ANESTHESIOLOGY FAST REVIEW

ANESTHESIOLOGY_FAST_REVIEWKAPAK1-0-25

THORACIC ANESTHESIA

Filiz Banu Çetinkaya Ethemoğlu

Ankara Bilkent City Hospital, Department of Anesthesiology and Reanimation, Ankara, Türkiye

Çetinkaya Ethemoğlu FB. Thoracic Anesthesia. In: Kazancı D, editor. Anesthesiology Fast Review. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.259-272.

ABSTRACT

  • Anesthetic management during thoracic surgery should be planned taking into account the patient’s position and associated physiological changes.
  • Preoperative assessment should focus on the optimal management of pre-existing pulmonary disease.
  • Lateral decubitus position, open pneumothorax and single lung ventilation are the main causes of physiological changes during thoracic surgery.
  • The ventilation/perfusion ratio in the lungs is altered by the lateral decubitus position.
  • During single-lung ventilation (SLV), deoxygenated blood from the non-dependent lung mixes with oxygenated blood from the dependent lung. This increases the alveolar-arterial (PA-a) O2 gradient and leads to hypoxaemia.
  • Hypoxic pulmonary vasoconstriction (HPV) is a mechanism by which there is a reduction in blood flow to hypoxic regions of the lung in response to low alveolar oxygen pressure.
  • General anesthesia with controlled ventilation is the safest approach to elective thoracic surgery.
  • Most thoracic surgery patients are at risk of bronchoconstriction due to chronic smoking, chronic bronchitis or COPD.
  • In tracheal resection, the main challenge for the anesthetist is to maintain ventilation while the airway remains open and to preserve the integrity of the anastomosis in the postoperative period.
  • For postoperative pain control after thoracotomy, thoracic epidural anesthesia (TEA) is very effective.

Keywords: Thoracic surgery; Single-lung ventilation (SLV); Dual-lumen endotracheal tube; Bronchial blocker; Hypoxic pulmonary vasoconstriction (HPV); Tracheal resection; Thoracic Epidural Anesthesia (TEA)

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