Bronchovascular Sleeve Resection Periprocedural Care

Updated: Oct 31, 2019
  • Author: Setu K Patolia, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Periprocedural Care

Pre-Procedure Planning

Preoperative planning includes the following:

  • History and physical examination, including past history of radiation exposure and 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, using a double-lumen endotracheal tube. Bronchoscopy is performed to identify correct placement of the endotracheal tube. The involved lung is deflated with the balloon blocker. Alternatively, the normal lung can be intubated 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 ventilation/perfusion (V/Q) mismatch after collapse of the lung can be mitigated by increasing the fraction of inspired oygen (FiO2) and minute ventilation. The dependent lung is ventilated by intermittent positive pressure ventilation, and the nondependent lung is ventilated by continuous positive airway pressure (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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