Thoracic Anaesthesia

785 Pages·2011·3.1 MB·English

by  Jonathan Wilkinson

OXFORD MEDICAL PUBLICATIONS
Thoracic

Anaesthesia
Oxford Specialist Handbooks published and forthcoming
General Oxford Specialist Oxford Specialist Handbooks in
Handbooks Neurology
A Resuscitation Room Guide Epilepsy
Addiction Medicine Parkinson’s Disease and Other
Perioperative Medicine, Movement Disorders
Second Edition Stroke Medicine
Post-Operative Complications,
Second edition Oxford Specialist Handbooks in
Paediatrics
Oxford Specialist Handbooks in Paediatric Endocrinology and Diabetes
Anaesthesia Paediatric Dermatology
Cardiac Anaesthesia Paediatric Gastroenterology,
Day Case Surgery Hepatology, and Nutrition
General Thoracic Anaesthesia Paediatric Haematology and
Neuroanaesthesia Oncology
Obstetric Anaesthesia Paediatric Nephrology
Paediatric Anaesthesia Paediatric Neurology
Regional Anaesthesia, Stimulation Paediatric Radiology
and Ultrasound Techniques Paediatric Respiratory Medicine
Thoracic Anaesthesia
Oxford Specialist Handbooks in
Oxford Specialist Handbooks in Psychiatry
Cardiology Child and Adolescent Psychiatry
Adult Congenital Heart Disease Old Age Psychiatry
Cardiac Catheterization and
Coronary Intervention Oxford Specialist Handbooks in
Cardiovascular Computed Radiology
Tomography Interventional Radiology
Cardiovascular Imaging Musculoskeletal Imaging
Echocardiography
Oxford Specialist Handbooks in
Fetal Cardiology
Surgery
Heart Disease in Pregnancy
Cardiothoracic Surgery
Heart Failure
Hand Surgery
Hypertension
Hepato-pancreatobiliary Surgery
Inherited Cardiac Disease
Oral Maxillo Facial Surgery
Nuclear Cardiology
Neurosurgery
Pacemakers and ICDs
Operative Surgery, Second Edition
Oxford Specialist Handbooks in Otolaryngology and Head and Neck
Critical Care Surgery
Advanced Respiratory Critical Care Plastic and Reconstructive Surgery
Surgical Oncology
Oxford Specialist Handbooks in Urological Surgery
End of Life Care Vascular Surgery
End of Life Care in Cardiology
End of Life Care in Dementia
End of Life Care in Nephrology
End of Life Care in Respiratory
Disease
End of Life Care in the Intensive
Care Unit
Oxford Specialist
Handbooks in
Anaesthesia
Thoracic
Anaesthesia
Edited by
Jonathan N. Wilkinson
Consultant in Intensive Care and Anaesthesia
(past Fellow in Thoracic Anaesthesia
Nottingham University Hospitals)
Northampton General Hospital
Northampton, UK
Stephen H. Pennefather
Consultant Anaesthetist
Liverpool Heart & Chest Hospital
Liverpool, UK
Robert A. McCahon
Consultant Anaesthetist
Queen’s Medical Centre
Nottingham, UK
1
1

