The pleural space, or pleural cavity, in the chest is surrounded by a thin membrane, called the pleura, that is folded over on itself. A little fluid in this space between these membranes is quite normal, but in the event of a pleural effusion — when the fluid begins to build up — a medical procedure called a pleurodesis may be necessary to prevent breathing problems. This procedure is often performed to prevent a recurrence of an accumulation of fluid due to certain medical conditions. A pleurodesis can be done either using general anesthesia or local anesthesia, and the lungs are irritated using either a chemical or mechanical means. This irritation will cause the membranes of the pleural space to become irritated and expand, thereby leaving little or no room for excess fluid.
Cancer is considered to be the most common cause of pleural effusion. Cancer of the lungs, lymph nodes, and breasts can all cause pleural effusion, which can put pressure on the chest and lungs and prevent them from expanding to their full capacity. This can then make it hard to breathe. After a chest x-ray is done to confirm the diagnosis, a pleurodesis is generally the next step. Other common causes of pleural effusion include heart, liver, or kidney failure, along with respiratory diseases such as pneumonia.
A pleurodesis done using general anesthesia is typically done on the operating table, while a procedure done using just a local anesthetic is typically done in the patient's hospital room. In both types of procedures, an incision is made between the patient's ribs, and a drain is attached to rid the pleural space of all or most of the fluid. A chemical pleurodesis is usually done using talc, while a mechanical pleurodesis is often done using some sort of rough surface.
First used in 1935, inserting talc into the pleural space is the most popular method of performing a pleurodesis. It is often considered to have the best success rate. Other chemicals used during the procedure can also include doxycycline, quinacrine, bleomycin, and povidone iodine.
During a chemical pleurodesis, an irritant, usually talc, is inserted into the pleural space. In some procedures, depending on the anesthesia used, the patient may be rolled, or asked to roll from side to side and even sit up. This will evenly distribute the irritant and ensure that it covers the entire space. The irritated membranes will then become inflamed and swell.
After this procedure, there is often moderate to severe pain, especially around the incision area. Fluids may build up in the lungs again, especially if the patient takes any kind of anti-inflammatory drug for pain, so patients are prescribed a pain reliever to ease any discomfort. Fevers are also reported by many of the patients who have this type of procedure done, and it is considered to be a relatively common side effect.