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Anesthesia

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Minimally Invasive Thoracic and Cardiac Surgery

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Abstract

This chapter aims to summarize (i) monitoring, (ii) airway and ventilation strategy, and (iii) anesthetic implications and perioperative analgesia. Important aspects of lung separation and one-lung ventilation are knowledge of distal airway anatomy, fiber-optic bronchoscopy, and correct interpretation of radiological chest imaging. Double-lumen tubes or bronchial blockers controlled by fiber-optic bronchoscopy are suitable for lung separation and one-lung ventilation. Hypoxic pulmonary vasoconstriction reduces the right-to-left shunt during one-lung ventilation. No advantage could be found for intravenous or inhalational anesthesia in terms of intraoperative oxygenation, but sevoflurane might reduce inflammatory response and postoperative adverse events. Thoracic paravertebral block provides effective perioperative pain treatment with fewer incidences of side effects compared with epidural analgesia.

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References

  1. The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–8

    Google Scholar 

  2. Bassi A, Milani WR, El Dib R et al (2008) Intravenous versus inhalation anaesthesia for one-lung ventilation. Cochrane Database Syst Rev: CD006313

    Google Scholar 

  3. Benumof JL (1985) One-lung ventilation and hypoxic pulmonary vasoconstriction: implications for anesthetic management. Anesth Analg 64:821–833

    Article  PubMed  CAS  Google Scholar 

  4. Brodsky JB (2004) Fiberoptic bronchoscopy need not be a routine part of double-lumen tube placement. Curr Opin Anaesthesiol 17:7–11

    Article  PubMed  Google Scholar 

  5. Brodsky JB, Lemmens HJ (2003) Left double-lumen tubes: clinical experience with 1,170 patients. J Cardiothorac Vasc Anesth 17:289–298

    Article  PubMed  Google Scholar 

  6. Campos JH (2009) Fast track in thoracic anesthesia and surgery. Curr Opin Anaesthesiol 22:1–3

    Article  PubMed  Google Scholar 

  7. Campos JH (2009) Update on selective lobar blockade during pulmonary resections. Curr Opin Anaesthesiol 22:18–22

    Article  PubMed  Google Scholar 

  8. Campos JH (2010) Lung isolation techniques for patients with difficult airway. Curr Opin Anaesthesiol 23:12–17

    Article  PubMed  Google Scholar 

  9. Casati A, Mascotto G, Iemi K et al (2005) Epidural block does not worsen oxygenation during one-lung ventilation for lung resections under isoflurane/nitrous oxide anaesthesia. Eur J Anaesthesiol 22:363–368

    Article  PubMed  CAS  Google Scholar 

  10. Chow MY, Liam BL, Thng CH et al (1999) Predicting the size of a double-lumen endobronchial tube using computed tomographic scan measurements of the left main bronchus diameter. Anesth Analg 88:302–305

    PubMed  CAS  Google Scholar 

  11. Cinnella G, Grasso S, Natale C et al (2008) Physiological effects of a lung-recruiting strategy applied during one-lung ventilation. Acta Anaesthesiol Scand 52:766–775

    Article  PubMed  CAS  Google Scholar 

  12. Cohen E (2004) Double-lumen tube position should be confirmed by fiberoptic bronchoscopy. Curr Opin Anaesthesiol 17:1–6

    Article  PubMed  Google Scholar 

  13. Daly DJ, Myles PS (2009) Update on the role of paravertebral blocks for thoracic surgery: are they worth it? Curr Opin Anaesthesiol 22:38–43

    Article  PubMed  Google Scholar 

  14. De Conno E, Steurer MP, Wittlinger M et al (2009) Anesthetic-induced improvement of the inflammatory response to one-lung ventilation. Anesthesiology 110:1316–1326

    Article  PubMed  Google Scholar 

  15. Dumans-Nizard V, Liu N, Laloe PA et al (2009) A comparison of the deflecting-tip bronchial blocker with a wire-guided blocker or left-sided double-lumen tube. J Cardiothorac Vasc Anesth 23:501–505

    Article  PubMed  Google Scholar 

  16. Eberle B, Weiler N, Vogel N et al (1999) Computed tomography-based tracheobronchial image reconstruction allows selection of the individually appropriate double-lumen tube size. J Cardiothorac Vasc Anesth 13:532–537