Great Clarendon Street, Oxford OX2 6DP .
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide in
Oxford New York
Auckland Cape Town Dar es Salaam Hong Kong Karachi
Kuala Lumpur Madrid Melbourne Mexico City Nairobi
New Delhi Shanghai Taipei Toronto
With offi ces in
Argentina Austria Brazil Chile Czech Republic France Greece
Guatemala Hungary Italy Japan Poland Portugal Singapore
South Korea Switzerland Thailand Turkey Ukraine Vietnam
Oxford is a registered trade mark of Oxford University Press
in the UK and in certain other countries
Published in the United States
by Oxford University Press Inc., New York
© Oxford University Press, 2011
The moral rights of the author have been asserted
Database right Oxford University Press (maker)
First published 2011
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
without the prior permission in writing of Oxford University Press,
or as expressly permitted by law, or under terms agreed with the appropriate
reprographics rights organization. Enquiries concerning reproduction
outside the scope of the above should be sent to the Rights Department,
Oxford University Press, at the address above
You must not circulate this book in any other binding or cover
and you must impose this same condition on any acquirer
British Library Cataloguing in Publication Data
Data available
Library of Congress Cataloging-in-Publication-Data
Data available
Typeset by Glyph International, Bangalore, India
Printed in Great Britain
on acid-free paper by
Ashford Colour Press Ltd, Gosport, Hampshire
ISBN 978–0–19–956309–8
10 9 8 7 6 5 4 3 2 1
Oxford University Press makes no representation, express or implied, that the drug
dosages in this book are correct. Readers must therefore always check the product
information and clinical procedures with the most up-to-date published product
information and data sheets provided by the manufacturers and the most recent
codes of conduct and safety regulations. The authors and publishers do not accept
responsibility or legal liability for any errors in the text or for the misuse or misap-
plication of material in this work. Except where otherwise stated, drug dosages and
recommendations are for the non-pregnant adult who is not breastfeeding.
v
Foreword
Providing safe perioperative management for thoracic surgical patients
remains one of the most consistently challenging areas, both technically
and intellectually, within the specialty of anaesthesia. This excellent up-to-
date handbook on Thoracic Anaesthesia by Drs. Wilkinson, Pennefather,
McCahon and associates is a major advance in the information available to
the practitioner working in this fi eld.
The practice of thoracic anesthesia is continually evolving. The large
majority of thoracic surgical patients in the fi rst half of the last century
presented for treatment of pulmonary processes secondary to infection.
These patients are now infrequent in an adult practice in the developed
world. However, complications such as empyema and broncho-pleural
fi stula still occur and the anaesthesia practitioner needs to know the
principles of management which allow for maintenance of ventilation and
protection of healthy lung regions in these diffi cult cases.
The majority of major pulmonary surgery now is for lung cancer and this
surgical volume continues to increase as the cohort of the population with
a high incidence of cigarette-smoking ages. Surgery has progressed from
the fi rst pneumonectomies in the 1930s to more complex operations
such a segmentectomies and sleeve-lobectomies and more complex
techniques such as video-assisted resections. These advances continually
challenge the anaesthetist’s ability to provide reliable lung isolation and to
maintain oxygenation during one-lung anaesthesia.
Most recently thoracic surgery has been extended to treating a variety
of end-stage lung diseases with lung transplantation and, in selected
circumstances, lung-volume reduction. This extension now means than
many severely disabled patients, previously considered inoperable, require
safe anaesthetic management during prolonged surgery.
This handbook offers the trainee a comprehensive preview of peri-
operative management for all types of non-cardiac intra-thoracic surgery.
It also offers the consultant a chance to review the specifi c anaesthetic
considerations for all of these procedures, some of which occur
infrequently, even in the busiest thoracic practices.
Even in centres which do not have a large volume of elective thoracic
surgery, thoracic trauma cases present for surgery, often on very short
