Anesthesiology clinics
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Anesthesiology clinics · Dec 2012
ReviewHow to choose the double-lumen tube size and side: the eternal debate.
Although disposable double-lumen tubes have been used for many years, there is still controversy regarding what size and which side to use for thoracic procedures requiring lung isolation. Thoracic and nonthoracic anesthesiologists often debate performance, efficiency, and outcome of small and large double-lumen tubes, and left- and right-sided tubes. This article focuses on current data in the literature and expert opinion on the topic.
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Anesthesiology clinics · Dec 2012
Review Case ReportsPerioperative management of the pregnant patient with an anterior mediastinal mass.
This article describes the perioperative risks of pregnant patients with anterior mediastinal masses, and demonstrates the importance of a multidisciplinary approach for the management of high-risk patients. Mediastinal mass syndrome is defined as immediate right heart failure secondary to vascular compression when positive pressure ventilation is initiated. Greater emphasis on the potential for cardiovascular collapse (versus respiratory collapse) challenges the conventional teaching of risks associated with mediastinal masses in the adult population.
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Anesthesiology clinics · Dec 2012
ReviewPerioperative lung protection strategies in cardiothoracic anesthesia: are they useful?
Patients are at risk for several types of lung injury in the perioperative period. These injuries include atelectasis, pneumonia, pneumothorax, bronchopleural fistula, acute lung injury, and acute respiratory distress syndrome. ⋯ Lung-protective ventilation strategies using more physiologic tidal volumes and appropriate levels of positive end-expiratory pressure can decrease the extent of this injury. This review discusses the effects of mechanical ventilation and its role in ventilator-induced lung injury with specific reference to cardiothoracic anesthesia.
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Surgical resection remains a standard treatment option for localized esophageal cancer. Surgical approaches to esophagectomy include transhiatal and transthoracic techniques as well as minimally invasive techniques that have been developed to reduce the morbidities associated with laparotomy and thoracotomy incisions. The perioperative mortality for esophagectomy remains high with cardiopulmonary and anastomotic complications as the most frequent and serious morbidities. This article reviews the management of patients presenting for esophagectomy, with a focus on evidence-based anesthetic and perioperative approaches for improving outcomes.
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Anesthesiology clinics · Dec 2012
ReviewManaging hypoxemia during minimally invasive thoracic surgery.
An ever-increasing number of thoracic procedures are being performed through minimally invasive techniques. Although the incidence of hypoxemia during one-lung ventilation (OLV) has decreased over the years, it remains an issue in roughly 10% of cases. Algorithms for the management of OLV hypoxemia have to be adapted to the thoracoscopic approach, in particular the need for optimal surgical exposure. With appropriate planning and caution, most of the treatment modalities for OLV hypoxemia can be applied to the thoracoscopy setting, with some modifications.