Principles of Anesthetic Management for Pulmonary Resection

  • Philip M. Hartigan


Pulmonary resection, in one form or another, is the most ­commonly performed thoracic surgical procedure. This chapter ­discusses anesthetic considerations for lobectomy and lesser resections (segmentectomy, wedge resection) with attention to common anesthetic issues of thoracic anesthesia (Box 16-2).


Wedge resection Lobectomy Segmentectomy Pulmonary resection VATS Limited thoracotomy Open thoracoctomy Video-assisted thoracic surgical approach 

Selected References

  1. 1.
    Nakahara K, Ohno K, Hashimotot J, et al. Prediction of postoperative respiratory failure in patients undergoing lung resection for cancer. Ann Thorac Surg. 1988;46:549–52.PubMedCrossRefGoogle Scholar
  2. 2.
    Wittnich C, Trudel J, Zidulka A, Chiu R. Misleading “pulmonary wedge pressure” after pneumonectomy. Its importance in postoperative fluid therapy. Ann Thorac Surg. 1986;42:192.PubMedCrossRefGoogle Scholar
  3. 3.
    Beattie WS, Badner N, Choi P. Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg. 2001;93:853–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Vic-Mo H, Ottesen S, Renck H. Cardiac effects of thoracic epidural analgesia before and during acute coronary occlusion in open chest dogs. Scand J Clin Lab Invest. 1978;38:737–48.CrossRefGoogle Scholar
  5. 5.
    Saada M, Catoire P, Bonnet F, Delaunay L, et al. Effect of thoracic epidural anesthesia combined with general anesthesia on segmental wall motion assessed by transesophageal echocardiography. Anesth Analg. 1992;75:329–35.PubMedCrossRefGoogle Scholar
  6. 6.
    Horlocker T, Wedel D, Benzon H, Brown D, et al. Regional anesthesia in the anticoagulated patient: defining the risks. (The second ASRA consensus conference on neuraxial anesthesia and anticoagulation). Reg Anesth Pain Med. 2003;28(3):172–97.PubMedGoogle Scholar
  7. 7.
    Ko R, McRae K, Darling G, et al. The use of air in the inspired gas mixture during two-lung ventilation delays lung collapse during one-lung ventilation. Anesth Analg. 2009;108(4):10926.CrossRefGoogle Scholar
  8. 8.
    Narayanaswamy M, McRae K, Slinger P, Dugas G, et al. Choosing a lung isolation device for thoracic surgery: a randomized trial of three bronchial blockers versus double-lumen tubes. Anesth Analg. 2009;108(4):1097–101.PubMedCrossRefGoogle Scholar
  9. 9.
    Campos J, Kernstein K. A comparison of the left-sided Broncho-Cath with the torque control blocker Univent and the wire-guided blocker. Anesth Analg. 2003;96:283–9.PubMedGoogle Scholar
  10. 10.
    Schwarzkopf K, Schreiber T, Preussler N, Gaser E, Huter L, Bauer R, et al. Lung perfusion, shunt fraction, and oxygenation during one-lung ventilation in pigs: the effects of desflurane, isoflurane, and propofol. J Cardiothorac Vasc Anesth. 2003;17(1):73–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Saito M, Cho S, Morooka H, Hasuo H, Shibata O, Sumikawa K. Effects of sevoflurane compared with those of isoflurane on arterial oxygenation and hemodynamics during one-lung ventilation. J Anesth. 2000;4(1):1–5.CrossRefGoogle Scholar
  12. 12.
    Slinger PD. Perioperative fluid management for thoracic surgery: the puzzle of post-pneumonectomy pulmonary edema. J Cardiothorac Vasc Anesth. 1995;9(4):442–51.PubMedCrossRefGoogle Scholar

Further Suggested Reading

  1. Hartigan PM. Anesthesia management. Chapter 5. In: Zellos L, Sugarbaker DJ, Bueno R, Krasna MJ, Mentzer SJ, editors. Adult chest surgery. New York: McGraw-Hill Co., Inc.; 2009. p. 44–59.Google Scholar
  2. Hartigan PM, Body SC, Sugarbaker DJ. Pulmonary resection. Chapter 11. In: Kaplan JA, Slinger PD, editors. Thoracic anesthesia. 3rd ed. Philadelphia, PA: Churchill Livingstone; 2003. p. 213–42.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Philip M. Hartigan
    • 1
  1. 1.Division of Thoracic Anaesthesia Department of AnaesthesiologyPerioperative and Pain Medicine, Brigham and Women’s HospitalBostonUSA

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