Complication following resection of lung

Editor's Notes

• #3: is a complete or partial collapse of the entire lung or area (lobe) of the lung. It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid. Atelectasis is one of the most common breathing (respiratory) complications after surgery.
• #5: Somatic afferents are conveyed by the intercostal nerves after skin incision, rib retraction, muscle splitting, injury to the parietal pleura, and chest drain insertion to the ipsilateral dorsal horn of the spinal cord (T4–T10) visceral afferents are conveyed by the phrenic and vagus nerves after injury to the bronchi, visceral pleura, and pericardium
• #6: Somatic afferents are conveyed by the intercostal nerves after skin incision, rib retraction, muscle splitting, injury to the parietal pleura, and chest drain insertion to the ipsilateral dorsal horn of the spinal cord (T4–T10) visceral afferents are conveyed by the phrenic and vagus nerves after injury to the bronchi, visceral pleura, and pericardium
• #7: Hyperpathia- An increased sensitivity to feeling pain and an extreme response to pain. Hyperalgesia  painful sensation in response to a normally innocuous stimulus allodynia Activities that aren't usually painful (like combing one's hair) can cause severe pain
• #8: cision of the muscles is replaced with dissection and reflection onto the ribs
• #11: Insertion of a thoracic epidural before general anaesthesia facilitates patient feedback on improper placement and permits the assessment of its efficacy. The insertion point is usually midway along the dermatomal distribution of the thoracotomy incision at the level of T5–T6. Difficulty in locating the epidural space is often encountered due to the steep caudal angulation of the spinous processes at this level; therefore, some anaesthetists prefer a
• #12: Insertion of paramedian thoracic epidural. The needle is inserted 1 cm lateral to the superior tip of the spinous process and then advanced perpendicular to all planes to contact the lamina of the vertebral body immediately below. The needle is ‘walked’ up the lamina at an angle rostrally (45°) and medially (20°) until the rostral edge of the lamina is felt. The needle is advanced over the edge of the lamina, seeking a loss of resistance on entering the epidural space after transversing the ligamentum flavum. The laminar approach (B) is favoured by other practitioners. The needle is inserted next to the rostral edge of the spinous process and advanced straight without any angle from the midline
• #18: Bronchial stump and lung parenchyma - tested against 25cm water pressure using positive ventilation via hand bagging If the bronchial stump was the cause, it was re-sutured and retested until no air leak was present. If the culprit was from the lung parenchyma- Rx according to surgeon’s preference Mild air leaks (with a ventilatory loss of <500ml/min of air) were treated conservatively while for moderate or severe air leaks the source was sought
• #22: the patient is receiving positive-pressure ventilation, reducing the inspiratory time, end-expiratory pressure, and tidal volume can help diminish the air leak WhileHenry Heimlich developed a one-way tube in the 1960s in which air and fluid are only able to flow one way, from the pleural space to outside the chest wall. 
• #24: Sclerosants are chemicals that cause an inflammatory response and, when administered into the pleural space, allow for sealing of the pleural space, cessation of an air leak, and prevention of recurrent pneumothorax.
• #25: Typically, 50 to 100 mL of peripheral venous blood is taken from the patient’s arm and injected under sterile conditions through the chest tube into the pleural cavity.42 The chest tube is then flushed with 10 mL of normal saline and either clamped or hooked over a drip stand so that air can escape, reducing the risk of tension physiology developing while allowing the blood to remain in the pleural space.42 Reported complications are rare but include tension pneumothorax secondary to an obstructing clot in the chest tube, pleuritis, and empyema (incidence reported 0%-9%).
