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2 results

  • 15 - Fluid and Hemodynamic Monitoring in Pulmonary Surgery

  • from Section 3 - Practical Use
    • By
  • Edited by Alexandre Joosten, University of California, Los Angeles, Maxime Cannesson, University of California, Los Angeles, Robert G. Hahn, Karolinska Institutet, Stockholm
  • Book:
    Hemodynamic Monitoring and Fluid Therapy during Surgery
    Published online:
    11 April 2024
    Print publication:
    02 May 2024, pp 168-185

  • Summary

    In spite of numerous studies about fluid management and hemodynamic monitoring in thoracic anesthesia, the heterogeneity of the results has led to the fact that there is still no strong evidence on this topic. The historical recommendation of restricted fluid management has been replaced by normovolemia, but there are still many unsolved problems. Most importantly, not only the amount of the fluid, but also its indication, timing, the addition of a vasopressor and/or inotrope, its dosage, protection of glycocalyx layer and several other parameters play a role in the relationship of fluid strategy and overall outcome. Regarding the postoperative outcome, fluid management in its extensive form should be considered as an important part of a strategy.

    Goal-directed therapy (GDT) is associated with certain limitations, mainly because “open thorax” can affect the cardiopulmonary interaction. Still, it can give objective hints to achieve stable hemodynamics, protection of glycocalyx, prevention of pulmonary edema and avoidance of postoperative organ injury.

  • Chapter 29 - Chronic pain after thoracic surgery

  • from Section 3 - Post-operative management
  • Edited by Cait P. Searl, Sameena T. Ahmed
  • Book:
    Core Topics in Thoracic Anesthesia
    Published online:
    10 December 2009
    Print publication:
    02 April 2009, pp 196-202

  • Summary

    The population in the developed world is aging, together with an increasing life expectancy for both men and women. The incidence of thoracic pathologies in the elderly of the developed world is rising. The main cautions of thoracic anesthesia in the elderly are those of geriatric anesthesia in general and those of the surgical procedure itself. In the elderly, risk assessment should focus on identifying the physiologic state and reserve of specific organ systems. It is often more challenging to identify previously undiagnosed comorbidity, optimize it and try to predict its bearing on the outcome. The aim of the pre-anesthetic assessment is to detect and optimize comorbidities, and quantify objectively the extent of reduced physiologic reserve of systems. The goalposts of healthcare delivery standards have been moved with expectations of better results following anesthesia and surgery in thoracic surgery in the elderly.