Abstract
Initial attempts at anesthesia for thoracic surgery in the late 1800s were all made with non-intubated patients breathing air-ether spontaneously through a mask. The lung collapse and pendelluft effect (see Chap. 1) when the surgeon opened the chest led to hypoxemia, hypercapnia, and hemodynamic instability [1]. The first major advance in thoracic anesthesia came in the first decade of 1900 when Sauerbruch developed the negative pressure chamber for thoracic anesthesia (see Fig. 25.1) [2]. Non-intubated patients continued to breathe air-ether spontaneously, but the negative pressure in the chamber (which excluded the patients head) prevented the lung in the open hemithorax from collapsing. However, this technique did not deal well with the problem of secretions. This was a major drawback since most of the chest surgery in the early part of the past century was for infectious causes.
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