notice. I believe the comprehensive section on anaesthesia for thoracic
trauma in this handbook will be a valuable reference to anyone practicing
in a surgical center that manages trauma.
I congratulate the Editors on this outstanding addition to the literature
in thoracic anaesthesia and I thank them for allowing me to contribute a
small portion of the text.
Peter Slinger MD, FRCPC
Professor of Anesthesia
University of Toronto, Canada
vi
Acknowledgements
Medical artwork
Many thanks to our medical artists for their help with the book.
Mr Giles Barnwell Mr John M. Ross
Nottingham, UK Northampton, UK
Dr Polly Davies Dr Jonathan N. Wilkinson
Northampton, UK Northampton, UK
vii
Contents
C ontributors viii
S ymbols and abbreviations xi
1 Basic physiology for thoracic anaesthesia 1
2 Basic anatomy for thoracic anaesthesia 17
3 Basic pharmacology for thoracic anaesthesia 51
4 Pre-operative assessment of the thoracic patient 147
5 Diagnostic and therapeutic procedures in
thoracic anaesthesia 281
6 Surgery to the lung and upper airway 315
7 Surgery to the chest wall and pleura 409
8 Upper gastrointestinal and mediastinal surgery 423
9 Thoracic trauma, emergencies, and special cases 451
10 Management of intra-operative problems 543
11 Critical care and the post-operative
thoracic patient 569
12 Techniques in thoracic anaesthesia 679
Index 749
viii
Major contributors
Dr Kan Alagesan Dr Simon Leach
Consultant Anaesthetist and Specialist Registrar in
Intensivist Anaesthesia
Nottingham University Hospitals Northampton General Hospital
City Hospital Campus Northampton, UK
Nottingham, UK
Dr Martin Ma
Dr Victoria Banks Consultant Anaesthetist
Specialist Registrar in Anaesthesia Toronto General Hospital
Nottingham University Hospitals Toronto, Canada
Queens Medical Centre Campus
Dr Thomas McCarthy
Derby Road
Nottingham, UK Specialist Registrar in
Anaesthesia
Dr Jonathan Burch Northampton General
Specialist Registrar in Anaesthesia Hospital
Queens Medical Centre Northampton, UK
Nottingham, UK
Dr Nicola Moores
Dr Alison Chalmers Consultant Anaesthetist
Consultant Anaesthetist Lincoln County Hospital
Queen Victoria Hospital Lincoln, UK
Holtye Road
Dr Gayle Rutherford
West Sussex, UK
Consultant Radiologist
Dr Myles Dowling Sheffi eld Teaching Hospitals
Consultant Anaesthetist NHS Foundation Trust
Nottingham University Hospitals Sheffi eld, UK
Nottingham, UK
Dr Michael Scanlan
Dr Helen Fenwick Specialist Registrar in Anaesthesia
Specialist Registrar in Anaesthesia Sheffi eld Teaching Hospitals
Nottingham University Hospitals NHS Trust
Nottingham, UK Sheffi eld, UK
Dr Alistair Glossop Dr Peter D. Slinger
Consultant in Intensive Care Consultant Anaesthetist
and Anaesthesia Toronto General Hospital
Sheffi eld Teaching Hospitals Toronto, Canada
NHS Foundation Trust
Dr Paul Smith
Sheffi eld, UK
Consultant Anaesthetist
Dr Christopher Harber and Intensivist
Consultant Anaesthetist Sherwood Hospitals
Queens Medical Centre NHS Foundation Trust
Nottingham, UK Sutton-In-Ashfi eld, UK
OTHER CONTRIBU TORS ix
Dr Hannah Sycamore Dr Patrick Waits
Consultant Anaesthetist Consultant Anaesthetist
Queens Medical Centre North Manchester General
Nottingham, UK Hospital
Oldham, UK
Dr Paul Townsley
Specialist Registrar in Anaesthesia Dr Matthew Wiles
Nottingham University Hospitals Consultant Anaesthetist
Nottingham, UK Sheffi eld Teaching Hospitals NHS
Foundation Trust
Sheffi eld, UK
Other contributors
Dr Alison Brewer Dr Suresh Paranjothy
Consultant Anaesthetist Research Fellow in Anaesthesia
Leicester, UK Liverpool, UK
Dr David Castillo Dr Darshan Pathak
Research Fellow in Anaesthesia Research Fellow in Anaesthesia
Liverpool, UK Liverpool, UK
Dr Melanie Davies Dr Som Sarkar
Consultant Anaesthetist Consultant Anaesthetist
Lincoln, UK Sutton-In-Ashfi eld, UK
Dr Polly Davies Dr Vyacheslav Seppi
Consultant Anaesthetist Research Fellow in Anaesthesia
Northampton, UK Liverpool, UK
Dr Chloe Fairbairns Dr Vishal Thanawala
Specialist Registrar in Anaesthesia Specialist registrar in Anaesthesia
York, UK Leicester, UK
Dr Nicola Hames Dr Madan Thirugnanam
Consultant Anaesthetist Specialist Registrar in Anaesthesia
Northampton, UK Leicester, UK
Dr Jonathan Hardwick Dr Liana Vele
Consultant in Anaesthesia Specialist Registrar in Anaesthesia
and Intensivist London, UK
Northampton, UK
Dr Pamela Wake
Dr Senthil Kumaran Consultant Anaesthetist
Consultant Anaesthetist Nottingham, UK
Northampton, UK
Mr Richard Warwick
Dr Ruffa Mustaq Specialist Registrar in
Research Fellow in Anaesthesia Cardiothoracic Surgery
Liverpool, UK Liverpool, UK