Decided to make some notes on small topics that I keep on forgetting: steroid conversion and perioperative therapy. I used to reference this particular clinical guideline for perioperative steroids (which is simpler to just follow), but it turns out that there's something more current published in Anesthesiology (more complex in deriving rationale of recommendations).
And lately I've been involved with a few "thoracic cases":
1) 30 year old woman with an anterior mediastinal mass with subsequent right bronchial obstruction and subsequent right lower lobe collapse and pericardial effusion with tamponade (with symptomatic disease) was referred for workup for SVC stenting and mediastinal biopsy. Managed by successfully tapping the effusion with just local anesthesia (after brief spine supine position), followed by inhalational anesthesia and intubation for the biopsy and stenting. The patient was successfully extubated without any hemodynamic instability.
2) A 50 year old woman with a left upper lobe aspergilloma was referred for workup for lobectomy. Effort tolerance was reduced with orthopnea present. PFT showed FEV1 of only 1.2 L, ppo FEV1 < 40, ppo DLCO 46. Decision made to refer for CPET further stratify the risk.
3) A 60 year old man with inoperable stage T4 NSC lung cancer was referred for workup for craniotomy and excision of brain metastasis. The right main bronchus was encased within the tumor, with upper lobe collapse and some disease of the right lower lobe too. FEV1 was only 1.17 L with PEFR 352 ml/s (severe obstruction). No positional problems, but effort tolerance is reduced. Planned for further discussion regarding risk and benefits of surgery.
So here are my old notes on lung function testing which was somehow still useful to refer to. I wish I would be the one to review these patients again as personal follow up.