    Article  PubMed  CAS  Google Scholar 

  17. Fiorelli A, Vicidomini G, Laperuta P et al (2010) Pre-emptive local analgesia in video-assisted thoracic surgery sympathectomy. Eur J Cardiothorac Surg 37: 588–593

    Article  PubMed  Google Scholar 

  18. Fischer GW, Cohen E (2010) An update on anesthesia for thoracoscopic surgery. Curr Opin Anaesthesiol 23:7–11

    Article  PubMed  Google Scholar 

  19. Fukuoka N, Iida H, Akamatsu S et al (2009) The association between the initial end-tidal carbon ­dioxide difference and the lowest arterial oxygen tension value obtained during one-lung anesthesia with propofol or sevoflurane. J Cardiothorac Vasc Anesth 23:775–779

    Article  PubMed  CAS  Google Scholar 

  20. Grichnik KP, Shaw A (2009) Update on one-lung ventilation: the use of continuous positive airway pressure ventilation and positive end-expiratory pressure ventilation – clinical application. Curr Opin Anaesthesiol 22:23–30

    Article  PubMed  Google Scholar 

  21. Hill SE, Keller RA, Stafford-Smith M et al (2006) Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures. Anesthesiology 104:1047–1053

    Article  PubMed  CAS  Google Scholar 

  22. Jung SM, Cho CK, Kim YJ et al (2010) The effect of thoracic epidural anesthesia on pulmonary shunt fraction and arterial oxygenation during one-lung ventilation. J Cardiothorac Vasc Anesth 24:456–462

    Article  PubMed  Google Scholar 

  23. Karzai W, Schwarzkopf K (2009) Hypoxemia during one-lung ventilation: prediction, prevention, and treatment. Anesthesiology 110:1402–1411

    Article  PubMed  Google Scholar 

  24. Ko R, McRae K, Darling G et al (2009) The use of air in the inspired gas mixture during two-lung ventilation delays lung collapse during one-lung ventilation. Anesth Analg 108:1092–1096

    Article  PubMed  Google Scholar 

  25. Kotze A, Scally A, Howell S (2009) Efficacy and safety of different techniques of paravertebral block for analgesia after thoracotomy: a systematic review and metaregression. Br J Anaesth 103:626–636

    Article  PubMed  CAS  Google Scholar 

  26. Ku CM, Slinger P, Waddell TK (2009) A novel method of treating hypoxemia during one-lung ventilation for thoracoscopic surgery. J Cardiothorac Vasc Anesth 23:850–852

    Article  PubMed  Google Scholar 

  27. Lytle FT, Brown DR (2008) Appropriate ventilatory settings for thoracic surgery: intraoperative and postoperative. Semin Cardiothorac Vasc Anesth 12:97–108

    Article  PubMed  Google Scholar 

  28. Merli G, Guarino A, Della Rocca G et al (2009) Recommendations for airway control and difficult airway management in thoracic anesthesia and lung separation procedures. Minerva Anestesiol 75:59–78; 79–96

    PubMed  CAS  Google Scholar 

  29. Nagahiro I, Andou A, Aoe M et al (2001) Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure. Ann Thorac Surg 72:362–365

    Article  PubMed  CAS  Google Scholar 

  30. Nagendran J, Stewart K, Hoskinson M et al (2006) An anesthesiologist’s guide to hypoxic pulmonary vasoconstriction: implications for managing single-lung anesthesia and atelectasis. Curr Opin Anaesthesiol 19:34–43

    Article  PubMed  Google Scholar 

  31. Neustein SM (2009) The use of bronchial blockers for providing one-lung ventilation. J Cardiothorac Vasc Anesth 23:860–868

    Article  PubMed  Google Scholar 

  32. Nicastri DG, Wisnivesky JP, Litle VR et al (2008) Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance. J Thorac Cardiovasc Surg 135:642–647

    Article  PubMed  Google Scholar 

  33. Ozcan PE, Senturk M, Sungur Ulke Z et al (2007) Effects of thoracic epidural anaesthesia on pulmonary venous admixture and oxygenation during one-lung ventilation. Acta Anaesthesiol Scand 51:1117–1122

