Chapter 24 - General post-operative management

Summary

Post-operative management of thoracic patients continues to evolve. Smoking cessation can reduce postoperative morbidity. Preoperative chest physiotherapy can reduce pulmonary post-operative complications in high-risk patients. Flexible fiberoptic bronchoscopy and bronchial toileting should be performed if there are excessive bloody secretions in the airway prior to extubation. Patients who have undergone high esophageal resection and anastomosis are prone to aspiration due to delayed recovery of airway reflexes. Chest drains allow the escape of air and blood from the thoracic cavity. Surgeons usually place a single basal chest drain. This is connected to an underwater seal and left clamped. Pneumonectomy drains are usually removed the day after surgery if there is no active bleeding. Thoracic high dependency units should have guidelines about management of bleeding and re-exploration of the chest. The incidence of post-operative delirium (POD) after thoracic surgery is reported to be 5-21%.