• #26: are one-way valves placed with a flexible bronchoscope in segmental or subsegmental bronchi to limit airflow to portions of the lungs distal to the placed valve while allowing mucous and air movement in the proximal direction. hese steps include “air leak isolation, airway sizing, and valve deployment.”45 Leak isolation is achieved by sequential balloon occlusion of segmental airways, moving proximally to distally, starting at the mainstem bronchi. The IBV system comes with an airway sizing kit that calibrates the balloon catheter to measure the airway and determine the valve size. Once the valve is placed, the air leak chamber should be observed for four to five ventilatory cycles to assess any change in the degree of the air leak
• #27: decreased arterial PaO2/FiO2 ratio mild ARDS: 201-300 mmHg (≤39.9 kPa) moderate ARDS: 101-200 mmHg (≤26.6 kPa) severe ARDS: ≤100 mmHg (≤13.3 kPa)
• #30: decreased arterial PaO2/FiO2 ratio mild ARDS: 201-300 mmHg (≤39.9 kPa) moderate ARDS: 101-200 mmHg (≤26.6 kPa) severe ARDS: ≤100 mmHg (≤13.3 kPa) e diffuse bilateral coalescent opacities (the only radiological criterion defined by the Consensus Conference).
• #46: right pneumonectomy stump has minimal mediastinal coverage of the bronchial stump compared with a left-sided stump, Finally, the vascular supply to the left mainstem bronchus is augmented by direct vascular branches as the bronchus passes behind the aorta. The blood supply on the right travels from the trachea via local branches in the subcarinal space, which are often disrupted by dissection and lymph node removal.
• #49: Decreasing in the level of airfluid level indicates BPF
• #56: apical portion of the parietal pleura is dissected from the chest wall and tacked to a lower intercostal muscle. The pleura adhere to the surface of the remaining lung and help seal over any leaking areas, and they decrease the volume of space that the remaining lung needs to fill. Either the space on top of the pleural tent in the apex fills with serous fluid, as it does after a pneumonectomy, or the lung expands to fill the whole space. This change is also aided by elevation of the hemidiaphragm. Injection of the phrenic nerve with local anesthetic causes a temporary paralysis that also encourage the hemidiaphragm to rise
• #57: Thoracoplasty is a surgical procedure that was originally designed to permanently collapse the cavities It involved resection of multiple ribs, allowed the apposition of parietal to the visceral or mediastinal pleura. with ribs rection it will decrease th space.
• #58: If massive hemoptysis occurs, an attempt at placing a double-lumen tube to isolate the nonaffected lung from blood spillage may allow enough time for the chest to be opened and the bleeding controlled if DLT not available single lumen tube can be inserted easier in rt bronchus, as it is short vertical and wider left bronchus technically difficult so need bronchoscope diaphragm can be used most vascularised pedicle can be taken and closure of diaphragm and taken tissue can close the stump
• #64: Tracheomalacia is the collapse of the airway when breathing. This means that when your child exhales, the trachea narrows or collapses so much that it may feel hard to breathe. This may lead to a vibrating noise or cough.
• #73: The thoracic duct typically starts at the second lumbar vertebra at the cisterna chyli, ending at the junction of the left subclavian and jugular veins. A total of 1.5 to 2 liters of lymph flows through the thoracic duct per day.[2][3] Any leak from this system results in significant morbidity with loss of lymph and secondarily causing respiratory distress. Go to: Surgical causes: Iatrogenic injury while performing procedures on the esophagus, aorta, pleura, lung, vagotomy, spine surgery, and others. One of the leading reasons for the damage of the thoracic duct during surgical interventions is its anatomical variation.[1][4] A variation is seen in almost one-third of the population.[5] 
• #76: Chyle contains abundant proteins, and patient can become nutritionally depleted quickly It is used in the treatment of chylothorax, because it acts directly on vascular somatostatin receptors to minimize lymphatic fluid excretion. In addition, octreotide increases splanchnic arteriolar resistance and decreases gastrointestinal blood flow, indirectly reducing lymphatic flow.8
• #78: Surgery is recommended if chyle drainage persists for more than 3 weeks, if the daily fluid loss exceeds 1.5 L, or if there is imminent nutritional complication in debilitated patients. ligated between the 8th and 12th vertebrae