A right middle lobectomy was performed. Would you extubate the trachea at the end of the procedure?
Answer:
After routine lung resection, the trachea can be extubated if the patient meets criteria and has adequate analgesia. If the patient cannot maintain adequate oxygenation and ventilation, postoperative mechanical support is indicated. If so, the DLT needs to be exchanged to a single lumen tube or a supraglottic device. Spontaneous ventilation avoids the potential hazards of positive pressure on the suture lines of the new bronchial stump or parenchymal air leaks. The combination of modest CPAP and pressure support ventilation is usually preferable to controlled intermittent mandatory ventilation.
Reference(s):
- Slinger PD, ed. Principle and Practice of Anesthesia for Thoracic Surgery. Cham, Switzerland: Springer; 2019:885-923.