Coleman John R, Hanson Neil A
Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia.
Department of Anesthesiology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
Curr Opin Anaesthesiol. 2023 Feb 1;36(1):68-73. doi: 10.1097/ACO.0000000000001215. Epub 2022 Nov 24.
Emphasizing a systems-based approach, we discuss the timing for referral for perioperative surgical consultation. This review then highlights several types of comorbidities that may complicate thoracic procedures, and references recent best practices for their management.
Patients requiring thoracic surgeries present some of the most challenging cases for both intraoperative and postoperative management. The recent SARS-CoV-2 pandemic has only exacerbated these concerns. Effective preoperative optimization, however, provides for identification of patient comorbidities, allowing for mitigation of surgical risks. This kind of planning is multidisciplinary by nature. We believe patients benefit from early engagement of a dedicated preoperative clinic experienced for caring for complex surgical patients.
Optimizing patients for thoracic surgery can be challenging for small and large health systems alike. Implementation of evidence-based guidelines can improve care and mitigate risk. As surgical techniques evolve, future research is needed to ensure that perioperative care continues to progress.
强调基于系统的方法，我们讨论围手术期外科会诊的转诊时机。然后本综述重点介绍了几种可能使胸科手术复杂化的合并症类型，并引用了近期针对其管理的最佳实践。
需要进行胸科手术的患者在术中和术后管理方面都呈现出一些最具挑战性的病例。最近的新冠疫情更是加剧了这些担忧。然而，有效的术前优化可实现对患者合并症的识别，从而降低手术风险。这种规划本质上是多学科的。我们认为患者能从早期参与由经验丰富的专门术前诊所来护理复杂手术患者中受益。
无论是小型还是大型医疗系统，优化患者的胸科手术条件都可能具有挑战性。实施循证指南可改善护理并降低风险。随着手术技术的发展，未来需要开展研究以确保围手术期护理持续进步。
