Current opinion in anaesthesiology
-
To provide an update on fast track thoracic anesthesia for patients undergoing lung resection. ⋯ Fast track in thoracic surgery and anesthesia has evolved quite slowly in contrast to other surgical specialties; further studies are needed to weigh the risks and benefits in thoracic surgical patients in order to determine who can benefit from the concept of fast track.
-
Pneumonectomy has the highest perioperative risk among common pulmonary resections. The purpose of this review is to update clinicians on the importance of anesthetic management for these patients. ⋯ Patients should have a preoperative assessment of their respiratory function in three areas: lung mechanical function, pulmonary parenchymal function and cardiopulmonary reserve. Interventions that have been shown to decrease the incidence of respiratory complications include cessation of smoking, physiotherapy and thoracic epidural analgesia. Extrapleural pneumonectomy and sleeve pneumonectomy are surgical variations that place specific increased demands on the anesthesiologist. The rare but treatable complication of cardiac herniation must always be remembered as a potential cause of life-threatening hemodynamic instability in the early postoperative period.