RT Book, Section
A1 Cossu, Anne E.
A1 Hardacker, Doris M.
A2 Ellinas, Herodotos
A2 Matthes, Kai
A2 Alrayashi, Walid
A2 Bilge, Aykut
SR Print(0)
ID 1176458046
T1 Anesthesia for Thoracic Procedures
T2 Clinical Pediatric Anesthesiology
YR 2021
FD 2021
PB McGraw Hill
PP New York, NY
SN 9781259585746
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1176458046
RD 2024/04/20
AB FOCUS  POINTS1.Type  II  pneumocytes  develop  at  24  to  26  weeks  of  gestation  and  begin  producing  surfactant.  Eight  to  ten  percent  of  the  number  of  adult  alveoli  are  present  at  birthInfants  and  children  have  reduced  functional  residual  capacity  (FRC)  and  higher  oxygen  consumption  (6  to  8  ml/kg/min)  rendering  them  susceptible  to  faster  oxygen  desaturation.Etiologies  for  increased  ventilation  to  perfusion  (V/Q)  mismatch  during  thoracic  surgery  include  lateral  positioning,  general  anesthesia  and  blunting  of  hypoxic  pulmonary  vasoconstriction,  mechanical  ventilation  and  surgical  manipulation  or  single-lung  ventilation.One-lung  ventilation  (OLV)  can  be  achieved  utilizing  single  lumen  endotracheal  tubes  inserted  into  the  main  stem  bronchus,  endobronchial  blockers,  Univent  tubes  or  double  lumen  tubes  dependent  on  the  size  of  the  patient.Management  of  hypoxemia  during  OLV  includes  100%  oxygen,  continuous  positive  airway  pressure  (CPAP)  to  the  nondependent  lung,  positive  end-expiratory  pressure  (PEEP)  to  the  dependent  lung,  double  lung  ventilation  and  in  extremis  occlusion  of  the  pulmonary  artery  to  the  operative  lung.Thoracic  and  mediastinal  masses  are  lesions  that  may  cause  airway  compromise  prior  to  or  during  a  procedure  under  anesthesia.  Thorough  preoperative  evaluation  that  includes  review  of  echocardiogram,  available  imaging,  and  symptoms  allow  for  a  safer  anesthetic.  Spontaneous  ventilation  with  min  sedation  may  be  the  anesthetic  of  choice.