    Article  PubMed  CAS  Google Scholar 

  34. Pardos PC, Garutti I, Pineiro P et al (2009) Effects of ventilatory mode during one-lung ventilation on intraoperative and postoperative arterial oxygenation in thoracic surgery. J Cardiothorac Vasc Anesth 23:770–774

    Article  PubMed  Google Scholar 

  35. Pruszkowski O, Dalibon N, Moutafis M et al (2007) Effects of propofol vs. sevoflurane on arterial oxygenation during one-lung ventilation. Br J Anaesth 98: 539–544

    Article  PubMed  CAS  Google Scholar 

  36. Schultz MJ (2008) Lung-protective mechanical ventilation with lower tidal volumes in patients not suffering from acute lung injury: a review of clinical studies. Med Sci Monit 14:RA22–RA26

    PubMed  Google Scholar 

  37. Slinger P (2008) Con: the new bronchial blockers are not preferable to double-lumen tubes for lung isolation. J Cardiothorac Vasc Anesth 22:925–929

    Article  PubMed  Google Scholar 

  38. Smith GB, Hirsch NP, Ehrenwerth J (1986) Placement of double-lumen endobronchial tubes. Correlation between clinical impressions and bronchoscopic findings. Br J Anaesth 58:1317–1320

    Article  PubMed  CAS  Google Scholar 

  39. Thomsen RW (2008) Mediastinoscopy and video-assisted thoracoscopic surgery: anesthetic pitfalls and complications. Semin Cardiothorac Vasc Anesth 12: 128–132

    Article  PubMed  Google Scholar 

  40. Unzueta MC, Casas JI, Moral MV (2007) Pressure-controlled versus volume-controlled ventilation ­during one-lung ventilation for thoracic surgery. Anesth Analg 104:1029–1033, tables of contents

    Article  PubMed  Google Scholar 

  41. Vogt A, Stieger DS, Theurillat C et al (2005) Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery. Br J Anaesth 95:816–821

    Article  PubMed  CAS  Google Scholar 

  42. Wolthuis EK, Choi G, Dessing MC et al (2008) Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury. Anesthesiology 108:46–54

    Article  PubMed  Google Scholar 

  43. Xu Y, Tan Z, Wang S et al (2010) Effect of thoracic epidural anesthesia with different concentrations of ropivacaine on arterial oxygenation during one-lung ventilation. Anesthesiology 112:1146–1154

    Article  PubMed  CAS  Google Scholar 

  44. Yoshioka M, Mori T, Kobayashi H et al (2006) The efficacy of epidural analgesia after video-assisted thoracoscopic surgery: a randomized control study. Ann Thorac Cardiovasc Surg 12:313–318

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of General and Thoracic Surgery, University Department of Anaesthesiology and Pain Therapy, Berne University Hospital/Inselspital, and University of Bern, Berne, 3010, Switzerland

    Andreas Vogt M.D.

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  1. Andreas Vogt M.D.
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Correspondence to Andreas Vogt M.D. .

Editor information

Editors and Affiliations

  1. Klinik Hirslanden, Thoraxzentrum Zürich, Witellikerstr. 40, Zürich, 8008, Switzerland

    Rolf Gilbert Carl Inderbitzi

  2. , Division of General Thoracic Surgery, University Hospital Berne
, Freiburgstr. 2010, Berne, 3010, Switzerland

    Ralph Alexander Schmid

  3. , Department of Cardio-Thoracic Surgery, University of Pisa, Via Paradisa 2, Pisa, 56100, Italy

    Franca M. A. Melfi

  4. St. Mary's Hospital, Department of Cardio-Thoracic Surgery, Imperial College Healthcare NHS Trust, Praed Street, LONDON, W2 1NY, United Kingdom

    Roberto Pasquale Casula

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© 2012 Springer-Verlag Berlin Heidelberg

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Vogt, A. (2012). Anesthesia. In: Inderbitzi, R., Schmid, R., Melfi, F., Casula, R. (eds) Minimally Invasive Thoracic and Cardiac Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11861-6_5

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  • DOI: https://doi.org/10.1007/978-3-642-11861-6_5

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-11860-9

  • Online ISBN: 978-3-642-11861-6

  • eBook Packages: MedicineMedicine (R0)

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