• Thoracic Anaesthesia
• Indications for OLV
• Protection of healthy lung
• Infection
• Lung lavage
• Massive haemorrhage
• Preventing ventilation to one lung
• Bronchopleural fistula
• Risk of rupture eg large bulla
• Surgical procedures
• VAT
• Surgery to proximal bronchial tree
• Improve surgical access
• Pneumonectomy
• Lobectomy
• Oesophagectomy
• Spinal surgery
• Lung carcinoma resection
• 3 conditions need to be met:
  1. Non-small cell
  2. Surgically resectable
  3. Patient wants surgery
  
• High risk
  pCO₂ >6kPa
  SpO₂ <90%
  Desaturation >4% with exercise
• FEV1 of >1.5L for Lobectomy
  FEV1 of >2L for pneumonectomy
• Predicted post-op values
  Lobectomy: bronchopulmonary segments to left out of of total number (19) x pre-op FEV1.
  Quantitative V/Q scanning using technetium labelled macroaggregates gives more accurate results.
  Aim for PPO-FEV1 of 0.7-0.8L
• CPEX testing
• Patients with major CV risk factors need cardiology opinion
• Within 6 months of MI
  USA
  CCF
  High degree AV block
  Symptommatic arrhythmias
  Severe valvular disease
• Routine PFTs
• FEV1 >1.5L suitable for Lobectomy
  FEV1 >2L suitable for pneumonectomy
• FEV1 <1.5L (Lobectomy)
  FEV1 <2L (pneumonectomy)
• Quantitative lung scan
• % ppo FEV1 >40%
  % ppo TLCO >40%
• SURGERY
  Proceed
• % ppo FEV1 <40%
  % ppo TLCO <40%
• Exercise testing
• VO₂ max >15ml/kg/min
• VO₂ max <15ml/kg/min
• High risk