OPEN LUNG SURGERY Division of Pleural Cavity Disorders

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1 OPEN LUNG SURGERY Division of Pleural Cavity Disorders There are two lobes in the left lung and three lobes in the right lung. In the lungs, the bronchi divide into several small airways. These end in even smaller alveoli. The exchange of gases takes place in these alveoli. Oxygen in the alveolar air is released into the circulation while carbon dioxide is removed. Surgery can be used to treat several pulmonary and pleural conditions. An open surgery is performed either through left- or right-sided thoracotomy. Sometimes sternotomy, i.e. an incision in the middle of the chest, is also necessary. Surgeons try to save as much of the lung tissue as possible in lung operations. Despite this, breathing usually becomes harder and is at its weakest during the days following the operation. As lung tissue is not removed in pleural operations, breathing may even improve. You will have undergone several examinations before your operation. These examinations have assessed your illness and the condition of your organs. A university hospital may have also asked you to participate in one of its studies. You will always be asked for a written consent for the studies. Whether or not you decide to participate in a study, has no effect on the treatment you receive. OPERATION OF THE WARD Thorax and Esophagus Surgery Ward M11 is located in Meilahti Tower Hospital on the 11th floor. Access to the ward is through the main entrance of Meilahti Hospital. Take with you your personal items (toothbrush, shaver, indoor shoes/slippers) and any current prescriptions, asthma sprays and insulin. Each bed has a locker for storing personal items. We will give you the locker key and ask you to keep it safe. During your procedure or at your request the staff will take the key for safekeeping. We recommend that you do not bring any valuables (jewellery/studs) or large sums of money to the hospital. The treatment bill will be posted to your home address. On the day of the operation, family members can enquire after the patient in the afternoon by telephone, calling the ward directly on In order to minimise calling volumes, we ask that only one family member be appointed as a contact person. The best time to contact the operating surgeon is in the morning before the operations at 9 a.m. or after 2 p.m. Patients often feel tired when they return to the ward. We ask for your consideration in keeping visits and other contacts to a moderate level. Patients can use their own mobile phones normally. Each bed also has a landline telephone with a direct number. The ward visiting hours are between 1 p.m. and 7 p.m. every day. Visitors are not allowed to bring flowers to the ward. Persons with coughs and colds may not visit the ward. Visitors should wash their hands and rinse them using the disinfectant liquid (found by the ward corridor door and by each room door) before entering.

2 Preparing for the operation After the operation time has been confirmed, you will be asked to attend a laboratory appointment for blood tests and ECG. You can eat before the tests. You will be asked to attend a preoperational appointment where you meet a nurse, physiotherapist, surgeon and anaesthesiologist. You can bring a family member to the appointment if you wish. The appointments are held on Mondays and Wednesdays on the 14 th floor of the Meilahti Tower Hospital. Please reserve sufficient time for the appointment, preferably the whole day. Fill in the forms you were sent with the waiting list letter and bring them to the appointment. Your will be informed by telephone on your laboratory appointment and preoperational appointment times. Some patients will meet the surgeon, anaesthesiologist and physiotherapist only after they have been admitted to the ward. Please fill in the forms you received with the letter and return them at this time. Most patients are admitted to the hospital on the morning of the operation day. In the morning, take a shower at home and wash yourself carefully. Do not eat or drink anything after 2 a.m before your arrival at the hospital. Please avoid smoking and alcohol over a few days before your operation. Your anaesthesiologist will prescribe the medication for your operation day. You can take them normally with water. If you are using any of the following products, you must temporarily suspend your medication before the operation: Diabetes medication containing metformin hydrochloride (Diformin, Metforem, Metformin alpharma, Avandamet, Oramet hexal ) 2 days before the operation. If you are using any products affecting blood coagulation (such as Marevan, Plavix, Primaspan, Disperin ), please inform the nurse when your surgery appointment is confirmed. You may have to temporarily suspend your medication before the operation. The nurse will give you the instructions regarding the suspension. AT THE HOSPITAL On arrival at the hospital, the nurse will check the condition of your skin, and you are given hospital clothes and suitable antiembolic stockings, which will prevent the occurrence of venous thrombosis and pulmonary embolisms. The preparations also include the fitting of an epidural catheter. Under local anaesthesia, a thin catheter is placed between your vertebrae next to your spinal cord in the epidural space. The catheter will be used for postoperative pain management. About an hour before we take you to the operating unit, you will be given a preoperative sedative prescribed by your anaesthesiologist. If you are using dentures, please remove them at this time. After you have taken the sedative, you may not get up from bed by yourself. We will take you to the operating unit on a bed.

