{"title":"Minimally Invasive Thoracic Surgery","authors":"Joseph Capone, Antony R. Tharian","doi":"10.1093/MED/9780197506127.003.0021","DOIUrl":"https://doi.org/10.1093/MED/9780197506127.003.0021","url":null,"abstract":"This chapter on novel approaches to minimally invasive thoracic surgery explores the latest techniques being utilized in thoracic surgery. It reviews anesthetic considerations including patient positioning, intraoperative monitoring, and temperature management. It also reviews commonly utilized anesthetic approaches to thoracic surgery such as general endotracheal anesthesia with lung isolation as well as nonintubated anesthesia, regional anesthetic techniques, and approaches to postoperative pain management. This chapter also provides an up-to-date review of the latest approaches being utilized for thoracic surgery including single port video assisted thoracic surgery, robot-assisted thoracic surgery, and single port robotic surgery.","PeriodicalId":109583,"journal":{"name":"Thoracic Anesthesia Procedures","volume":"154 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127338630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Physiology of One-Lung Ventilation","authors":"G. Shanmugam, Raymond Pla","doi":"10.1093/MED/9780197506127.003.0003","DOIUrl":"https://doi.org/10.1093/MED/9780197506127.003.0003","url":null,"abstract":"Ventilation and perfusion are matched under physiologic conditions for optimal gas exchange and oxygenation. Ventilation involves the entry and exit of air from the lungs, while perfusion involves the flow of blood through alveolar pulmonary capillaries. Both are necessary for the diffusion of oxygen into and carbon dioxide out of the bloodstream. During thoracic surgery, the ventilation/perfusion (V/Q) relationship is disrupted by induction of general anesthesia, lateral decubitus positioning, one-lung ventilation, and the open chest. Despite ventilation/perfusion alterations, severe hypoxia is usually avoided with the aid of several intrinsic and extrinsic factors. This chapter will delve into the changing V/Q relationship that occurs during thoracic surgery; modifying factors, including hypoxic pulmonary vasoconstriction and position, among others; and strategies to address hypoxia intraoperatively.","PeriodicalId":109583,"journal":{"name":"Thoracic Anesthesia Procedures","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127628676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Enhanced Recovery in Thoracic Surgery","authors":"Manxu Zhao, Zhongyuan Xia, Henry Liu","doi":"10.1093/MED/9780197506127.003.0022","DOIUrl":"https://doi.org/10.1093/MED/9780197506127.003.0022","url":null,"abstract":"With the development and improvement of enhanced recovery after surgery protocol over the past 20 years, there is an increasing acceptance and application of enhanced recovery after surgery in many surgical subspecialties. Thoracic surgery has also started adopting the practice of enhanced recovery after surgery, and some hospitals have already implemented elements of enhanced recovery after surgery pertinent to thoracic surgical patients such as optimization of preoperative pulmonary rehabilitation, increasing application of regional anesthesia in multimodal analgesia, single chest tube placement, and early removal of chest tube. Enhanced recovery in thoracic surgery has resulted some improved clinical outcomes with multidisciplinary multimodal perioperative approach.","PeriodicalId":109583,"journal":{"name":"Thoracic Anesthesia Procedures","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128107799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Sidoran, Hanan Tafeese, Tiffany D. Perry, Tricia Desvarieux
{"title":"Anterior Mediastinal Masses","authors":"K. Sidoran, Hanan Tafeese, Tiffany D. Perry, Tricia Desvarieux","doi":"10.1093/MED/9780197506127.003.0011","DOIUrl":"https://doi.org/10.1093/MED/9780197506127.003.0011","url":null,"abstract":"Anterior mediastinal masses can affect the airway, breathing, and circulation (ABC) and often entail a well-planned multidisciplinary team approach with regard to management. The anesthetic management of these cases depends on the individual’s risk and symptomology. Anesthesia can range from standard general to awake cannulation for extracorporeal membrane oxygenation depending on severity of presentation and extent of airway and cardiovascular compromise. It is crucial to avoid an “intubate, cannot ventilate” situation or cardiovascular