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Anesthesia in Thoracic Surgery

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Pediatric Thoracic Surgery

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Abstract

In the pediatric population, thoracic surgery is performed to treat a great variety of pathologies. The wide age range and clinical conditions of the pediatric patients require particular anesthetic considerations and management strategies for each case.

In the last decades, the use of video-assisted thoracoscopic surgery (VATS) has dramatically increased even in smaller patients; although VATS can be performed while both lungs are ventilated, single lung ventilation (SLV) provides improved surgical conditions and is increasingly requested.

Methods of lung isolation depend on the age and weight of the child, and the anesthesiologist will decide, in each case, which is the best option, considering that SLV always creates an intrapulmonary shunt and some degree of desaturation and that while surgery is in progress it may be difficult to maintain adequate ventilation.

Postoperative care will depend on many criteria such as preoperative conditions, age of the patient, type, and length of the operation; many children need to be ventilated in the postoperative period while others can be extubated at the end of the surgery. All patients must be carefully monitored for respiratory and hemodynamic status.

Physicians must calibrate pain therapy on the degree of invasivity of the surgical procedure; FANS, opioids, local anesthetics, and adjuvants are administrated intravenously or using regional or neuraxial techniques even in the smallest infants.

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Authors and Affiliations

  1. Anesthesiology and Therapy of Acute and Procedural Pain Unit, IRCCS Giannina Gaslini, Genoa, Italy

    Giovanni Montobbio & Clelia Zanaboni

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  1. Giovanni Montobbio
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  2. Clelia Zanaboni
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Correspondence to Clelia Zanaboni .

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Editors and Affiliations

  1. Department of Pediatric Surgery, IRCCS Giannina Gaslini Institute, Genova, Italy

    Girolamo Mattioli

  2. IRCCS Istituto Giannina Gaslini, Genova, Italy

    Paolo Petralia

  3. Unit of Pediatric Thoracic and Airway Surgery, IRCCS Istituto Giannina Gaslin, Genova, Italy

    Michele Torre

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Montobbio, G., Zanaboni, C. (2021). Anesthesia in Thoracic Surgery. In: Mattioli, G., Petralia, P., Torre, M. (eds) Pediatric Thoracic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-74668-1_5

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