Awake thoracic surgery procedures have now been successfully performed in early series with satisfactory results.
Potential advantages include short hospitalization and immediate resumption of daily life activities, even in functionally compromised patients, as well as a minor impact on postoperative immune function and hormone stress response.
So far, awake anesthesia has been mainly employed to perform simple surgical procedures. In this setting, we have preferred thoracic epidural anesthesia but local anesthesia and paravertebral blocks are also promising alternatives, which have been successfully used.
Future perspectives might include ambulatory awake thoracic surgery programs as well as standardization of more complex awake surgical procedures such as thymectomy and anatomical lung resections.
The rapidly growing clinical experience and the accomplishment of properly controlled studies will provide more answers regarding the advantages and limits of this intriguing novel surgical approach when dealing with the various proposed indications.