Modern Anesthetic Techniques for Thoracic Operations

Abstract

Continuing advances in anesthesiology enable surgeons to perform more and more complex operations. Nowhere is this relation more important than for the patient undergoing thoracic surgery. Specialized anesthetic techniques including safe lung separation, the maintenance of oxygenation during selective one-lung ventilation, and effective postoperative analgesia allow procedures such as lung volume reduction surgery and lung transplantation to be performed routinely. This paper reviews modern clinical practices in the field of thoracic anesthesia.

Update on one-lung ventilation: the use of continuous positive airway pressure ventilation and positive end-expiratory pressure ventilation – clinical application

“…Therefore, guidelines were published in multiple papers and books, many of them based on the studies by Katz et al [13] who found that large tidal volumes produced the highest arterial oxygen tension (PaO 2 ) during OLV, leading to the recommendation that tidal volume during OLV should be as high as in two-lung ventilation (i.e., 8-12 ml/kg) [14]. However, ALI is now known to be a problem after thoracic surgery [15], which may be augmented or ameliorated by the strategies chosen for OLV.…”

Step-by-step clinical management of one-lung ventilation: Continuing Professional Development

“…These recommendations were based on studies showing improved oxygenation with a larger Vt. 1,2 In the last decade, however, two significant changes have impacted the management of OLV: the recognition of OLV-induced acute lung injury (ALI) and the increasing popularity of VATS as a surgical technique. Hypoxemia, previously the primary concern of anesthesiologists during OLV, has become less frequent due to improved lung isolation, newer anesthetic agents, and better ventilation management.…”

Protective Ventilatory Approaches to One-Lung Ventilation: More than Reduction of Tidal Volume

“…Atelectasis formation has been demonstrated to be connected with decreased arterial oxygen tension of more than 50 % and increased intrapulmonary shunt of [11 % during OLV [45]. Therefore, a traditional approach to mechanical ventilation during OLV [46,47] included the application of relatively high tidal volumes in the range of 10-12 ml/kg with zero PEEP in the dependent ventilated lung to maintain hypoxic pulmonary vasoconstriction and thus to overcome hypoxemia during OLV.…”