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Clinical Thoracic Anesthesia pp 285–293Cite as

General Principles of Postoperative Care

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Abstract

Postoperative care of patients undergoing thoracic surgery focuses mainly on obtaining an early recovery from anaesthesia and mechanical ventilation, achieving optimal postoperative pain control, appropiate fluid administeration, preventing postoperative pulmonary complications and facilitating early mobilization. The management varies from observing and monitoring of vital signs to providing cardiorespiratory and other organs support. The optimal postoperative patient destination which could be the recovery room, high dependency unit (HDU) or an intensive care unit (ICU), depends on the combination of patient and procedurerelated risk factors and the availability of local infrastructure. However, this initial assessment may be modified by intraoperative complications.

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References

  1. Kreienbühl L, Cassina T, Licker M. Where should I send my patient after the operation? In: Şentürk M, Sungur MO, editors. Postoperative Care in Thoracic Surgery. Cham: Springer; 2017. https://doi.org/10.1007/978-3-319-19908-5_2.

    Chapter  Google Scholar 

  2. Anand Iyer, Sumit Yadav. Postoperative care and complications after thoracic surgery, Principles and practice of cardiothoracic surgery, Michael S. Firstenberg, IntechOpen. 2013 12 June. https://doi.org/10.5772/55351. Available from https://www.intechopen.com/books/principles-and-practice-of-cardiothoracic-surgery/postoperative-care-and-complications-after-thoracic-surgery.

  3. Feltracco P, Serra E, Barbieri S, et al. Postoperative care of patients undergoing lung resection. J Anesthe Clinic Res. 2012;4:288. https://doi.org/10.4172/2155-6148.1000288.

  4. Brunelli A, Ferguson MK, Rocco G, et al. A scoring system predicting the risk for intensive care unit admission for complications after major lung resection: a multicenter analysis. Ann Thorac Surg. 2008;86:213–8.

    Google Scholar 

  5. Agostini P, Cieslik H, Rathinam S, et al. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? Thorax. 2010;65:815–8.

    Google Scholar 

  6. Stéphan F, Boucheseiche S, Hollande J, et al. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest. 2000;118:1263–70.

    Google Scholar 

  7. Brunelli A, Al Refai M, Monteverde M, et al. Stair climbing test predicts cardiopulmonary complications after lung resection. Chest. 2002;121(4):1106–10.

    Article  Google Scholar 

  8. Bernard A, Deschamps C, Allen MS, et al. Pneumonectomy for malignant disease: factors affecting early morbidity andmortality. J Thorac Cardiovasc Surg. 2001;121:1076e82.

    Article  Google Scholar 

  9. Licker MJ, Widikker I, Robert J, et al. Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg. 2006;81:1830–7.

    Article  Google Scholar 

  10. Akrawi W, Benumof JL. A pathophysiological basis for informed preoperative smoking cessation counseling. J Cardiothorac Vasc Anesth. 1997;11:629.

    Article  CAS  Google Scholar 

  11. Vaporciyan AA, Merriman KW, Ece F, et al. Incidence of major pulmonary complications after pneumonectomy; association with timing of smoking cessation. Ann Thorac Surg. 2002;73:420.

    Article  Google Scholar 

  12. Barrera R, Shi W, Amar D, et al. Smoking and timing of cessation: impact on pulmonary complications after thoracotomy. Chest. 2005;127:1977.

    Article  Google Scholar 

  13. Cooper JD, Trulock EP, Triantafillou AN, et al. Bilateral pneumonectomy (volume reduction) for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg. 1995;109:106–16.

    Article  CAS  Google Scholar 

  14. Ries AL, Make BJ, Lee SM, et al. The effects of pulmonary rehabilitation in the national emphysema treatment trial. Chest. 2005;128:3799–809.

    Article  Google Scholar 

  15. Mujovic N, Mujovic N, Subotic D, et al. Preoperative pulmonary rehabilitation in patients with non-small cell lung cancer and chronic obstructive pulmonary disease. Arch Med Sci. 2014;10:68–75.