collapse. Patients who present with the superior vena cava syndrome can be particularly challenging. The goal of this chapter is to describe a case-based approach to anterior mediastinal masses focused on the ABCs. By reviewing the etiology of mediastinal masses, examining the presentation of symptoms, exploring the pathophysiology and the risks to the ABCs, the authors emphasize the need for a multidisciplinary approach to care for these patients effectively.","PeriodicalId":109583,"journal":{"name":"Thoracic Anesthesia Procedures","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116748459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgical Airway Management","authors":"Zipei Feng, Meng-Tzung Wu, M. Nikolaidis, Yi Deng","doi":"10.1093/MED/9780197506127.003.0014","DOIUrl":"https://doi.org/10.1093/MED/9780197506127.003.0014","url":null,"abstract":"Surgical airway management is used to address a variety of diseases affecting the larynx, such as anatomic pathologies, tumors, and voice disorders. The management is typically the purview of otorhinolaryngologists, although other specialties such as pulmonary and surgical critical care physicians have lately begun performing percutaneous procedures as well. In this chapter we outline the approaches to common surgical airway management procedures as performed by otorhinolaryngologists, including direct laryngoscopy and bronchoscopy with intervention, cricothyroidotomy, and tracheostomy. Only traditional open procedures are described in detail here as these serve as the foundational knowledge for more advanced endoscopic interventions.","PeriodicalId":109583,"journal":{"name":"Thoracic Anesthesia Procedures","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125675740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lung Isolation Techniques","authors":"W. Johnson, M. Nikolaidis, Nahel N. Saied","doi":"10.1093/MED/9780197506127.003.0006","DOIUrl":"https://doi.org/10.1093/MED/9780197506127.003.0006","url":null,"abstract":"Lung isolation can be used during thoracic surgery to selectively ventilate a single lung for a discrete purpose. There are several indications for lung isolation, with the strength of each indication varying from absolutely indicated to preferable. Indications for lung isolation are reviewed in this chapter. Three main techniques for achieving lung isolation are also reviewed in detail. These include intentional mainstem with a single-lumen endotracheal tube, use of a double-lumen endobronchial tube and use of a bronchial blocker. The benefits and drawbacks of each technique are discussed. Finally, specific steps to troubleshoot hypoxia during one-lung ventilation are reviewed.","PeriodicalId":109583,"journal":{"name":"Thoracic Anesthesia Procedures","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125797666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Parker D. Freels, G. Wynn, Travis E. Meyer, G. Giuratrabocchetta
{"title":"Thoracic Radiology","authors":"Parker D. Freels, G. Wynn, Travis E. Meyer, G. Giuratrabocchetta","doi":"10.1093/MED/9780197506127.003.0002","DOIUrl":"https://doi.org/10.1093/MED/9780197506127.003.0002","url":null,"abstract":"Diagnostic imaging plays an important role in patient care and management. Particularly in the procedural setting, the likelihood of a patient receiving some form of perioperative imaging is high. Therefore, the anesthesiologist should be familiar with the various available radiologic tools, their proper utilization, and the common imaging findings. These diagnostic imaging techniques allow clinicians the opportunity to gain insight into a patient’s unique anatomy and, based on these findings, prepare for a more appropriate patient-centered course of treatment based on these findings. Thoracic radiology is an extensive subject with a long list of potential pathology that can occur within the chest. In this chapter, the authors’ goal is to review the more routinely used imaging modalities (radiography, computed tomography, and ultrasonography) while focusing on some of the most common diseases, disorders, and defects of the thorax encountered by anesthesiologists during their daily practice. These include abnormalities of the airways, lungs, pleura, vasculature, and esophagus.","PeriodicalId":109583,"journal":{"name":"Thoracic Anesthesia Procedures","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134589920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pneumonectomy","authors":"Lacey