The physician has scheduled a client for a left pneumonectomy. The position that will most likely be ordered postoperatively for his is the:
A. Nonoperative side or back
B. Operative side or back
C. Back only
D. Back or either side.
Correct Answer: B. Operative side or back
Following pneumonectomy, the client is positioned on the operative side to allow the fluid left in the lung space to consolidate and avoid the heart from shifting to the operative side. Pneumonectomy is defined as the surgical removal of the entire lung. Extrapleural pneumonectomy is an expanded procedure that also involves resection of parietal and visceral pleura, ipsilateral hemidiaphragm, pericardium, and mediastinal lymph nodes.
Option A: The patient is then usually positioned in a lateral decubitus position with the operating side up. Proper positioning of the DLT or the bronchial blocker is usually reconfirmed with the FOB, and single lung ventilation is then started. Care should be taken to ensure proper positioning to avoid perioperative nerve injury.
Option C: Following pneumonectomy, pulmonary functions decrease but are usually less than anticipated for removal of 50% of lung, especially for residual volume, and this may be explained by overexpansion of the remaining lung tissue. FEV1, FVC, DLCO, and lung compliance decrease. Airway resistance increases.
Option D: Patients with no disease in the remaining lung usually do have normal SaO2, PO2, and PaCO2 at rest. A chest X-ray immediately following pneumonectomy usually shows the trachea in the midline and the postpneumonectomy space to be filled with air. Later, that space becomes filled gradually with fluid at a rate of 1 to 2 intercostal spaces/day. The ipsilateral diaphragm becomes elevated, and the mediastinum is gradually shifted towards the operative side.
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