Clinical pearls in anaesthesia for pleurectomy/decortication
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No solitary variable is powerful enough to predict pulmonary complications in the thoracic surgical population. Insight into the lung pathology, its effect on pulmonary function, the nature of pleurectomy decortication surgery with its unique ventilatory requirements and physiology of one lung ventilation (OLV) is essential for optimum management. The fibrous tissues that get deposited in the pleural cavity over the lung parenchyma can be so intense that the underlying lung fails to expand and needs to be decorticated. In pleurectomy decortication surgeries, pleural dissection can be aided by tailored lung inflation and deflation manoeuvres(by the anaesthetist) on the lung being operated. Asbestos and mesothelioma are so strongly co-related that mesothelioma is considered a “signature tumor” for asbestosis, but patient did not give a history of asbestos exposure. Rare causes of mesothelioma include chest radiotherapy, intrapleural thorium dioxide contrast, simian virus 40 infection and fibrosilicate (talc) inhalation...

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