Bronchovascular Sleeve Resection Periprocedural Care

Updated: Mar 20, 2014
  • Author: Setu K Patolia, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Periprocedural Care

Pre-Procedure Planning

See the list below:

  • History and physical, including history of radiation in the past and history of thoracic procedures
  • Chest radiograph
  • Chest CT
  • Bronchoscopy
  • Ventilation perfusion scan and predicted postoperative lung function
  • CT/MRI of the brain
  • Bone scan
  • Mediastinoscopy and evaluation of lymph node status
  • PET scan
Next:

Patient Preparation

Anesthesia

Endotracheal intubation is performed by double-lumen endotracheal tube. Bronchoscopy is performed to identify correct placement of endotracheal tube. The involved lung is deflated with the balloon blocker. Alternatively, the patient can be intubated in the normal side with a Wilson tube, which is created by attaching an extension to square-ended armored tube. The greater flexibility of Wilson tube allows greater mobility of the carina.

Hypoxemia secondary to V/Q mismatch after collapse of the lung can be mitigated by increasing the FiO2 and minute ventilation. The dependent lung is ventilated by intermittent positive pressure ventilation, and the nondependent lung is ventilated by CPAP or jet ventilation.

The surgeon should perform bronchoscopy to evaluate the extent of tumor and possible resection. During flexible bronchoscopy, the bronchoscope should be passed beyond the tumor to evaluate for the appropriateness of the surgery. The condition of the mucosa including any erythema or nodularity should be noted.

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