Abstract
IntroductionAnesthetic care in patients undergoing thoracic surgery presents specific challenges that necessitate standardized, multidisciplionary, and continuously updated guidelines for perioperative care.MethodsA multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, comprising 24 members from 19 Italian centers, was established to develop recommendations for anesthesia practice in patients undergoing thoracic surgery (specifically lung resection for cancer). The project focused on preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and PubMed and Embase literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventative Services Task Force criteria.ResultsRecommendations for preoperative care focus on risk assessment, patient preparation (prehabilitation), and the choice of procedure (open thoracotomy vs. video-assisted thoracic surgery).ConclusionsThese recommendations should help pulmonologists to improve preoperative management in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.
Highlights
Anesthetic care in patients undergoing thoracic surgery presents specific challenges that necessitate standardized, multidisciplionary, and continuously updated guidelines for perioperative care
Further refinement of the recommendations can be anticipated as the literature continues to evolve
We suggest a course of care that includes the use of a Patient Health Engagement (PHE) model to measure the level of engagement; in addition, education about the procedure should be provided to family members, because there is evidence that engagement of both the patient and family members contributes to improved postoperative outcomes (Graffigna and Barello 2018)
Summary
The PACTS group is a joint task force of the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva, SIAARTI); the Italian Society of Thoracic Surgery (Società Italiana di Chirurgia Toracica, SICT); the Italian Society of Thoracic Endoscopy (Società Italiana di Endoscopia Toracica, SIET); the Italian Society of Surgery (Società Italiana di Chirurgia, SIC); the Italian Association of Hospital Pneumologists (Associazione Italiana Pneuomologi Ospedalieri, AIPO); and the Italian Society of Pneumology (Società Italiana di Pneumologia, SIP/IRS). Level of evidence: Fair Strength of recommendation: A Several studies have shown that alcohol abuse in patients undergoing surgery for lung cancer is associated with increased rates of postoperative pulmonary complications and reduced long-term survival (Batchelor et al 2019). Level of evidence: Fair Strength of recommendation: A Spirometric measurement of forced expiratory volume in 1 second (FEV1) and predicted postoperative FEV1 (ppoFEV1) has traditionally been a key component of the preoperative evaluation of lung cancer patients, and decreases in these measures are associated with increased morbidity and mortality (Brunelli et al 2013). Specific data on the preoperative use of benzodiazepines are lacking in thoracic surgery
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
