Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care

Abstract

Introduction Anesthetic care in patients undergoing thoracic surgery presents specific challenges that require a multidisciplinary approach to management. There remains a need for standardized, evidence-based, continuously updated guidelines for perioperative care in these patients. Methods A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, was established to develop recommendations for anesthesia practice in patients undergoing elective lung resection for lung cancer. The project addressed three key areas: preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventive Services Task Force criteria. Results Recommendations for intraoperative care focus on airway management, and monitoring of vital signs, hemodynamics, blood gases, neuromuscular blockade, and depth of anesthesia. Recommendations for postoperative care focus on the provision of multimodal analgesia, intensive care unit (ICU) care, and specific measures such as chest drainage, mobilization, noninvasive ventilation, and atrial fibrillation prophylaxis. Conclusions These recommendations should help clinicians to improve intraoperative and postoperative management, and thereby achieve better postoperative outcomes in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.

Thoracic Anesthesia during the COVID-19 Pandemic: 2021 Updated Recommendations by the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) Thoracic Subspecialty Committee

“…We electronically searched specialist thoracic anesthesia societies’ and groups’ previous recommendations on the perioperative management principles for patients with potential SARS-CoV-2 infection focusing on unique aspects of thoracic anesthesia. 5 , 6 , 7 , 8 , 9 …”

“…We electronically searched specialist thoracic anesthesia societies' and groups' previous recommendations on the perioperative management principles for patients with potential SARS-CoV-2 infection focusing on unique aspects of thoracic anesthesia. [5][6][7][8][9] C. The thoracic subcommittee of EACTIC has performed a survey exploring changes in clinical practice occurring during the COVID-19 era to better understand how practice has evolved and to aid development of further general recommendations on the perioperative management of patients with ‗suspected' or ‗diagnosed' COVID-19 undergoing thoracic surgery (unpublished). This survey included a 36-item questionnaire to explore the changes in daily practice during the COVID-19 pandemic, emphasizing the general aspects of anesthesia, airway management and lung isolation, ventilation, and postoperative analgesia.…”

“…If the application of CPAP is deemed necessary, we recommend incorporating an antiviral filter to the operative lung. 7,9 In some cases, application of inhaled nitric oxide (iNO) or even extracorporeal assist systems (for oxygenation and/or carbon dioxide removal) can be indicated. These cases are beyond the scope of this review.…”

“…If the application of CPAP is deemed necessary, we recommend incorporating an antiviral filter to the operative lung. 7 , 9 …”

Special Anesthesiologic Considerations in Robot-Assisted Thoracic Surgery

“…For airway separation, double-lumen tubes or bronchial blocking devices are applied [40,41]. In studies no advantages of either device have been shown [42][43][44]. The decision how to instrument the airways depends on (1) patient-specific factors (e.g., difficult airway), (2) local hospital standards, and (3) practical experience of the individual anesthesiologist.…”