Given a higher prevalence of smoking, pulmonary and cardiovascular
disease, and in many cases carcinoma, thoracic surgical patients experience a higher
risk for perioperative morbidity and mortality than that of broader surgical populations.
Careful preoperative assessment of functional status and a focus on optimizing
preexisting conditions prove critical to successful surgical outcomes. As open
thoracotomies decline in number, minimally invasive surgeries – including video
assisted thoracoscopy (VAT) and robotic surgical approaches pose new challenges for
intraoperative anesthetic management. Although double lumen endotracheal tubes
remain the most common approach to lung isolation, an array of newer endobronchial
blockers provide opportunities to facilitate surgery in patients with difficult airways as
well as those requiring lobar isolation to tolerate surgical resection. Surgery of the
esophagus and trachea continue to pose enormous challenges to both our intraoperative
management and postoperative care. In thoracic surgery, perhaps more so than any
other field, there is no doubt that anesthetic interventions in the preoperative,
intraoperative, and postoperative settings directly impact patient survival and recovery.
Evolving surgical techniques – particularly the move toward less invasive surgery –
will challenge our current dogma pertaining to anesthetic management of the thoracic
surgical patient – necessitating outcomes based research to further reduce adverse
perioperative outcomes and enhance surgical recovery.
Keywords: Bronchial Blocker, Bronchoscopy, Double Lumen Tube,
Esophagectomy, Hypoxemia, Lung Cancer, Mediastinoscopy, Non-small Cell
Lung Cancer, One Lung Ventilation, Paravertebral Block, Small Cell Lung
Cancer, Spirometry, Thoracotomy, Thoracic Anesthesia, Thoracic Epidural,
Tracheal Resection, Tracheal Stenosis, Univent, VAT’s.
