General Aspects of Thoracic Anesthesia

Abstract

Thoracic anesthesia, a fascinating subspecialty, provides perioperative medicine for a spectrum of dynamically evolving surgical procedures ranging from classical thoracotomies to minimally invasive and ultra-minimally invasive video or robotically assisted procedures. Its core mission is to provide optimal surgical conditions by deflating the operative lung while providing adequate oxygenation and avoiding injury to the ventilated lung. Thoracic anesthesia also provides preoperative care to achieve best possible health status before surgery and improves postoperative recovery by providing means of pain therapy and enhanced recovery following some of the most painful procedures in patients who are at the highest risk for developing chronic pain. This chapter focuses on major current paradigms of general thoracic anesthesia representing the clinical views and preferences of a substantial core leadership of the EACTA thoracic subcommittee. As such, it is a uniquely European perspective not on the exact procedure specific details but, as the title demands, on the fundamentally basic principles of thoracic anesthesia. While covering the traditional topics of airway management, ventilation and acute pain in sufficient detail, it also expands into newer areas of interest as preoperative optimization through prehabilitation and introducing new methods to prevent chronic pain. While the discussed strategies currently represent our view as a group, we hope to formally test these concepts in the near future by subjecting these recommendations to a formal consensus statement (Thoracic Anaesthesia Consensus Agreement, TOSSCA) through a robust Delphi process involving the full membership of the EACTA Thoracic committee and the wider EACTA membership.