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What are the 3 approaches to thoracic surgery? Briefly describe each.
- median sternotomy- most invasive, dog in dorsal recumbency, dissect pectorals to expose sternum, poor dorsal exposure, stay on midline but keep manubrium intact
- intercostal- moderately invasive, good access to dorsal structures, limited exposure
- MIS- minimally invasive, thorascopy, subxyphoid, primarily for biopsy/ explore
How do you close a sternotomy?
- cerclage wire- figure 8 or double loop
- REMEMBER: chest tube! (after any thoracic surgery)
Where do you enter for minimally invasive surgery of the thorax?
What are the anesthesia goals (physiologic values) during thoracic surgery? (4)
- SpO2 >95%
- Tidal volume 10-15 mL/kg
- Resp rate 10-30 rpm
- Peak airway pressures <20mmHg