Thoracic Anesthesia

Given a higher prevalence of smoking, pulmonary and cardiovascular disease, and in many cases carcinoma, thoracic surgical patients experience a higher risk for perioperative morbidity and mortality than that of broader surgical populations. Careful preoperative assessment of functional status and a focus on optimizing preexisting conditions prove critical to successful surgical outcomes. As open thoracotomies decline in number, minimally invasive surgeries – including video assisted thoracoscopy (VAT) and robotic surgical approaches pose new challenges for intraoperative anesthetic management. Although double lumen endotracheal tubes remain the most common approach to lung isolation, an array of newer endobronchial blockers provide opportunities to facilitate surgery in patients with difficult airways as well as those requiring lobar isolation to tolerate surgical resection. Surgery of the esophagus and trachea continue to pose enormous challenges to both our intraoperative management and postoperative care. In thoracic surgery, perhaps more so than any other field, there is no doubt that anesthetic interventions in the preoperative, intraoperative, and postoperative settings directly impact patient survival and recovery. Evolving surgical techniques – particularly the move toward less invasive surgery – will challenge our current dogma pertaining to anesthetic management of the thoracic surgical patient – necessitating outcomes based research to further reduce adverse perioperative outcomes and enhance surgical recovery.

Keywords: Bronchial Blocker, Bronchoscopy, Double Lumen Tube, Esophagectomy, Hypoxemia, Lung Cancer, Mediastinoscopy, Non-small Cell Lung Cancer, One Lung Ventilation, Paravertebral Block, Small Cell Lung Cancer, Spirometry, Thoracotomy, Thoracic Anesthesia, Thoracic Epidural, Tracheal Resection, Tracheal Stenosis, Univent, VAT’s.