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Intravenous Anesthesia for Thoracic Procedures

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Principles and Practice of Anesthesia for Thoracic Surgery

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Abstract

Total intravenous anesthesia (TIVA) is indicated for procedures in which inhalational anesthetics may not be safely or effectively delivered, including endobronchial procedures using flexible or rigid bronchoscopy and proximal airway-disrupting surgeries. TIVA may also be beneficial in lung volume reduction surgery, lung transplantation, and thymectomy. TIVA is safer and more practical for thoracic procedures performed outside of the operating room, such as off-site locations, military field, or impoverished areas of the world. Target-controlled infusion (TCI) is a relatively new delivery system for TIVA that is based on pharmacokinetic models to optimize intravenous anesthetic delivery. TCI has many advantages over conventional calculator pumps but is not currently available in the United States. Because well-established MAC-type systems for intravenous anesthetics are not available, anesthetic depth monitors are useful in monitoring patients undergoing TIVA. Propofol, dexmedetomidine, ketamine, lidocaine, and remifentanil may be used in combination with anesthetic depth monitoring to execute an effective TIVA regimen. This chapter reviews the balanced TIVA technique currently used at the University of Texas MD Anderson Cancer Center.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Javier D. Lasala

  2. Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Cardiothoracic Anesthesia Group, Unit 409, Faculty Center, Houston, TX, USA

    Ron V. Purugganan

Authors
  1. Javier D. Lasala
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Correspondence to Javier D. Lasala .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, University of Toronto, Toronto, ON, Canada

    Peter Slinger

Clinical Case Discussion: TIVA for Thoracic Procedures (Fig. 12.2)

Clinical Case Discussion: TIVA for Thoracic Procedures (Fig. 12.2)

Fig. 12.2
figure 2

Left: rigid bronchoscopy view of an intratracheal mass obstructing the airway. Right: trachea after stent placement

Full size image

Case

A 52-year-old male smoker diagnosed with advanced pulmonary squamous cell carcinoma (stage IV) presents with progressive shortness of breath and orthopnea. Bronchoscopy reveals a distal tracheal mass causing moderate to severe airway obstruction. He is scheduled for rigid bronchoscopy with stent placement to lessen tracheal obstruction. This procedure will be performed in the pulmonary procedure suite.

Questions

  1. 1.

    What are the disadvantages of using volatile anesthetics in this operation?

    For discussion, see section “TIVA in special thoracic surgical conditions” and “Scenarios that benefit from TIVA.”

  2. 2.

    What are the advantages of using (1) propofol, (2) dexmedetomidine, (3) remifentinil in this patient?

    For discussion, see section “Intravenous anesthetic agents.”

  3. 3.

    What is the basic concept of target controlled infusion, and how is it advantageous over manually controlled infusion?

    For discussion, see section “Infusion systems.”

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Lasala, J.D., Purugganan, R.V. (2019). Intravenous Anesthesia for Thoracic Procedures. In: Slinger, P. (eds) Principles and Practice of Anesthesia for Thoracic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-00859-8_12

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  • DOI: https://doi.org/10.1007/978-3-030-00859-8_12

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  • Online ISBN: 978-3-030-00859-8

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