Pneumonectomy Periprocedural Care

Updated: Dec 15, 2015
  • Author: Dale K Mueller, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Periprocedural Care

Equipment

Thoracotomy instruments are used for pneumonectomy and extrapleural pneumonectomy.

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Patient Preparation

Prior to the start of surgery, a thoracic epidural catheter, arterial line, central venous catheter, and oximeter are placed for monitoring during the procedure.

The patient is intubated with a double-lumen tube or endobronchial blocker and placed in the lateral decubitus position. A nasogastric tube can then be placed and used intraoperatively for palpation of the esophageal position and postoperatively for stomach decompression.

Anesthesia

General anesthesia with an epidural or alternative is used.

Positioning

The patient should be positioned in the lateral decubitus position to allow proper surgical access and secured to the operating table with a safety belt across the upper thighs or tape across the hip.

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Monitoring & Follow-up

No chest tube is necessary but is are often used. [5]

The postpneumonectomy space is expected to slowly fill with fluid and air. [9]

Pain relief should be established via epidural blocks, along with patient-controlled analgesia and/or pain pumps. [7]

Thrombolytic prophylaxis is necessary in all thoracotomy patients and can include sequential compression devices only.

Several anatomic changes are expected: mediastinal shift, spleen, and liver position changes. [5]

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