Thorascopic manipulation of the lung and mediastinal structures may result in cardiac arrhythmias. Electrical current from the cautery may initiate atrial or ventricular tachycardia or fibrillation. Sinus tachycardia may occur secondary to CO2 retention when insufflation techniques are used. A mediastinal shift with compromise of venous return to the heart may initiate a reflex sinus tachycardia. Vagal stimulation and air or CO2 embolism with insufflation techniques may lead to bradycardia or asystole. Hypotension may result from mediastinal tamponade, air or CO2 embolization, or hemorrhage. Hypercarbia, which results from CO2 insufflation, can result in hypertension and tacjycardia. Hemorrhage from the intracostal vessels may occur at the site of trocar placement.
Exposure of the thoracic sympathetic chain requires retraction of the lung apex away from the posterior chest wall. Improper instrumentation and the frequent presence of apical blebs or adhesions may result in a parenchymal lung injury and postoperative pneumothorax or persistent air leak.
The operative procedure and the potential complications of hemorrhage, arrythmia, hypotension, pneumothorax, pain, persistent air leak, inability to complete the procedure thoracoscopically, and death are reviewed with the patient.
Haimovici's Vascular Surgery
Edition: 5, illustrated
Published by Blackwell Publishing, 2004