Wood, Antony R. Tharian","doi":"10.1093/med/9780197506127.003.0012","DOIUrl":"https://doi.org/10.1093/med/9780197506127.003.0012","url":null,"abstract":"Pneumonectomy is a complex surgical procedure requiring a multidisciplinary approach and multifaceted anesthetic management. In this chapter, the authors begin with the history of pneumonectomy and indications and contraindications to the procedure. There is an overview of lung cancer, staging, and appropriate treatment for the different stages of lung cancer. The preoperative evaluation is briefly summarized with an algorithm to follow and is then covered in depth through breaking it down into cardiovascular risk assessment and evaluation, cardiac risk calculators, respiratory mechanics, lung parenchymal function, and finally evaluation of the cardiopulmonary interaction. The surgical procedure and types of pneumonectomy are explained for a thorough understanding before diving into anesthetic management. Preoperative planning and appropriate review prior to taking the patient to the operating room are covered, followed by a discussion of lines and monitors, lung isolation, one-lung ventilation recommendations, hemodynamic management and clamping of the pulmonary artery, supplemental studies, intraoperative fluid management, special considerations for extrapleural pneumonectomy and tracheal sleeve pneumonectomy, guidelines for extubation, and pain management. Lastly, postoperative monitoring and complications including cardiac arrhythmias, stroke, perioperative pulmonary complications and postneumonectomy pulmonary edema, bronchopleural fistula, and cardiac herniation are described.","PeriodicalId":109583,"journal":{"name":"Thoracic Anesthesia Procedures","volume":"2012 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116760507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Panjeton, W. Kirk Fowler, Hess A. Panjeton, Yi Deng, J. D. White
{"title":"Bronchoscopic Anatomy","authors":"G. Panjeton, W. Kirk Fowler, Hess A. Panjeton, Yi Deng, J. D. White","doi":"10.1093/med/9780197506127.003.0004","DOIUrl":"https://doi.org/10.1093/med/9780197506127.003.0004","url":null,"abstract":"A functional understanding of normal tracheobronchial anatomy as well as its clinically relevant variations is essential to effective, safe perioperative anesthetic evaluation and management for thoracic procedures. This chapter reviews the anatomy of the airway and lung structures that are encountered during basic bronchoscopy. The larynx, trachea, and tracheobronchial tree, including right and left lung and bronchial anatomy and vascular supply to the trachea and bronchial tree, are presented in addition to key identifying features for each structure. Labeled illustrations and bronchoscopic images are provided for reference and clarity. The vascular supply is also described and depicted. This chapter includes possible anatomical and pathological variants that may be discovered during bronchoscopy.","PeriodicalId":109583,"journal":{"name":"Thoracic Anesthesia Procedures","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116419748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lung Transplantation","authors":"Loren R. Francis, Jared McKinnon","doi":"10.1093/med/9780197506127.003.0017","DOIUrl":"https://doi.org/10.1093/med/9780197506127.003.0017","url":null,"abstract":"Anesthesia for lung transplant surgery involves careful preoperative assessment, close intraoperative monitoring, prompt evaluation and treatment of hemodynamic and respiratory instability, and clear communication with the surgical team. This chapter discusses key elements of lung transplant surgery and offers clinical guidance for the cardiothoracic anesthesiologist. It details preoperative, intraoperative, and postoperative management considerations and offers a focused overview of mechanical support strategies. Specifically, pulmonary artery catheter placement is explained, relevant transesophageal echocardiography anatomy is reviewed, and ventilator and fluid management strategies are discussed. The chapter begins with the preoperative assessment and then moves to intraoperative management. The chapter ends with a discussion of mechanical support and posttransplant management.","PeriodicalId":109583,"journal":{"name":"Thoracic Anesthesia Procedures","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124957438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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