医学
围手术期
心胸外科
麻醉
外科
潮气量
血流动力学
胸腔镜检查
冲程容积
通风(建筑)
心脏外科
血压
心率
内科学
呼吸系统
工程类
机械工程
作者
Kai Kaufmann,Sebastian Heinrich
出处
期刊:Current Opinion in Anesthesiology
[Ovid Technologies (Wolters Kluwer)]
日期:2020-12-10
卷期号:34 (1): 13-19
被引量:35
标识
DOI:10.1097/aco.0000000000000945
摘要
Purpose of review Quantification and optimization of perioperative risk factors focusing on anesthesia-related strategies to reduce postoperative pulmonary complications (PPCs) after lung and esophageal surgery. Recent findings There is an increasing amount of multimorbid patients undergoing thoracic surgery due to the demographic development and medical progress in perioperative medicine. Nevertheless, the rate of PPCs after thoracic surgery is still up to 30–50% with a significant influence on patients’ outcome. PPCs are ranked first among the leading causes of early mortality after thoracic surgery. Although patients’ risk factors are usually barely modifiable, current research focuses on procedural risk factors. From the surgical position, the minimal-invasive approach using video-assisted thoracoscopy and laparoscopy leads to a decreased rate of PPCs. The anesthesiological strategy to reduce the incidence of PPCs after thoracic surgery includes neuroaxial anesthesia, lung-protective ventilation, and goal-directed hemodynamic therapy. Summary The main anesthesiological strategies to reduce PPCs after thoracic surgery include the use of epidural anesthesia, lung-protective ventilation: PEEP (positive end-expiratory pressure) of 5–8 mbar, tidal volume of 5 ml/kg BW (body weight) and goal-directed hemodynamics: CI (cardiac index) ≥ 2.5 l/min per m 2 , MAD (Mean arterial pressure) ≥ 70 mmHg, SVV (stroke volume variation) < 10% with a total amount of perioperative crystalloid fluids ≤ 6 ml/kg BW (body weight) per hour.
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