    Article  Google Scholar 

  16. Brunelli A. Enhanced recovery after surgery in thoracic surgery: the past, the present and the future. Video-assist Thorac Surg. 2017;2:37.

    Article  Google Scholar 

  17. Crumley, Stefan Schraag. The role of local anaesthetic techniques in ERAS protocols for thoracic surgery. Seamus. J Thorac Dis. 2018;10(3):1998–2004.

    Article  Google Scholar 

  18. D’Andrilli A, Rendina EA. Enhanced recovery after surgery (ERAS) and fast-track in video-assisted thoracic surgery (VATS) lobectomy: preoperative optimisation and care-plans. J Vis Surg. 2018;4:4.

    Article  Google Scholar 

  19. Jokinen J, Smith AF, Roewer N, et al. Management of postoperative nausea and vomiting: how to deal with refractory PONV. Anesthesiol Clin. 2012 Sep;30(3):481–93.

    Google Scholar 

  20. Onaitis M, D’Amico T, Zhao Y, et al. Risk factors for atrial fibrillation after lung cancer surgery: analysis of the society of thoracic surgeons general thoracic surgery database. Ann Thorac Surg. 2010;90:368–74.

    Google Scholar 

  21. Vaporciyan AA, Correa AM, Rice DC, et al. Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: analysis of 2588 patients. J Thorac Cardiovasc Surg. 2004;127:779–86.

    Google Scholar 

  22. Amar D, Zhang H, Roistacher N. The incidence and outcome of ventricular arrhythmias after noncardiac thoracic surgery. Anesth Analg. 2002;95:537–43.

    PubMed  Google Scholar 

  23. Asamura H, Naruke T, Tsuchiya R, et al. What are the risk factors for arrhythmias after thoracic operations? A retrospective multivariate analysis of 267 consecutive thoracic operations. J Thorac Cardiovasc Surg. 1993;106:1104–10.

    Google Scholar 

  24. Amar D, Roistacher N, Burt M, et al. Clinical and echocardiographic correlates of symptomatic tachydysrhythmias after noncardiac thoracic surgery. Chest. 1995;108:349–54.

    Google Scholar 

  25. Creswell LL. The problem of atrial arrhythmias after noncardiac thoracic surgery. J Thorac Cardiovasc Surg. 2004;127(3):629–30.

    Article  Google Scholar 

  26. Wenk M, Schug SA. Perioperative pain management after thoracotomy. Curr Opin Anaesthesiol. 2011 Feb;24(1):8–12.

    Article  Google Scholar 

  27. Khelemsky Y, Noto CJ. Preventing post-thoracotomy pain syndrome. Mt Sinai J Med. 2012;79(1):133–9.

    Article  Google Scholar 

  28. Slinger PD, Johnston MR. Preoperative assessment: an anesthesiologist's perspective. Thorac Surg Clin. 2005 Feb;15(1):11–25.

    Article  Google Scholar 

  29. Licker MJ, Widikker I, Robert J, et al. Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg. 2006 May;81(5):1830–7.

    Google Scholar 

  30. Popping DM, Elia N, Marret E, et al. Protective effects of epidural analgesia on pulmonary compications after abdominal and thoracic surgery: a meta-analysis. Arch Surg. 2008;143:990–9.

    Google Scholar 

  31. Nomori H, Horio H, Naruke T, et al. What is the advantage of a thoracoscopic lobectomy over a limited thoracotomy procedure for lung cancer surgery? Ann Thorac Surg. 2001;72:879–84.

    Google Scholar 

  32. Scawn ND, Pennefather SH, Soorae A, et al. Ipsilateral shoulder pain after thoracotomy with epidural analgesia: the influence of phrenic nerve infiltration with lidocaine. Anesth Analg. 2001 Aug;93(2):260–4.

