Pneumonektomie - pooperační komplikace

Anest. intenziv. Med. 2000;11(5):191-196

Pneumonectomy: Postoperative ComplicationsArticles

V. Bosek¹, L. A. Robinson²: ¹ Department of Anesthesiology; ² Division of Cardiovascular and Thoracic Surgery, Director Ass. Prof. Lary A. Robinson, M. D., H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida

The risk of complications following the pulmonary resection tends to be directly proportional to the amount of lung removed and to the pulmonaryand cardiac reserve of the patient. The surgical consideration must respect the cardiopulmonary state of the patient and the vast majority of pulmonaryresection. The resectability refers to the anatomic location of the cancer.The authors summarize the surgical and non-surgical complications. The direct surgical complications are hemorrhage, intraoperative arrhytmias,recurrent laryngeal nerve injury, bronchopleural fistula, wound infection, mediastinal shift and empyema. The ventilation techniques may playa important role often. The cardiac complications are concerned on perioperative arrhytmia, ischemia and congestive heart failure. The therapy withthe betablocators will be successful.Atalectasis is probably the most common postoperative pulmonary complication. It occurs from mucus plugging, due to a poor cough. The pneumonia(22 %) has a high mortality of 30 % or more. The most common predisposing factor is atalect asis. Postoperative (non-cardiogenic) edema is reportedat 2 - 4 % and with a mortality of 50 % to 100 %. The venous thrombosis (21 %) after the pulmonary resection carries a high incidence of the pulmonaryembolism in 2 - 3 %.The other systemic complications occur as the renal failure and stroke. The problem of the complications occurring in 15% in patients is associatedwith the age greater than 70 years. The incidence of an isolated stroke is exceeding small and is reported to be approximately < 1 but with a highmortality when it occurs.The article was to summarize surgical and non-surgical complications of pneumonectomy as they occur in daily practice of oncology centers in theUnited States.