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. 2020 Dec 1;9(1):37.
doi: 10.1186/s13741-020-00168-y.

Recommendations from the Italian intersociety consensus on Perioperative Anesthesia Care in Thoracic surgery (PACTS) part 1: preadmission and preoperative 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  24   25 , Flavia Petrini  26 ; AIPO, Associazione Italiana Pneumologi Ospedalieri; SIAARTI, Società Italiana di Anestesia Analgesia Rianimazione e 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 Anesthesia Care in Thoracic surgery (PACTS) part 1: preadmission and preoperative care

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

Abstract

Introduction: Anesthetic care in patients undergoing thoracic surgery presents specific challenges that necessitate standardized, multidisciplionary, and continuously updated guidelines for perioperative care.

Methods: A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, comprising 24 members from 19 Italian centers, was established to develop recommendations for anesthesia practice in patients undergoing thoracic surgery (specifically lung resection for cancer). The project focused on preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and PubMed and Embase 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 Preventative Services Task Force criteria.

Results: Recommendations for preoperative care focus on risk assessment, patient preparation (prehabilitation), and the choice of procedure (open thoracotomy vs. video-assisted thoracic surgery).

Conclusions: These recommendations should help pulmonologists to improve preoperative management in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.

Keywords: Perioperative care; Pneumonectomy; Practice guideline; Risk assessment; Thoracic surgery.

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Conflict of interest statement

A 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.

References

    1. Agostini PJ, Lugg ST, Adams K, Smith T, Kalkat MS, Rajesh PB, et al. Risk factors and short-term outcomes of postoperative pulmonary complications after VATS lobectomy. J Cardiothorac Surg. 2018;13:28. doi: 10.1186/s13019-018-0717-6. - DOI - PMC - PubMed
    1. Ahn HJ, Kim JA, Lee AR, Yang M, Jung HJ, Heo B. The risk of acute kidney injury from fluid restriction and hydroxyethyl starch in thoracic surgery. Anesth Analg. 2016;122:186–193. doi: 10.1213/ANE.0000000000000974. - DOI - PubMed
    1. Akiba T, Marushima H, Hiramatsu M, Matsudaira H, Nakanishi K, Takeyama H, et al. Video-assisted thoracoscopic surgery for non-small cell lung cancer in patients on hemodialysis. Ann Thorac Cardiovasc Surg. 2010;16:40–44. - PubMed
    1. Aldecoa C, Bettelli G, Bilotta F, Sanders RD, Audisio R, Borozdina A, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol. 2017;34:192–214. doi: 10.1097/EJA.0000000000000594. - DOI - PubMed
    1. Baldvinsson K, Oskarsdottir GN, Orrason AW, Halldorsson H, Thorsteinsson H, Sigurdsson MI, et al. Resection rate and operability of elderly patients with non-small cell lung cancer: nationwide study from 1991 to 2014. Interact Cardiovasc Thorac Surg. 2017;24:733–739. doi: 10.1093/icvts/ivw415. - DOI - PubMed