Pneumonectomy

Pneumonectomy is a complex surgical procedure requiring a multidisciplinary approach and multifaceted anesthetic management. In this chapter, the authors begin with the history of pneumonectomy and indications and contraindications to the procedure. There is an overview of lung cancer, staging, and appropriate treatment for the different stages of lung cancer. The preoperative evaluation is briefly summarized with an algorithm to follow and is then covered in depth through breaking it down into cardiovascular risk assessment and evaluation, cardiac risk calculators, respiratory mechanics, lung parenchymal function, and finally evaluation of the cardiopulmonary interaction. The surgical procedure and types of pneumonectomy are explained for a thorough understanding before diving into anesthetic management. Preoperative planning and appropriate review prior to taking the patient to the operating room are covered, followed by a discussion of lines and monitors, lung isolation, one-lung ventilation recommendations, hemodynamic management and clamping of the pulmonary artery, supplemental studies, intraoperative fluid management, special considerations for extrapleural pneumonectomy and tracheal sleeve pneumonectomy, guidelines for extubation, and pain management. Lastly, postoperative monitoring and complications including cardiac arrhythmias, stroke, perioperative pulmonary complications and postneumonectomy pulmonary edema, bronchopleural fistula, and cardiac herniation are described.