Principles of Thoracic Surgery

Chapter 167 Principles of Thoracic Surgery



Thoracic surgery frequently is performed in small animals for a variety of disorders, especially in referral centers. Thoracotomy is commonly performed to correct routine cardiovascular defects such as patent ductus arteriosus and to evaluate and correct respiratory diseases such as pulmonary neoplasia. Exploratory thoracotomy may be indicated to determine the extent of diseases such as neoplasia and diffuse infection and to obtain biopsies to help establish a definitive diagnosis. It is important to be well versed in the anatomy and physiology of the thoracic cavity and its major structures and to be familiar with the principles of anesthetic management of the thoracic surgery patient.


Recently, minimally invasive thoracic exploratory (thoracoscopy) has become an alternative to traditional methods of thoracic surgery in veterinary medicine. Thoracoscopy requires specialized instrumentation and expertise, generally limiting its users to surgical specialists. Refer to the clinical literature and appropriate texts if more information on thoracoscopy is desired.


This chapter discusses surgical anatomy and physiology of the thorax, thoracic surgical technique, and patient care before, during, and after thoracic surgery.



SURGICAL ANATOMY





PREOPERATIVE CONSIDERATIONS




Preoperative Treatment and Stabilization









ANESTHETIC CONSIDERATIONS


The general principles of anesthesia described in Chapter 2 apply to thoracic surgery patients. Special considerations for thoracic surgery patients are outlined in this section.





Maintenance






Table 167-1 GENERAL GUIDELINES FOR CONTROLLED VENTILATION


























Physiologic Parameter Value
Respiratory 8–12 breaths/min
Tidal volume 15–20 ml/kg of ideal body weight
Peak airway pressure 15–20 cm H2O—closed
20–30 cm H2O—open
Inspiratory time 1–1.5 sec
Expiratory time 2–3 sec
Inspiratory-to-expiratory ratio 1:2–1:4

Modified from Faggella AM, Raffe MR: Anesthetic management of thoracotomy. Vet Clin North Am 17:480, 1987.



Aug 27, 2016 | Posted by in SMALL ANIMAL | Comments Off on Principles of Thoracic Surgery
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