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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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