Which Anesthesia Regimen Should Be Used for Lung Surgery?

Abstract

The aim of this review is to assess the particularities of general anesthesia for patients undergoing lung surgery and one-lung ventilation (OLV), and to suggest the ideal anesthesia regimen based on the current literature. Pulmonary surgery is often performed using OLV. This is accompanied by specific physiological challenges and risks, principally hypoxemia and acute lung injury (ALI). Anesthetic strategies to prevent ALI include close adjustment of mechanical ventilation settings using low tidal volumes (< 6 ml/kg for OLV), positive end-expiratory pressure between 5 and 10 cmH2O, and the minimum FiO2 required, as well as the use of volatile anesthetics, which have anti-inflammatory properties. For thoracotomies, combined general and neuraxial anesthesia are recommended. So far, there is still no evidence if certain anesthetics have a beneficial effect on tumor outcome in lung cancer surgery. Protective ventilation and the use of volatile anesthetics are recommended to diminish the occurrence of ALI in lung surgery patients, for thoracotomies in combination with neuraxial anesthesia. Both general and local anesthetics can have an effect on growth and recurrence of some cancer types, and their specific effect on lung cancer must be further clarified.