Optimisation, Anaesthetic Plan & Monitoring
Pre-operative optimisation — the 5-pronged approach
5-pronged optimisation
AntibioticsTreat active infection
Cessation of smoking
Bronchodilators
Chest physiotherapy
Mucolytic agents
🗺️ Anaesthetic plan
General anaesthesia with controlled ventilation + thoracic epidural analgesia (TEA).
- NPO; informed consent; premedication — midazolam may be given; aspiration prophylaxis.
Monitoring
SpO₂, ECG, NIBP, temperature, urine output, EtCO₂; invasive arterial line (IBP) for beat-to-beat pressure and repeated ABGs; CVP on the side of the thoracotomy (so a line complication doesn't risk a bilateral pneumothorax); and neuromuscular monitoring.
1
Induction
- Two IV lines; IV or inhalational technique with short-acting agents for rapid emergence and recovery.
- Pre-oxygenate → propofol + fentanyl + muscle relaxant → lung isolation (next tab).