3 Postoperative care After the surgery, you will be moved to the recovery room. Depending on your condition, a few hours after the operation, you will be moved back to the ward. After major operations or when risk patients are in question, the monitoring takes place in the intermediate care unit. During the operation, you will be fitted with 1-2 drains, which remove any air and secretions from the operated areas. The drains are connected to a suction device next to your bed. The drains are usually removed 1-3 days after the operation. Other catheters related to your care include urine, venous and epidural catheters. Breathing and moving Intensive breathing exercises, blowing into a bottle and coughing ensure sufficient oxygen intake, keep your lungs open and prevent lung infections. You will begin with these on the day after the operation, guided by your physiotherapist. You will perform the exercises both independently and with assistance several times a day. A day after the surgery we will help you to sit up and get out of bed. You will first need assistance when moving about. Hygiene and wound care You must take good care of your normal hygiene, oral hygiene and hand washing. You can take a shower as soon as you feel well enough to do so, assisted by a nurse. You can shower the wounds with warm water but avoid rubbing them. Dressings will be changed daily for secreting wounds. Except for the wound area, you can use body lotions normally. Pain management Your anaesthesiologist will choose the pain management methods with you. The options are epidural pain management, a PCA pump and the traditional pain medication injected into the muscle. You will also be given an anti-inflammatory analgesic to support these methods. We use the scale of 0-10 for monitoring your pain management. This individual monitoring of the strength of the pain you feel will help the nursing staff assess the effectiveness and effects of pain management and decide the dosing of pain medication. Pain management must enable you to breathe deeply, cough, move around and sleep. Food and special measures You may usually eat on the day after the operation. A balanced diet usually meets the increased need for energy and nutrients. If you do not feel like eating and your portions are small, you may be given dietary supplements or intravenous feed. You may have constipation after the operation, caused by certain pain medications, insufficient fluid intake, small amount of dietary fibre and insufficient exercise. You may be given laxatives to help your stomach function.

4 Feelings The information about your illness and possible operation may come as a surprise. In these circumstances, you may feel insecure, tense and anxious. You should discuss your feelings with your physician and the nursing staff, as talking and receiving information will reduce your fears. DISCHARGE The average length of hospital treatment is 4-10 days. Patients enjoy getting back home after an operation. After your discharge, you must be able to move independently and manage with oral pain medication. During the first days at home, you may need help in your everyday tasks. Complete recovery is an individual process and will take weeks or months. At the time of your discharge, you will have discussions with your treating physician, nurses and physiotherapist. You will have an opportunity to discuss your working and functional capacity, income and social security with a social worker. Your family members can be involved in the home care guidance. Breathing and moving It is normal for your energy levels to fluctuate depending on the day. Exercise will help recovery. In the early stages, walking is a good form of exercise. Continue to do the breathing exercises and breathing into the bottle until you are able to move around more easily. Wound pain may cause neck, shoulder and upper back pains and tension. These can be relieved by doing relaxation stretches that increase mobility. After an open surgery, during the recovery we recommend that you avoid lifting heavy weights (for 4-6 weeks), sudden movements of your upper body and extremities, and driving. Hygiene and wound care Keep the wound clean by showering it daily until secretion has ended. Stiches or staples are removed days after the operation. It is normal that after an operation the wound area appears swollen. Should the swelling increase, the wound become red and tender or if you develop fever, please contact the health center or your physician. Sauna or swimming are not recommended before the stiches have been removed. Home medication We recommend that you take pain medication regularly for 2-4 weeks following the instructions provided separately. If the guideline pain medication is not strong enough or pain increases, contact the ward or your treating physician. Increase in pain may be caused by insufficient pain medication or a postoperative complication, such as an infection. At home, the injection treatment to prevent vascular obstructions (Klexane ) will often continue for about a month. You will be given instructions for giving the injections during your treatment period at hospital. Follow-up examination You will be given an appointment for a follow-up examination, which will take place after approximately a month from the operation. The examination includes blood tests and a chest x-ray. During the appointment, you will hear about the results of any biopsies taken during the operation and about the further treatment plan.

5 CONTACT INFORMATION Contact nurse, tel Thorax and Esophagus Surgery Ward M11, tel NOTE! We are a non-smoking hospital. We ask that those accompanying and visiting patients will also note this when visiting the hospital campus. STRECHES AFTER SURGERY 1. Lift your shoulders up, release and relax. 2. With your fingers on your shoulders: Roll your elbows back. And forward. 3. With your fingers interlocked on the back of your head, elbows on the side and neck extended: Pull your chin to your chest and bring your elbows to the front in front of your nose. Extend your back and shoulders and take your elbows to the side. 4. Fingers interlocked: In the front, extend your arms straight, lift them up and let them down again. 5. Sitting down, fingers on your shoulders: Twist your upper body to the left and right. Follow the movement with your eyes. 6. Sitting down, arms relaxed on the side: Flex your upper body to the left and right repeatedly. Keep your movements calm and stretch at the same time. Keep breathing evenly. Repeat each movement as many times as you can, according to your condition.