The anesthesiologist perspective

Abstract

We are facing an era of great challenges and opportunities. Since new requests arise, new answers should be offered to our patients, especially to the more fragile ones. Cooperation between anesthesiologists and thoracic surgeons plays a pivotal role in successfully managing difficult procedures in vulnerable patients. Non-Intubated Thoracic Surgery (NITS) is among the techniques found effective to handle this population, offering a number of surgical opportunities for patients who are too risky for general anesthesia (GA): one-lung ventilation under spontaneous breathing allows maintaining a better match of ventilation and perfusion; respiratory efficiency can be guaranteed by a preserved diaphragmatic function, intubation-related trauma and mechanical ventilation are avoided, and no residual neuromuscular blockage problems occur. Nevertheless, the intraoperative management, as well as management in critical situations, is quite different during NITS compared to the standard procedures performed under GA. We will briefly discuss some key topics, starting from the Anesthesiologist’s Perspective, while keeping in mind that a multidisciplinary approach is essential for safe and effective management.