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. 2020 Oct 23:9:31.
doi: 10.1186/s13741-020-00159-z. eCollection 2020.

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

Federico Piccioni  1 , Andrea Droghetti  2 , Alessandro Bertani  3 , Cecilia Coccia  4 , Antonio Corcione  5 , Angelo Guido Corsico  6 , Roberto Crisci  7 , Carlo Curcio  8 , Carlo Del Naja  9 , Paolo Feltracco  10 , Diego Fontana  11 , Alessandro Gonfiotti  12 , Camillo Lopez  13 , Domenico Massullo  14 , Mario Nosotti  15 , Riccardo Ragazzi  16 , Marco Rispoli  17 , Stefano Romagnoli  18   19 , Raffaele Scala  20 , Luigia Scudeller  21 , Marco Taurchini  9 , Silvia Tognella  22 , Marzia Umari  23 , Franco Valenza  1   24 , Flavia Petrini  25 ; AIPO, Associazione Italiana Pneumologi Ospedalieri; SIAARTI, Società Italiana di Anestesia Analgesia Rianimazione Terapia Intensiva; SIC, Società Italiana di Chirurgia; SICT, Società Italiana di Chirurgia Toracica; SIET, Società Italiana di Endoscopia Toracica; SIP, Società Italiana di Pneumologia
Affiliations

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

Federico Piccioni et al. Perioper Med (Lond). .

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.

Keywords: Anesthesia; Intraoperative care; Pneumonectomy; Postoperative care; Practice guideline; Thoracic surgery.

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Conflict of interest statement

Competing interestsA Bertani, A Corcione, C Coccia, A Corsico, R Crisci, C Curcio, C Del Naja, A Droghetti, P Feltracco, D Fontana, A Gonfiotti, C Lopez, D Massullo, M Nosotti, R Ragazzi, M Rispoli, R Scala, S Tognella, M Taurchini, M Umari, and F Valenza report no conflict of interest. F Petrini reports personal fees from MSD, unrelated to the submitted work. F Piccioni reports personal fees and non-financial support from MSD Italia, and Edwards Lifescience, unrelated to the submitted work. S Romagnoli reports personal fees and non-financial support from MSD Italia, Masimo, Medtronic, Pall, Medigas, and Vygon, unrelated to the submitted work.

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