    Google Scholar 

  33. Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol. 2009 Oct;22(5):588–93.

    Article  Google Scholar 

  34. Bunchungmongkol N, Pipanmekaporn T, Paiboonworachat S, et al. Incidence and risk factors associated with ipsilateral shoulder pain after thoracic surgery. J Cardiothorac Vasc Anesth. 2014 Aug;28(4):979–82.

    Google Scholar 

  35. Imai Y, Imai K, Kimura T, et al. Evaluation of postoperative pregabalin for attenuation of postoperative shoulder pain after thoracotomy in patients with lung cancer, a preliminary result. Gen Thorac Cardiovasc Surg. 2015 Feb;63(2):99–104.

    Google Scholar 

  36. Jackson SM, Whitlark JD. Pain control with liposomal bupivacaine after Thoracoscopies/thoracotomies. Ann Thorac Surg. 2015 Dec;100(6):2414–5.

    Article  Google Scholar 

  37. Rice DC, Cata JP, Mena GE, et al. Posterior intercostal nerve block with liposomal bupivacaine: an alternative to thoracic epidural analgesia. Ann Thorac Surg. 2015 Jun;99(6):1953–60.

    Google Scholar 

  38. Zeldin RA, Normandin D, Landtwing D, et al. Postpneumonectomy pulmonary edema. J Thorac Cardiovasc Surg. 1984 Mar;87(3):359–65.

    Google Scholar 

  39. Alam N, Park BJ, Wilton A, et al. Incidence and risk factors for lung injury after lung cancer resection. Ann Thorac Surg. 2007 Oct;84(4):1085–91.

    Google Scholar 

  40. Brandstrup B, Tønnesen H, Beier-Holgersen R, et al. Danish study group on perioperative fluid therapy. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003;238(5):641–8.

    Google Scholar 

  41. Arslantas MK, Kara HV, Tuncer BB, et al. Effect of the amount of intraoperative fluid administration on postoperative pulmonary complications following anatomic lung resections. J Thorac Cardiovasc Surg. 2015 Jan;149(1):314–20.

    Google Scholar 

  42. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006 Jun 15;354(24):2564–75.

    Google Scholar 

  43. Chappell D, Jacob M, Hofmann-Kiefer K, et al. A rational approach to perioperative fluid management. Anesthesiology. 2008 Oct;109(4):723–40.

    Google Scholar 

  44. Awad S, Varadhan KK, Ljungqvist O, et al. A meta-analysis of randomized controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clin Nutr. 2013 Feb;32(1):34–44.

    Google Scholar 

  45. Yates DR, Davies SJ, Milner HE, et al. Crystalloid or colloid for goal-directed fluid therapy in colorectal surgery. Br J Anaesth. 2014 Feb;112(2):281–9.

    Google Scholar 

  46. Gupta R, Gan TJ. Peri-operative fluid management to enhance recovery. Anaesthesia. 2016 Jan;71(Suppl 1):40–5.

    Article  Google Scholar 

  47. George RS, Papagiannopoulos K. Advances in chest drain management in thoracic disease. J Thorac Dis. 2016 Feb;8(Suppl 1):S55–64.

    PubMed  PubMed Central  Google Scholar 

  48. Bertolaccini L, Rizzardi G, Terzi A. A golden key can open any door of new protocol: the use of continuous digital measurement for postoperative air leak. Interact Cardiovasc Thorac Surg. 2011 Jan;12(1):31.

    Article  Google Scholar 

  49. Reeve J, Denehy L, Stiller K. The physiotherapy management of patients undergoing thoracic surgery: a survey of current practice in Australia and New Zealand. Physiother Res Int. 2007 Jun;12(2):59–71.

    Article  Google Scholar 

  50. Zehr KJ, Dawson PB, Yang SC, et al. Standardized clinical care pathways for major thoracic cases reduce hospital costs. Ann Thorac Surg. 1998 Sep;66(3):914–9.

