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Post-Pneumonectomy Positioning — FRCA Final MCQ

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ModerateCardiothoracic AnaesthesiaPost-Pneumonectomy PositioningFRCA Final

A 65-year-old man (ASA III) undergoes a right pneumonectomy. Post-operatively in ICU, he is placed on the operative (right) side for positioning. Why is this position preferred after pneumonectomy?

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Correct answer: C — It reduces pain from the thoracotomy incision

After pneumonectomy, the operative (pneumonectomy) side should be dependent when positioned laterally. This prevents: (1) fluid or blood from the pneumonectomy space flooding the remaining lung via the bronchial stump, (2) mediastinal shift towards the remaining lung (which could compress it and the contralateral pulmonary vasculature), and (3) aspiration into the remaining lung. The pneumonectomy space gradually fills with serous fluid over weeks-months. A chest drain is NOT routinely placed after pneumonectomy (to allow the space to fill and prevent mediastinal shift).

Reference: RCOA – 2023 – Cardiothoracic post-operative care; ERS/ESTS – 2019 – Lung resection guidelines