Our Summary

This research paper discusses the challenge of providing anesthesia in low-to-middle income countries (LMICs), where it is often administered by non-doctor anesthetists due to limited resources and training opportunities. When planning or expanding a thoracic (chest) surgery program in these countries, it’s crucial to evaluate these limitations. Additionally, in these settings, understanding a patient’s baseline lung and heart health is usually based on basic tests and a thorough history and physical examination, as more advanced tests are often not available. The paper emphasizes the need for careful consideration of patient selection before surgery, the ability to provide one-lung ventilation during surgery, and management of care after surgery.

FAQs

  1. What are the challenges of providing anesthesia in low-to-middle income countries (LMICs) for thoracic surgery?
  2. Why is it important to evaluate a patient’s baseline lung and heart health before thoracic surgery in LMICs?
  3. What does the paper suggest for managing care after thoracic surgery in LMICs?

Doctor’s Tip

A helpful tip a doctor might tell a patient about thoracic surgery is to carefully follow post-operative instructions, including proper wound care, medication management, and physical activity restrictions. It’s important to communicate any concerns or changes in symptoms to your healthcare provider promptly to ensure a smooth recovery process. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help support healing and reduce the risk of complications following thoracic surgery.

Suitable For

Patients who are typically recommended for thoracic surgery include those with conditions such as lung cancer, esophageal cancer, mediastinal tumors, pleural diseases, and thoracic trauma. Additionally, patients with conditions such as emphysema, severe chronic obstructive pulmonary disease (COPD), and severe lung infections may also be recommended for thoracic surgery to improve their quality of life and overall health. Patients who have failed conservative treatment options or who have a high likelihood of benefitting from surgery are also candidates for thoracic surgery. It is important for healthcare providers to carefully evaluate each patient’s individual case and consider their overall health and potential risks before recommending thoracic surgery.

Timeline

Before thoracic surgery:

  1. Referral to a thoracic surgeon: The patient is referred to a thoracic surgeon by their primary care physician or another specialist for evaluation and treatment of a chest-related condition.

  2. Pre-operative assessment: The patient undergoes a thorough pre-operative assessment, which includes a review of their medical history, physical examination, and various tests such as chest X-rays, CT scans, and pulmonary function tests to evaluate their lung and heart function.

  3. Informed consent: The patient is provided with information about the risks and benefits of the surgery and gives their consent to proceed with the procedure.

  4. Anesthesia consultation: The patient meets with an anesthesiologist to discuss the anesthesia plan for the surgery and any potential risks or complications.

  5. Surgery: The thoracic surgery is performed by the surgeon, which may involve procedures such as lung resection, chest wall reconstruction, or mediastinal surgery.

After thoracic surgery:

  1. Post-operative care: The patient is monitored closely in the recovery room after surgery and may be transferred to a specialized thoracic surgery unit for further observation and management.

  2. Pain management: The patient receives pain medication to help manage post-operative pain and discomfort.

  3. Respiratory care: The patient may require assistance with breathing, such as using a spirometer to improve lung function and prevent complications like pneumonia.

  4. Physical therapy: The patient may work with a physical therapist to improve mobility, strength, and lung function after surgery.

  5. Follow-up appointments: The patient has regular follow-up appointments with their surgeon to monitor their recovery, address any concerns, and evaluate the success of the surgery.

What to Ask Your Doctor

  1. What is the specific reason for recommending thoracic surgery in my case?
  2. Are there alternative treatments or less invasive procedures that could be considered?
  3. What are the potential risks and complications associated with the surgery?
  4. How experienced is the surgical team in performing thoracic surgeries, particularly in challenging cases?
  5. What is the expected recovery time and post-operative care plan?
  6. Will I require any additional tests or evaluations before the surgery?
  7. What is the success rate for this type of surgery in patients with similar conditions?
  8. How will pain management be handled after the surgery?
  9. Are there any lifestyle changes or precautions I should take before or after the surgery?
  10. What follow-up appointments or monitoring will be necessary after the surgery?

Reference

Authors: Phelps JR, Lizi H, Murphy BA. Journal: Thorac Surg Clin. 2022 Aug;32(3):307-315. doi: 10.1016/j.thorsurg.2022.04.001. PMID: 35961739