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Thoracic Surgery Complications

Thoracic Surgery Complications. Complications. ?. Complications. Air Leak Atalectasis Sputum Retention Chest Infections Atrial Fibrillation Bleeding Wound Infections Recurrent Disease Inadequate Resection Medical Problems MRSA Bronchopleural Fistula Post Pneumonectomy Problems

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Thoracic Surgery Complications

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  1. Thoracic SurgeryComplications

  2. Complications ?

  3. Complications • Air Leak • Atalectasis • Sputum Retention • Chest Infections • Atrial Fibrillation • Bleeding • Wound Infections • Recurrent Disease • Inadequate Resection • Medical Problems • MRSA • Bronchopleural Fistula • Post Pneumonectomy Problems • Post Pneumonectomy Empyema • Lobectomy Space Problems

  4. AIR LEAK

  5. AIR LEAK • What operation • Aetiology • Conservative • Talc • Tetracycline • Blood • Flutter bag • Sort out in Theatre saline, bagging and prolene

  6. Atelectasis • Obstructive tumour, mucous or foreign body • Non obstructive effusion or mass • Pain • Double lumen tube malposition • Temperature • WCC • TNF alpha • Nebs • Physio • Bronch

  7. Sputum Retention • Pain • Phrenic nerve block • Anatomical stenosis • Surgical, • Foreign body, • Tumour • Preoperative sputum and smoking • Physio, Nebs, stop smoking, pain relief- epidural, pre op admission for a week

  8. Chest Infections • Frequent • Pre op PFTs and performance predict • Medical and surgical causes • Pre op cultures from bronch • Pain relief, Nebs, Antibiotics and Physio

  9. Atrial Fibrillation • pO2, K+ • Intrapericardail dissection • Pneumonectomy > lobectomy > wedge • Chest infection / Atelectasis • Role digoxin prophylaxis • Beta blockers • Oesophageal leak

  10. Bleeding • Should be rare unless on anticoagulants • Usually massive or from chest wall • Probably little role for platelets, FFP or Aprotinin • CXR most helpful, if collecting TAKE BACK

  11. Wound Infections • Rare with thoracotomies • Empyema not unusual • MRSA • Surgical technique • Haemostasis • Suture tension • Diathermy on skin

  12. Recurrent Disease • Bronch and biopsy • ? Restage if fit • Further surgery • Chemo large field recurrence • Radio local recurrence

  13. Inadequate Resection • Positive resection margins • Different types • Obvious tumour • Microscopic +Ve • Odd cell • Nothing • Radiotherapy • Repeat Bronch and CT scan • No role for chemo

  14. Medical Problems • MI / Angina • Pain • CVA • Renal • GIT • MRSA • Isolate • Screen outside patients • ? Change antibiotic prophylaxis • Admit electively if possible

  15. Bronchopleural Fistula • Usually pneumonectomy • 2 peaks early and late • Technical • Post radiotherapy • Recurrence • Infection • Lie on operated side • Drain • ? Clagget procedure

  16. Post Pneumonectomy Problems • Cardiac herniation / torsion • Haemorrhage • Pulmonary oedema • Chylothorax • Bronchopleural Fistula • Stump Clot • Empyema • Post-pneumonectomy Syndrome • Recurrent neoplasm

  17. Post Intra Pericardial Pneumonectomy Cardiac Herniation

  18. Post Pneumonectomy Empyema • Clinical suspicion • Temperature • WCC • Wound • Needle space • Drain • Irrigate • Instil antibiotics

  19. Lobectomy Space Problems • Space in thorax after resection • Adhesions • Stiff lung • Pleural tent • Muscle flap • Thoracoplasty

  20. Any Questions ?

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