53 - Anesthesia for Thoracic Surgery

Abstract

Thoracic anesthesia encompasses a wide variety of diagnostic and therapeutic procedures involving the lungs, airways and other intrathoracic structures. As the patient population presenting for non-cardiac thoracic surgery has evolved so have the anesthetic techniques to manage these patients. Thoracic surgery at the beginning of the last century was primarily for infectious indications (lung abscess, bronchiectasis, empyema). Although these cases still present for surgery in the post-antibiotic era, now the commonest indications are related to malignancies (pulmonary, esophageal and mediastinal). In addition, the last two decades has seen the beginnings of surgical therapy for end-stage lung diseases with procedures such as lung transplantation and lung volume reduction. Fundamental to anesthetic management for the majority of thoracic procedures are two techniques: lung isolation to facilitate surgical access within the thorax, and management of one lung anesthesia. This chapter will initially discuss pre-anesthetic assessment for thoracic surgery, then will outline intraoperative management principles common to most thoracic surgical procedures, then will discuss specific anesthetic considerations in common and less-common surgical operations and will finish with a description of postoperative management issues in thoracic surgical patients.