension
  • Diathermy on skin

13
Recurrent Disease
  • Bronch and biopsy
  • ? Restage if fit
  • Further surgery
  • Chemo large field recurrence
  • Radio local recurrence

14
Inadequate Resection
  • Positive resection margins
  • Different types
  • Obvious tumour
  • Microscopic Ve
  • Odd cell
  • Nothing
  • Radiotherapy
  • Repeat Bronch and CT scan
  • No role for chemo

15
Medical Problems
  • MI / Angina
  • Pain
  • CVA
  • Renal
  • GIT
  • MRSA
  • Isolate
  • Screen outside patients
  • ? Change antibiotic prophylaxis
  • Admit electively if possible

16
Bronchopleural Fistula
  • Usually pneumonectomy
  • 2 peaks early and late
  • Technical
  • Post radiotherapy
  • Recurrence
  • Infection
  • Lie on operated side
  • Drain
  • ? Clagget procedure

17
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18
Post Pneumonectomy Problems
  • Cardiac herniation / torsion
  • Haemorrhage
  • Pulmonary oedema
  • Chylothorax
  • Bronchopleural Fistula
  • Stump Clot
  • Empyema
  • Post-pneumonectomy Syndrome
  • Recurrent neoplasm

19
Post Intra Pericardial Pneumonectomy Cardiac
Herniation
20
Post Pneumonectomy Empyema
  • Clinical suspicion
  • Temperature
  • WCC
  • Wound
  • Needle space
  • Drain
  • Irrigate
  • Instil antibiotics

21
Lobectomy Space Problems
  • Space in thorax after resection
  • Adhesions
  • Stiff lung
  • Pleural tent
  • Muscle flap
  • Thoracoplasty

22
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23
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24
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