Management of Lung Cancer in Older People by Cesare Gridelli & Riccardo A Audisio

Author:Cesare Gridelli & Riccardo A Audisio
Language: eng
Format: epub
Publisher: Springer London, London

Intraoperative and Postoperative Management

Intraoperative management should provide a minimization of anesthetic stress, and a continuous monitoring with electrocardiogram, arterial line, temperature, urine production, end tidal carbon dioxide, and pulse oximetry is mandatory [34, 42]. Attention must be paid to careful positioning of the patient due to the increased frequency of joint limitation and musculoskeletal alteration in elderly people [34]. Because elderly patients are often affected by chronic obstructive pulmonary ­disease, preoperative and postoperative respiratory physiotherapy is of paramount importance in order to obtain better postoperative recovery [57, 58]. A well-­addressed physiotherapy program can lead to a reduction of hospital stay and decrease of postoperative complications such as atelectasis and ­pneumonia [59].

The control of postoperative pain is extremely important, and a proper analgesia can improve respiratory function and stimulate a productive cough. The use of thoracic epidural analgesia has been recently associated with lower mortality and postoperative respiratory complications [59]. Intraoperative administration of local anesthetics (anesthesiology blocking of intercostal nerves) can be used to reduce perioperative pain and so the need for drug administration, while a recent study focused on the use of an intercostal nerve catheter with patient-controlled analgesia in order to effectively control the postoperative pain [60].

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