Anesthesiology clinics
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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.
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Despite advances in the therapy for acute lung injury and adult respiratory distress syndrome, mortality remains high. The iatrogenic risk of ventilator-induced lung injury might contribute to this high mortality because the lungs are hyperinflated. ⋯ Extracorporeal membrane oxygenation and interventional lung assist allow ultraprotective ventilation strategies. However, these assists have different technical aspects and different indications.
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Tracheal resection and reconstruction (TRR) is the treatment of choice for most patients with tracheal stenosis or tracheal tumors. Anesthesia for TRR offers distinct challenges, especially for the less experienced practitioner. This article explores the preoperative assessment, strategies for induction and emergence from anesthesia, the essential coordination between the surgical and anesthesia teams during airway excision and anastomosis, and postoperative care. ⋯ Targeted readership is practitioners with less extensive experience in managing airway surgery cases. As such, the article focuses first on the most common proximal tracheal resection. Final sections discuss specific considerations for more complicated cases.