Video-Assisted Thoracoscopy
Airway: ETT
Access: Large IV, often arterial line, CVC depending on nature of procedure
Pain: May be substantial
Position: Lateral with beanbag, upper arm support
Time: Variable
Blood loss: Variable but potential for substantial blood loss; G+H required
Special: One-lung ventilation
Intro and technique
Considerations
Preparation
Induction
Intraoperative
Fluid management:
- Aim <10ml/kg intraoperatively
Risk of exacerbating pulmonary oedema.
Bronchial stump check:
- Valsalva for check of air leak
Surgical Stages
Emergence
Postoperative
Analgesia:
- Requirement similar to open surgery
- Consider:
- Paravertebral catheter
- Extrapleural catheter
- Intercostal blocks
ICC management:
Disposition:
- Variable, but often ICU
- Aim for an early respiratory wean