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Thoracic Anesthesia PDF Print E-mail

The anesthetic care of patients undergoing surgery on any structure in the chest other than the heart is considered thoracic anesthesia. This includes surgery on the great vessels of the chest, the lungs, trachea, esophagus and chest wall. Because of the complex physiology and interactions between these structures, the anesthetic management of patients undergoing thoracic surgery requires rigorous attention to detail as well as airway devices and monitoring that go beyond the routine. Many patients undergoing lung surgery have a reduced capacity for providing oxygen to the body which can be further compromised due to their surgery and receiving anesthesia. In addition, there are often underlying comorbidities (other medical conditions) that can complicate the anesthetic plan. It is the role of the anesthesia team (anesthesiologist and nurse anesthetist) to understand your medical problems and to deliver a tailor-made safe, and comfortable anesthetic. 

 

Preoperative Evaluation

Prior to the day of your surgery, an anesthesiologist will go over your history and various tests (for example, labs, EKG, chest x-ray results, etc.). If needed, we will contact you prior to your surgery date to gather more information after we have reviewed your medical record. If additional tests need to be performed or there are concerns which could potentially delay your surgery, your anesthesiologist will contact your surgeon’s office to ensure that any necessary testing is performed prior to your surgery date. 

 

Day of Surgery

The peri-operative period begins when you arrive from the hospital floor, intensive care unit or from home to our pre-operative holding area. It is here that you will meet your anesthesiologist and nurse anesthetist and well as other members of your operating team. Your medical history will be reviewed and any recent changes in health will be assessed. Finally, a brief examination will be performed and your anesthesiologist will discuss the proposed anesthetic plan in words that you and your family can understand. You will have an opportunity to review the anesthesia consent form which describes the type and purpose of your anesthetic as well as any potential complications. You will then be given a change to ask any questions that you may have. When your surgeon, operating room nurses, and anesthesia providers are ready you will be transported to the operating room. Typically, a sedative is given which may calm any anxiety you have and prevent you from remembering your arrival to the OR. Our physicians and nurses will make every effort to make your transport to the operating room relaxing and as stress-free as possible. Pain medicine may be given in addition to the sedative to assure your comfort.

 

Pre-operative Epidural Placement

In some cases, your surgeon will request that you receive an epidural catheter prior to the start of your surgery. Typically this is performed to assist with your pain control and to allow you to breathe deeper after surgery. With improved breathing, you may reduce the likelihood of pneumonia and other breathing problems after your surgery. If appropriate, a mild sedative will be administered and you will be asked to either sit up or curl on your side. Your back will be cleaned and a very thin tube will be placed in an appropriate location to allow the delivery of a medication that will help to reduce pain sensation in the area of your surgery. You may review an animation showing the placement of an epidural under our patient education section by clicking this link.

 

Intraoperative Care

Once you have been placed on the operating room bed, your anesthesiologist or nurse anesthetist will place various monitors to safeguard your safety during the operation. As you prepare to go to sleep, we will deliver oxygen by gently placing an oxygen mask over your mouth and nose. In most cases, your general anesthetic begins at this point with an injection of medication through your IV. It generally takes about 30-60 seconds to fall asleep after the administration of this medication. Once we are assured you are asleep, a breathing tube will be placed into your trachea (also known as wind pipe) which serves the functions of protecting your lungs from stomach contents, facilitating the use of a ventilator and allowing the use of anesthetic gases which reliably ensure that you remain completely asleep throughout the duration of your surgery. In many cases, after you are asleep and we have secured the breathing tube, an arterial line will be placed to provide a constant measurement of your blood pressure. Some surgeries may require the placement of a central line to ensure your safety during or after your surgery. Your anesthesiologist or surgeon may discuss this with you prior to your surgery. At the conclusion of your surgery, the anesthetic gases are turned off and when we are assured you can maintain your own breathing and protect your airway without assistance the breathing tube is removed. In some cases it is necessary for the breathing tube to remain in place beyond your time in the operating room in which case you will be taken to the intensive care unit with a sedative and the breathing tube is removed when it is appropriate. The likelihood of this occurring will be discussed prior to your surgery.

 

Invasive Lines

Arterial Line

The arterial line (known also as A-line) is a monitor that usually is placed as you go to sleep but may also inserted prior to surgery while you are awake. This is a catheter that we usually placed in your radial artery by your wrist where you can check your pulse. Sometimes we place the catheter in your groin in the femoral artery if your surgeon plans to use that artery as one of your bypass grafts. We use this line to tightly monitor your blood pressure during the surgery. 

 

Central Line

A central line is a specialized intravenous line that is used to inject fluid, monitor fluid status and certain blood pressures and to deliver certain medications to you during and after your procedure. It is typically placed after you are asleep or under sedation in the operating room or in the ICU. In many cases, this is requested by your surgeon or needed due to medications that are injected during or after your surgery to maintain your blood pressure or appropriate blood volume. 

 

Questions

The physicians of American Anesthesiology are always available to answer any questions you might have concerning your care. If there is time available prior to your surgery, then your surgeon can arrange a consultation with us if necessary. American Anesthesiology and its physicians look forward to helping you and your family get through what can be a difficult time for both your family and yourself.

 

American Anesthesiology Associates of Virginia

1001 Sam Perry Blvd
Fredericksburg, VA 22401 (view map)

 

Office Phone: (540) 741-7614

Fax: (540) 741-7615

 

Billing Inquiries:

Dates of service prior to 4/18/14:
Call (800) 464-6075*

Dates of service 4/18/14 and after:
Call (888) 280-9533*

 

*In order to expedite your inquiries to our billing department, please have your account number available.