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Changes in lung function after routine exposure manipulations during thoracotomy.

M C Mancini, B P Griffith, H S Borovetz

    The Journal of Surgical Research
    |September 1, 1983
    PubMed
    Summary
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    Manual lung retraction and bronchial occlusion during thoracotomy significantly reduce right lung function. Both methods similarly decrease ventilation, perfusion, and V/Q ratio after lung reexpansion.

    Area of Science:

    • Thoracic Surgery
    • Pulmonary Physiology
    • Anesthesiology

    Background:

    • Thoracotomy requires lung manipulation, potentially affecting lung function.
    • Understanding the impact of manual retraction and bronchial occlusion is crucial for surgical safety.

    Purpose of the Study:

    • To evaluate the effects of manual lung retraction versus bronchial occlusion on right lung function during thoracotomy.
    • To compare the physiological changes induced by these two lung management techniques.

    Main Methods:

    • Sheep model with three groups: manual retraction, bronchial occlusion, and control.
    • Radioisotopic tracers used to measure capillary permeability-surface area product (PS-urea), extravascular lung water (VE), and intravascular blood volume (Vv).
    • Gravimetric technique for lung water quantification; assessment of pulmonary vascular resistance (PVR) and compliance.

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    Main Results:

    • Both retraction and occlusion increased PVR and decreased compliance.
    • Significant increase in right lung shunt (17% to 37% and 18% to 36%).
    • Reduced PS-urea and VE (>25%) in both intervention groups, indicating decreased lung perfusion.

    Conclusions:

    • Manual retraction and bronchial occlusion similarly reduce right lung perfusion, ventilation, and V/Q ratio post-reexpansion.
    • Both techniques compromise lung function during and after thoracotomy.
    • Findings highlight the importance of careful lung management during thoracic surgery.