Lobectomy or Wedge Resection
- Access
- PIV x2 large. Consider an arterial line if hemodynamic instability or near cardiac structures.
- Airway
- Size double lumen tube appropriately. Have Kelly clamps available (protect the ends with a bit of red rubber tubing, the kind used for stomas). Tape airway with both ends of tape up (or toward the operative side) so readjustment after positioning is easier. When clamping, place Kelly clamps pointing from down to up, so it can support its own position.
- Induction
- Standard
- Maintenance
- Gas and paralytic
- Emergence
- Awake
- Antibiotics
- Cefazolin
- Position
- Lateral with operative side up. Lots of padding, especially elbow, dependent arm, non-dependent arm. Legs angled down and break the bed. There should be a down divot around the neck/upper chest area.
Notes
Have the patient walk into the OR and onto bed unless midazolam given.
Place EKG leads out of the surgical field, which usually means below the spine. On the operative side, place below spine and posterior. On the opposite side, place anterior/lateral.
Upper body Bair Hugger. If robotic, no need for the head shield, but watch for robotic arm placement.
PEEP: For desaturation requiring PEEP in the dependent lung, connect a Mapleson and provide blow-by through the side channel of the double-lumen tube. Alternatively, remove the plastic cap and connect directly to provide more effective PEEP by closing the external opening.