Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care

Associazione Italiana Pneumologi Ospedalieri AIPO, Federico Piccioni, Andrea Droghetti, Alessandro Bertani, Cecilia Coccia, Antonio Corcione, Angelo Guido Corsico, Roberto Crisci, Carlo Curcio, Carlo Del Naja, Paolo Feltracco, Diego Fontana, Alessandro Gonfiotti, Camillo Lopez, Domenico Massullo, Mario Nosotti, Riccardo Ragazzi, Marco Rispoli, Stefano Romagnoli, Raffaele ScalaLuigia Scudeller, Marco Taurchini, Silvia Tognella, Marzia Umari, Franco Valenza, Flavia Petrini

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Anesthetic care in patients undergoing thoracic surgery presents specific challenges that require a multidisciplinary approach to management. There remains a need for standardized, evidence-based, continuously updated guidelines for perioperative care in these patients.Methods: A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, was established to develop recommendations for anesthesia practice in patients undergoing elective lung resection for lung cancer. The project addressed three key areas: preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventive Services Task Force criteria.Results: Recommendations for intraoperative care focus on airway management, and monitoring of vital signs, hemodynamics, blood gases, neuromuscular blockade, and depth of anesthesia. Recommendations for postoperative care focus on the provision of multimodal analgesia, intensive care unit (ICU) care, and specific measures such as chest drainage, mobilization, noninvasive ventilation, and atrial fibrillation prophylaxis.Conclusions: These recommendations should help clinicians to improve intraoperative and postoperative management, and thereby achieve better postoperative outcomes in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.
Original languageEnglish
JournalPerioperative Medicine
Volume9
DOIs
Publication statusPublished - Dec 2020

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