Anesthesiology clinics
-
One-lung ventilation (OLV) is essential for many thoracic and an increasing number of non-thoracic minimally invasive procedures. Beyond the well-recognized disturbance of ventilation-perfusion matching, recent years have seen a mounting body of evidence implicating OLV in the creation of acute lung injury. After reviewing the fundamentals of OLV physiology, this article examines the evidence for altering individual ventilatory parameters toward protective OLV.
-
Anesthesiology clinics · Jun 2008
ReviewAnesthetic considerations for patients with anterior mediastinal masses.
Anterior mediastinal tumors can cause severe airway and vascular compression, and these effects are exacerbated by general anesthesia. Tumor biopsy using a local anesthetic technique is preferable. General anesthesia for a biopsy procedure or resection of an anterior mediastinal mass should be undertaken only after a thorough preoperative assessment. ⋯ Some consider the maintenance of spontaneous respiration during anesthesia optimal. Others advocate airway stenting. Cardiopulmonary bypass, instituted at the outset of surgery under local anesthetic, may be used as a fall-back technique in extreme circumstances.
-
Pain after thoracotomy is very severe, probably the most severe pain experienced after surgery. Thoracic epidural analgesia has greatly improved the pain experience and its consequences and has been considered the standard for pain management after thoracotomy. This view has been challenged recently by the use of paravertebral nerve blocks. Nevertheless, severe ipsilateral shoulder pain and the prevention of the postthoracotomy pain syndrome remain the most important challenges for management of postthoracotomy pain.
-
Anesthesiology clinics · Jun 2008
ReviewPostthoracotomy paravertebral analgesia: will it replace epidural analgesia?
Thoracotomy is associated with significant acute postoperative pain and a high incidence of development of chronic pain. Thoracic epidural analgesia has long been standard treatment for postthoracotomy pain, but recently there has been increased interest in alternative regional techniques, particularly paravertebral analgesia. This article compares the analgesic efficacy, side effects, complications of, and contraindications for thoracic epidural and paravertebral analgesia techniques and discusses their effects on the development of chronic postthoracotomy pain. This information will allow a more considered choice of analgesic technique after thoracotomy.
-
Anesthesiology clinics · Jun 2008
ReviewOxygen toxicity during one-lung ventilation: is it time to re-evaluate our practice?
Lung cancer remains one of the leading causes of cancer-related mortality. Surgical resection remains the mainstay of non-small cell lung cancer therapy, but an increasing number of patients receive preoperative adjuvant chemotherapy that may predispose these patients to unique organ toxicities. This chemotherapy, along with exposure to high oxygen concentrations, may combine to increase the risk of reactive oxygen species-mediated lung injury. Continued efforts are needed to improve overall outcome in these patients, including a reevaluation of our management of oxygen therapy.