Skip to main content
SpringerLink
Log in

Anesthesia for Pleural and Chest Wall Surgery

  • Chapter
  • First Online:
Anesthesiology

  • 3037 Accesses

Abstract

Chest wall surgery includes cases such as resection for chest wall tumors, repair of pectus excavatum or carinatum, thoracoplasty and chest wall reconstruction. Procedures involving the pleural cavity include drainage of empyema, drainage of pleural effusions, decortication, thoracentesis, pleurodesis, and chest tube thoracostomy. These cases often present anesthetic challenges and require interdisciplinary cooperation. This chapter will discuss the physiologic considerations and alterations during chest wall and pleural cavity surgery and suggest the complete preoperative work-up. It will also delve into intraoperative considerations and monitoring as well as regional anesthetic techniques for postoperative pain control. A brief discussion of postoperative complications and special considerations for certain surgeries will be reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Neustein SM, Eisenkraft JB, Cohen E. Anesthesia for thoracic surgery. In: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, editors. Clinical anesthesia. Philadelphia: Lippincott Williams and Wilkins; 2009. p. 1032–72.

    Google Scholar 

  2. Vallieres E. Management of empyema after lung resections (pneumonectomy/lobectomy). Chest Surg Clin N Am. 2002;12:571–85.

    Article  PubMed  Google Scholar 

  3. Zanotti G, Mitchell JD. Bronchopleural fistula and empyema after anatomic lung resection. Thorac Surg Clin. 2015;25(4):421–7.

    Article  PubMed  Google Scholar 

  4. Maagaard M, Tang M, Ringgaard S, Nielsen HH, Frokiaer J, Haubuf M, et al. Normalized cardiopulmonary exercise function in patients with pectus excavatum three years after operation. Ann Thorac Surg. 2013;96:272–8.

    Article  PubMed  Google Scholar 

  5. Chatterjee K, Zhang J, Honbo N, Karlinerb JS. Doxorubicin cardiomyopathy. Cardiology. 2010;115(2):155–62.

    Article  PubMed  CAS  Google Scholar 

  6. Patil N, Paulose RM, Udupa KS, Ramakrishna N, Ahmed T. Pulmonary toxicity of Bleomycin—a case series from a Tertiary Care Center in Southern India. J Clin Diagn Res. 2016;10(4):FR01–3.

    PubMed  PubMed Central  CAS  Google Scholar 

  7. Slinger PD. Perioperative respiratory assessment and management. Can J Anaesth. 1992;39:115–31.

    Article  Google Scholar 

  8. McHugh MA, Poston PM, Rossi NO, Turek JW. Assessment of potential confounders when imaging pectus excavatum with chest radiography alone. J Pediatr Surg. 2016;51(9):1485–9.

    Article  PubMed  Google Scholar 

  9. Gerson MC, Hurst JM, Herrtzberg VS, et al. Prediction of cardiac and pulmonary complication related to elective abdominal and non-cardiac surgery in thoracic surgery in geriatric patients. Am J Med. 1990;88:101–7.

    Article  PubMed  CAS  Google Scholar 

  10. Ivanov A, Yossef J, Tailon J, Worku BM, et al. Do pulmonary function tests improve risk stratification before cardiothoracic surgery? J Thorac Cardiovasc Surg. 2016;151(4):1183–1189.e3.

    Article  PubMed  Google Scholar 

  11. Kurlansky P. Preoperative PFTs: the answer is blowing in the wind. J Thorac Cardiovasc Surg. 2016;151(4):918–9.

    Article  PubMed  Google Scholar 

  12. Mavi J, Moore DL. Anesthesia and analgesia for pectus excavatum surgery. Anesthesiol Clin. 2014;32(1):175–84.

    Article  PubMed  Google Scholar 

  13. Katlic MR. Video-assisted thoracic surgery utilizing local anesthesia and sedation. Eur J Cardiothorac Surg. 2006;30(3):529–32.

    Article  PubMed  Google Scholar 

  14. Lumb AB, Slinger P. Hypoxic pulmonary vasoconstriction: physiology and anesthetic implications. Anesthesiology. 2015;122(4):932–46.

    Article  PubMed  CAS  Google Scholar 

  15. Pruszkowski O, Dalibon N, Moutafis M, Jugan E, Law-Koune JD, Laloë PA, Fischler M. Effects of propofol vs sevoflurane on arterial oxygenation during one-lung ventilation. Br J Anaesth. 2007;98:539–44.

    Article  PubMed  CAS  Google Scholar 

  16. Fox ME, Bensard DD, Roaten JB, Hendrickson RJ. Positioning for the Nuss procedure: avoiding brachial plexus injury. Paediatr Anaesth. 2005;15(12):1067–71.

    PubMed  Google Scholar 

  17. Mansour KA, Thourani VH, Losken A, et al. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg. 2002;73(6):1720–6.

    Article  PubMed  Google Scholar 

  18. Hebra A, Swoveland B, Egbert M, Tagge EP, Georgeson K, Othersen HB Jr, Nuss D. Outcome analysis of minimally invasive repair of pectus excavatum: review of 251 cases. J Pediatr Surg. 2000;35(2):252–7; discussion 257–258.

    Article  PubMed  CAS  Google Scholar 

  19. Luh S-P, Chou M-C, Wang L-S, Chen J-Y, Tsai T-P. Video-assisted thoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas. Chest. 2005;127(4):1427–32. https://doi.org/10.1016/s0012-3692(15)34497-4.

    Article  PubMed  Google Scholar 

  20. Ambrosino N, Gabbrielli L. Physiotherapy in the perioperative period. Best Pract Res Clin Anaesthesiol. 2010;24(2):283–9.