    Google Scholar 

  51. Warner DO. Preventing postoperative pulmonary complications: the role of the anesthesiologist. Anesthesiology. 2000 May;92(5):1467–72.

    Article  CAS  Google Scholar 

  52. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–81.

    Article  CAS  Google Scholar 

  53. Kesten S. Pulmonary rehabilitation and surgery for end-stage lung disease. Clin Chest Med. 1997;18:174.

    Article  Google Scholar 

  54. Baddeley RA. Physiotherapy for enhanced recovery in thoracic surgery. J Thorac Dis. 2016;8(Suppl1):S107–10.

    PubMed  PubMed Central  Google Scholar 

  55. Kaneda H, Saito Y, Okamoto M, et al. Early postoperative mobilization with walking at 4 hours after lobectomy in lung cancer patients. Gen Thorac Cardiovasc Surg. 2007;55:493–8.

    Article  Google Scholar 

  56. Agostini P, Naidu B, Cieslik H, et al. Effectiveness of incentive spirometry in patients following thoracotomy and lung resection including those at high risk for developing pulmonary complications. Thorax. 2013;68:580–5.

    Article  Google Scholar 

  57. Reeve JC, Nicol K, Stiller K, et al. Does physiotherapy reduces the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomised single-blind clinical trial. Eur J Cardiothorac Surg. 2010;37:1158–67.

    Google Scholar 

  58. Gould MK, Garcia DA, Wren SM. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e227S–e77S.

    Article  CAS  Google Scholar 

  59. Bergqvist D, Angelli G, Cohen A. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med. 2002;346:975–80. https://doi.org/10.1056/NEJMoa012385.

    Article  CAS  PubMed  Google Scholar 

  60. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest. 2008;133:381S–453S.

    Article  CAS  Google Scholar 

  61. National Institute for Health and Care Excellence. Venous thromboembolism: reducing the risk for patients in hospital, Clinical Guideline CG92. Updated June 2015. Available from https://www.nice.org.uk/guidance/cg92, on September 5, 2017.

  62. Lyman GH, Bohlke K, Khorana AA, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update 2014. J Clin Oncol. 2015;33:654–6.

    Article  CAS  Google Scholar 

  63. National Institute for Health and Clinical Excellence Inadvertent perioperative hypothermia: the management of inadvertent perioperative hypothermia in adults having surgery [Internet]. [cited Apr. 2008; Last updated Dec. 2016]. Available from https://www.nice.org.uk/guidance/cg65/evidence. Accessed 8 October 2016.

  64. Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997;277:1127–34.

    Article  CAS  Google Scholar 

  65. Valeri CR, Feingold H, Cassidy G, et al. Hypothermia-induced reversible platelet dysfunction. Ann Surg. 1987;205:175–81.

    Article  CAS  Google Scholar 

  66. Rajagopalan S, Mascha E, Na J, et al. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008;108:71–7.

    Article  Google Scholar 

  67. Kiekkas P, Poulopoulou M, Papahatzi A, et al. Effects of hypothermia and shivering on standard PACU monitoring of patients. AANA J. 2005 Feb;73(1):47–53.

    Google Scholar 

  68. Lau LL, Hung CT, Chan CK, et al. Anaesthetic clinical indicators in public hospitals providing anaesthetic care in Hong Kong: prospective study. Hong Kong Med J. 2001;7:251–60.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India

    Bimla Sharma & Samia Kohli

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  1. Bimla Sharma
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  2. Samia Kohli
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Editors and Affiliations

  1. Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India

    Jayashree Sood

  2. Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India

    Shikha Sharma

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Sharma, B., Kohli, S. (2020). General Principles of Postoperative Care. In: Sood, J., Sharma, S. (eds) Clinical Thoracic Anesthesia. Springer, Singapore. https://doi.org/10.1007/978-981-15-0746-5_21

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  • DOI: https://doi.org/10.1007/978-981-15-0746-5_21

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