Anesthesia for Thoracic Surgery - Preoperative Preparation
Preoperative sedation should be given carefully to patients with tracheal or pulmonary disease.
- Heavy sedation may impair postoperative deep breathing, coughing, and airway protection. Patients with poor pulmonary function will be more prone to hypoxemia when their respiratory drive is suppressed. When sedating these patients, it is prudent to monitor oxygenation and administer supplemental oxygen.
- In the presence of airway obstruction, sedation must be carefully balanced. It is crucial to maintain spontaneous ventilation. Oversedation may profoundly suppress ventilation, but an anxious patient may make exaggerated respiratory efforts. In this case, the increased turbulence may worsen airway obstruction, leading to increased anxiety. Benzodiazepines, reassuring words, careful monitoring, and an expeditious start to the procedure are the best approach. In patients with airway stenosis, Heliox, a mixture of 79% helium and 21% oxygen, will lower the density of the respiratory gas and reduce airway resistance.
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