The main goal of enhanced recovery program after thoracic surgery is to minimize stress response, reduce postoperative pulmonary complications, and improve patient outcome, which will in addition decrease hospital stay and reduce hospital costs. As minimally invasive technique, video-assisted thoracoscopic surgery represents an important element of enhanced recovery program in thoracic surgery. Anesthetic management during preoperative, intraoperative and postoperative period is essential for the enhanced recovery. In the era of enhanced recovery protocols, non-intubated thoracoscopic procedures present a step forward. This article focuses on the key elements of the enhanced recovery program in thoracic surgery. Having reviewed recent literature, the authors highlight potential procedures and techniques that might be incorporated into the program.

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Ventilacija jednog plućnog krila se koristi iz različitih hirurških i ne-hirurških razloga. Ovaj tip ventilacije nosi sa sobom određene rizike za razvoj ventilaciono/perfuzionih poremećaja različitog stepena povezanim sa lateralnim dekubitalnim položajem, jednostranom plućnom ventilacijom i otvaranjem grudnog koša. Kako je hipoksemija jedna od posledica jednostrane plućne ventilacije, različite strategije ventilacije se preporučuju u cilju njene prevencije i lečenja. Strategija uključuje određene manevre na ventilišućem i ne-ventilišućem plućnom krilu kao i upotrebu određenih lekova koji mogu modulirati i intenzivirati fenomen jedinstven za plućnu cirkulaciju-hipoksičnu plućnu vazokontrikciju (HPV). Ključne reči: hipoksemija, jednostrana ventilacija pluća, hipoksična plućna vazokonstrikcija Sumarry Lung isolation is used for various surgical and non-surgical reasons. This type of ventilation carries the risk for various degrees of ventilation/perfusion mismatch associated with lateral decubitus position, one-lung ventilation (OLV) and opened chest. According to this, hypoxemia is common consequence of OLV. Among various recommended ventilation strategies in order to prevent hypoxemia, protective ventilation with lower tidal volumes and applied positive end-expiratory (PEEP) pressure give some promising results. Adequate treatment and possibility to predict hypoxemia during OLV is very important for reducing morbidity and mortality. Treatment includes ventilator strategies on both, ventilated and non-ventilated lung and applied therapy, which can influence and modulate the magnitude of phenomenon unique for lung circulation-hypoxic pulmonary vasoconstriction (HPV).

Anesthesiologists are in daily contact with patients who are preparing for noncardiosurgical interventions, and who have an increased risk of developing cardiovascular complications in the perioperative period. Less than 1% of patients develop perioperative IM, however the mortality rate for this complication ranges from 30% to 50%. The first step is the identification of patients in whom the cardiovascular system is a potential source of complications during and after surgery. The risk of perioperative complications depends on the condition of the patient prior to the intervention, prevalence of comorbidities and the extent, urgency and duration of the operation. The modern concept of preoperative preparation of patients for major non-cardiac surgery is now based on the measurement and interpretation of various biomarkers as prognosticators of perioperative cardiovascular complications and fatal outcomes. For these purposes, high-performance natriuretic peptides and cardiac troponins are used. There is evidence that the levels of cardiac-specific troponins, and especially highsensitivity troponin T(hs-TnT), have been elevated in patients with various cardiovascular diseases such as: cardiac insufficiency and coronary disease, reflecting in this way a lower degree of damage that can be of significant benefit in the preoperative assessment of cardiovascular morbidity and mortality in elective, major non-cardiac surgery. Although various natriuretic peptides have been in the greatest focus of interest as prognostic biomarkers over the past decade, the interest in other circulating biomarkers, such as midregional proadrenomedulin (MR-pro ADM), has been growing in recent years. This new biomarker represents a stable circulating peptide, and is the prohormone of adrenomedulin, a hormone responsible for regulating the volume of circulating fluid and electrolyte homeostasis. Elevated levels of this biomarker are seen in heart failure of different etiologies and can therefore serve as a useful prognostic marker of the development of perioperative cardiovascular complications in patients with different cardiovascular comorbid conditions.

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