Arterial Line for VATS

[turnupthevapor]

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During my training always put an A-line for the VATS....no big deal, adds 5 minutes, pretty safe, and I find the information it gives you useful. Helps me keep an eye on PAO2,CO2, BD, HGB, Glu, beat to beat variabilty, etc.


Our new surgeon does not want them on his patients....I am okay with this if the patients lungs aren't to bad and they have a good ticker.

What do you all think?

While we are at it, are you all putting thoracic epidurals in your VATS poss lobectomy patients? I do, but am not sure if its overkill (doesn't help chest tube pain anyway)?

thank you in advance
​

 

[huktonfonix]

If you think that it might provide useful information, by all means place an alne. Ask him what his rationale is for not wanting it. Thoracic epidurals do help with chest tube pain. I tend to place thoracic epidurals based on how likely it is that the surgeon will make a thoracotomy incision. You can always place them post op or while the patient is asleep if youre feeling brave. As always its a risk/benefit analysis. If its an otherwise healthy patient for a VATS/lobectomy I may be willing to do without an aline as long as I have easy access to the down hand to do ABGs or place an aline if neccesary. If the patient looks to be an easy epidural and the chance for thorcotomy is low then I'll hold off on the epidural. If the patient looks to be a hard epidural, I may choose to place it preop since it may be a pain in the a5# to place postop.

 

[urge]

A vats can be done safely without an a line as long as the pulse ox gives a good tracing. That's how I do mine. If you want to put them in there is nothing wrong with it.

I don't like placing epidurals unless I'm sure they will be necessary. They can be placed post op if needed.

 

[militarymd]

No A-line
No epidural


Big IV's.

 

[Jeff05]

big IVs suggests that there may be a potential for severe bleeding with hemodynamic instability. if you're gettn ready for that, shouldn't the patient have an a line, as well?

the truth is, this month i've done 6 vats and 4 thoracotomies. and all but 1 could have been done with a 20g iv and no aline. but, i was glad to have an aline and an introducer on the one that went south...

No A-line
No epidural


Big IV's.

 

[militarymd]

big IVs suggests that there may be a potential for severe bleeding with hemodynamic instability. if you're gettn ready for that, shouldn't the patient have an a line, as well?

the truth is, this month i've done 6 vats and 4 thoracotomies. and all but 1 could have been done with a 20g iv and no aline. but, i was glad to have an aline and an introducer on the one that went south...

You need an a-line to tell you when someone is hypotensive?

I guess I got better training than you did.

 

[Noyac]

I don't place either one for VATS.

But if the surgeon tells me not to place an a-line then you can be damn sure there will be an a-line in that pt.

Surgeons do surgery. Anesthesiologists do anesthesia. One does not tell the other how to do their job.

 

[drccw]

VATs= NIBP + 16 G....

how about carotids?
I don't.. don't need them.. average brain ischemia time is less than 10 mins...
One guy is around 7 mins.. the slow guy is about 12 mins...

no monitoring no awake stuff...
just induce, relax them with sux and let them start). Skin to skin it about 40-45 mins... if you throw the roc you can get burned... all of our vascular studs use lots of local as well..

 

[huktonfonix]

VATs= NIBP + 16 G....

how about carotids?
I don't.. don't need them.. average brain ischemia time is less than 10 mins...
One guy is around 7 mins.. the slow guy is about 12 mins...

no monitoring no awake stuff...
just induce, relax them with sux and let them start). Skin to skin it about 40-45 mins... if you throw the roc you can get burned... all of our vascular studs use lots of local as well..

I havent been burned with roc since early in residency. If you want to use it but you worry about getting burned, use less. Usually dont need to paralyze these cases after induction anyway.

 

[drccw]

I havent been burned with roc since early in residency. If you want to use it but you worry about getting burned, use less. Usually dont need to paralyze these cases after induction anyway.

My first carotid was with the fastest dude. 65 kg gal getting her carotid. 50 of Roc... skin to skin 25 mins... 1/4 twitches.... barely skated through...

 

[huktonfonix]

My first carotid was with the fastest dude. 65 kg gal getting her carotid. 50 of Roc... skin to skin 25 mins... 1/4 twitches.... barely skated through...

yeah, then ya might get burned. thats a pretty fast carotid.

 

[Noyac]

My first carotid was with the fastest dude. 65 kg gal getting her carotid. 50 of Roc... skin to skin 25 mins... 1/4 twitches.... barely skated through...

That reminds me of my first PP lap chole.

Can I get a vent to pacu, please. Had to walk the hall of shame in front of my new group with partners lined up all along the hall laughing their arses off.

 

[bigeyedfish]

VATs= NIBP + 16 G....

how about carotids?
I don't.. don't need them.. average brain ischemia time is less than 10 mins...
One guy is around 7 mins.. the slow guy is about 12 mins...

no monitoring no awake stuff...
just induce, relax them with sux and let them start). Skin to skin it about 40-45 mins... if you throw the roc you can get burned... all of our vascular studs use lots of local as well..

Wow. Ours are skin to skin minimum 2.5 hours for the slow guy, and 4-5 hours for the slower guy. We have no fast guy. I've done one 7 hour carotid. PP truly is the promised land.

 

[Noyac]

Wow. Ours are skin to skin minimum 2.5 hours for the slow guy, and 4-5 hours for the slower guy. We have no fast guy. I've done one 7 hour carotid. PP truly is the promised land.

😱

Holy Shiite

 

[drccw]

Wow. Ours are skin to skin minimum 2.5 hours for the slow guy, and 4-5 hours for the slower guy. We have no fast guy. I've done one 7 hour carotid. PP truly is the promised land.

When I was in residency it was like that also.. tons of monitoring, do we shunt, patch graft, etc....our guys transect, roll back the carotid and pluck out the clot. Takes 25 secs.... sewing the two ends back together takes the other 7 mins.

 

[Arch Guillotti]

That reminds me of my first PP lap chole.

Can I get a vent to pacu, please. Had to walk the hall of shame in front of my new group with partners lined up all along the hall laughing their arses off.

Hey it happens, I know someone that happened too except they induced with pavulon for a 30 minute case😎.

 

[jwk]

Hey it happens, I know someone that happened too except they induced with pavulon for a 30 minute case😎.

That would be me - 30 years ago - BEFORE anyone had those new nerve stimulator thingies, the way it was done was give the sux, wait for them to breathe (or cough) then give the pavulon (there was no roc). It was a VERY rude awakening to go from 3-5 hour open cholecystectomies at Grady in Atlanta, to a 20 minute PP cholecystectomy where the surgeon announced he was done about 5 minutes after I pushed 5mg of pavulon. Fortunately, I only made that mistake once.

 

[jwk]

Our VATS are probably 50/50 A-line or not, probably more with the slower and more likely to open surgeon, less with the faster less likely to open one. We rarely place a thoracic epidural unless the surgeon tells us the chance of opening is pretty high.

 

[Planktonmd]

That would be me - 30 years ago - BEFORE anyone had those new nerve stimulator thingies, the way it was done was give the sux, wait for them to breathe (or cough) then give the pavulon (there was no roc). It was a VERY rude awakening to go from 3-5 hour open cholecystectomies at Grady in Atlanta, to a 20 minute PP cholecystectomy where the surgeon announced he was done about 5 minutes after I pushed 5mg of pavulon. Fortunately, I only made that mistake once.

Hey JWK,
How long have you been in practice?
I did not realize that you were THAT old 😀

 

[jwk]

Hey JWK,
How long have you been in practice?
I did not realize that you were THAT old 😀

Finished in 81 - I'm a bona fide old fart.