The management of patients for thoracic surgical procedures remains challenging. Not only do patients present with a variety of comorbidites, but they are also subjected to surgical trauma with the requirement for one-lung ventilation and lateral decubitus position, while common intraoperative problems include proper isolation of the lungs utilizing a dual lumen endotracheal tube or bronchial blocker, the potential for dynamic pulmonary hyperinflation and hypoxia. The purpose of this review is to describe the main problems reported in the literature on managing general anesthesia in thoracic surgery, with the aim of choosing the best risk/benefit balance technique.
Mechanical ventilation can produce barotrauma, volotrauma, atelectrauma, and release of a variety of proinflammatory mediators (biotrauma), leading to the development of acute lung injury. Moreover, general anesthesia can lead to an increased risk of pneumonia, impaired cardiac performance, and neuromuscular problems in patients with myasthenia gravis.
Awake anesthesia with thoracic epidural technique, avoids endotracheal intubation, complications such as hypoxia due to double lumen endotracheal tube malposition, hyperinflation of the dependent lung, re-expansion pulmonary edema, and unilateral ventilator-induced lung injury.