    Article  PubMed  Google Scholar 

  21. Christine P-A, Gupta S. Choices in pain management follow thoracotomy. Chest. 1999;115(5):122S–4S.

    Article  Google Scholar 

  22. Li N-L, Yu B-L, Hung C-F. Paravertebral block plus thoracic wall block versus paravertebral block alone for analgesia of modified radical mastectomy: a retrospective cohort study. PLoS ONE. 2016;11(11):e0166227.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Hetta R. Pectoralis-serratus interfascial plane block versus thoracic paravertebral block for unilateral radical mastectomy with axillary evacuation. J Clin Anesth. 2016;34:91–7.

    Article  PubMed  Google Scholar 

  24. Choudry B, Sacks R. Continuous chest wall ropivacaine infusion for analgesia in children undergoing Nuss procedure: a comparison with thoracic epidural. Paediatr Anaesth. 2016;26(6):582–9.

    Article  Google Scholar 

  25. Frawley G, Frawley J, Crameri J. A review of anesthetic techniques and outcomes following minimally invasive repair of pectus excavatum (Nuss procedure). Paediatr Anaesth. 2016;26(11):1082–90. https://doi.org/10.1111/pan.12988; Epub 2016 Aug 11.

    Article  PubMed  Google Scholar 

  26. Waurick VA. Update in thoracic epidural anaesthesia. Best Pract Res Clin Anaesthesiol. 2005;19(2):201–13.

    Article  PubMed  CAS  Google Scholar 

  27. Kosinski S, et al. Comparison of continuous epidural block and continuous paravertebral block in postoperative analgaesia after video-assisted thoracoscopic surgery lobectomy: a randomised, non-inferiority trial. Anaesthesiol Intensive Ther. 2016;48(5):280–7. https://doi.org/10.5603/AIT.2016.0059.

    Article  PubMed  Google Scholar 

  28. Tamura T, et al. A randomized controlled trial comparing paravertebral block via the surgical field with thoracic epidural block using ropivacaine for post-thoracotomy pain relief. J Anesth. 2017;31(2):263–70. https://doi.org/10.1007/s00540-017-2307-5; Epub 2017 Jan 23.

    Article  PubMed  Google Scholar 

  29. Soniya B, et al. Comparison between thoracic epidural block and thoracic paravertebral block for post thoracotomy pain relief. J Clin Diagn Res. 2016;10(9):UC08–12.

    Google Scholar 

  30. Ahmed Z, Samad K, Ullah H. Role of intercostal nerve block in reducing postoperative pain following video-assisted thoracoscopy: a randomized controlled trial. Saudi J Anaesth. 2017;11(1):54–7. https://doi.org/10.4103/1658-354X.197342.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hord AH, Wang JM, Pai UT, Raj PP. Anatomic spread of India ink in the human intercostal space with radiologic correlation. Reg. Anesth. 1991;16(1):13–6.

    PubMed  CAS  Google Scholar 

  32. Jaroszewski DE, Temkit M, Ewais MM, et al. Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults. J Thorac Dis. 2016;8(8):2102–10. https://doi.org/10.21037/jtd.2016.06.62.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Dale O, Somogyi AA, Li Y, Sullivan T, Shavit Y. Does intraoperative ketamine attenuate inflammatory reactivity following surgery? A systematic review and meta-analysis. Anesth Analg. 2012;115(4):934–43.

    Article  PubMed  CAS  Google Scholar 

  34. Shah M, Frye R, Marzinsky A, et al. Complications associated with bar fixation following Nuss repair for pectus excavatum. Am Surg. 2016;82(9):781–2.

    PubMed  PubMed Central  Google Scholar 

  35. Kawai H, Tayasu Y, Saitoh A, et al. Nocturnal hypoxemia after lobectomy for lung cancer. Ann Thorac Surg. 2005;79(4):1162–6. https://doi.org/10.1016/j.athoracsur.2004.09.063.

    Article  PubMed  Google Scholar 

  36. Wildgaard K, Ravn J, Kehlet H. Chronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention. Eur J Cardiothorac Surg. 2009;36(1):170–80. https://doi.org/10.1016/j.ejcts.2009.02.005.

    Article  PubMed  Google Scholar 

  37. Kinney MA, Jacob AK, Passe MA, Mantilla CB. Increased risk of postthoracotomy pain syndrome in patients with Prolonged Hospitalization and increased postoperative Opioid use. Pain Res Treat. 2016;2016:7945145. https://doi.org/10.1155/2016/7945145; Epub 2016 Jun 2.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Cooper University Hospital, Camden, NJ, USA

    Jonathan Rost M.D. & Jeffery Gerritsen M.D.

  2. Division of Critical Care, Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, NJ, USA

    Talia K. Ben-Jacob M.D.

Authors
  1. Jonathan Rost M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffery Gerritsen M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Talia K. Ben-Jacob M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Talia K. Ben-Jacob M.D. .

Editor information

Editors and Affiliations

  1. Hospital University Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA

    Basavana G. Goudra

  2. Department of Anesthesiology, Emory University, Atlanta, Georgia, USA

    Michael Duggan

  3. Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA

    Vidya Chidambaran

  4. University Hospitals Birmingham, Birmingham, United Kingdom

    Hari Prasad Krovvidi Venkata

  5. Emory University Hospital, Atlanta, Georgia, USA

    Elizabeth Duggan

  6. University of Alabama at Birmingham, Birmingham, Alabama, USA

    Mark Powell

  7. All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India

    Preet Mohinder Singh

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Rost, J., Gerritsen, J., Ben-Jacob, T.K. (2018). Anesthesia for Pleural and Chest Wall Surgery. In: Goudra, B., et al. Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-74766-8_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74766-8_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74765-1

  • Online ISBN: 978-3-319-74766-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation