medical thoracoscopy - pheonix india内科胸腔镜.PPT

Risks ? Hemorrhage? Pneumothorax ? Recurrent laryngeal nerve injury, causing hoarseness? Infection? Tumor implantation?within the?wound? Phrenic nerve injury? Esophageal injury? Chylothorax? Air embolism? Transient hemiparesis THANX!! * Prepare bronchoscope/DLT, collection trap, and tubing. Prepare supplemental oxygen and monitoring equipment. ECG, pulse-oximetry, NIBP Premedicate with bronchodilators and/or warm the saline solution for those at risk for bronchospasm. Position patient, preferably in supine position when approaching RML or lingula. Apply monitors and supplemental oxygen. Sedation with a benzodiazepine and a narcotic will allow patient comfort and minimize cough reflex. Radiologic imaging, CT, and ventilation-perfusion scans help to determine the most impaired lung, which will be lavaged first. General anesthesia is induced and maintained with intravenous infusions as for lung transplantation. Airway management is with a left-sided DLT. Precise placement of the tube is confirmed by fiberoptic bronchoscopy Air-tight isolation is determined by monitoring inspired and expired tidal volumes with side-stream spirometry. Tube dislodgment and flooding of the nonlavaged lung is a major complication of this procedure. Specifically during lavage of the left lung, the pressure of saline in the lung will tend to push the bronchial cuff of the DLT proximally. To prevent this it is recommended that the anesthesiologist maintain his or her hand on the DLT, securing it firmly at the patient's mouth, throughout the entire procedure. The pulmonary compliance of the ventilated lung needs to be continuously monitored to diagnose any liquid spillage from the lavage lung. The patient is kept in the supine position during the procedure. To improve the effectiveness of the lavage, ventilation with FIO2 100% for a few minutes is initiated after induction to de-nitrogenate both lungs. OLV is instituted with the nonlavage l