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Anesthesia for Lung Resection

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Anesthesiology

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Abstract

Anesthesia for lung resection surgery is challenging and requires knowledge of the patient’s pathology and anatomy as well as excellent communication with the surgical team. The most common indication for lung resection surgery is lung cancer which offers the chance for a cure in patients with non-small cell carcinoma without metastases. Anesthesiologists need to perform a careful preoperative evaluation given the frequent occurrence of significant co-morbidities in patients presenting to the operating room for lung resection. Intraoperatively, the anesthesiologist will be called upon to provide one-lung ventilation, hemodynamic support, appropriate volume management, and optimal pain control. The current review will discuss important components that need to be understood and applied to provide general anesthesia for patients undergoing lung resection. Specific areas of relevance for open thoracic surgery and lung resection will be discussed. Suggested techniques for patient management and a brief discussion of postoperative complications will be included as well.

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References

  1. Rauma V, Salo J, Sintonen H, Räsänen J, Ilonen I. Patient features predicting long-term survival and health-related quality of life after radical surgery for non-small cell lung cancer. Thorac Cancer. 2016;7:333–9.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Desai H, Natt B, Kim S, Bime C. Decreased in-hospital mortality after lobectomy using video-assisted thoracoscopic surgery compared to open thoracotomy. Ann Am Thorac Soc. 2016;14(2):262–6. https://doi.org/10.1513/annalsats.201606-429oc.

    Article  Google Scholar 

  3. Cao C, Manganas C, Ang S, Peeceeyen S, Yan T. Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: a meta-analysis of propensity score-matched patients. Interact Cardiovasc Thorac Surg. 2012;16:244–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Boffa D, Allen M, Grab J, Gaissert H, Harpole D, Wright C. Data from the society of thoracic surgeons general thoracic surgery database: the surgical management of primary lung tumors. J Thorac Cardiovasc Surg. 2008;135:247–54.

    Article  PubMed  Google Scholar 

  5. Athanassiadi K, et al. Muscle-sparing versus posterolateral thoracotomy: a prospective study. Eur J Cardiothorac Surg. 2007;31(3):496–500. Web. 15 Mar 2017.

    Article  PubMed  Google Scholar 

  6. Van Der Spuy JC. The surgical anatomy of the pulmonary vessels. Thorax. 1953;8(3):189–94. Web.

    Article  Google Scholar 

  7. Della Rocca G, Vetrugno L, Coccia C, Pierconti F, Badagliacca R, Vizza C, Papale M, Melis E, Facciolo F. Preoperative evaluation of patients undergoing lung resection surgery: defining the role of the anesthesiologist on a multidisciplinary team. J Cardiothorac Vasc Anesth. 2016;30:530–538de.

    Article  PubMed  Google Scholar 

  8. Brunelli A, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery. Chest. 2013;143(5):e166S–90S. Web. 15 Mar 2017.

    Article  PubMed  CAS  Google Scholar 

  9. Ford MK, Beattie WS, Wijeysundera DN. Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index. Ann Intern Med. 2010;152:26–35.

    Article  PubMed  Google Scholar 

  10. Roshanov PS, Walsh M, Devereaux PJ, et al. External validation of the revised cardiac risk index and update of its renal variable to predict 30-day risk of major cardiac complications after non-cardiac surgery: rationale and plan for analyses of the VISION study. BMJ Open. 2017;7(1):e013510. https://doi.org/10.1136/bmjopen-2016-013510.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Brunelli A, Cassivi SD, Fibla J, et al. External validation of the recalibrated thoracic revised cardiac risk index for predicting the risk of major cardiac complications after lung resection. Ann Thorac Surg. 2011;92:445–8.

    Article  PubMed  Google Scholar 

  12. Seo J-H, et al. Double-lumen tube placement with the patient in the supine position without a headrest minimizes displacement during lateral positioning. Can J Anesth. 2012;59(5):437–41. Web. 15 Mar 2017.

    Article  PubMed  Google Scholar 

  13. Alam N, Park BJ, Wilton A, et al. Incidence and risk factors for lung injury after lung cancer resection. Ann Thorac Surg. 2007;84(4):1085–91.

    Article  PubMed  Google Scholar 

  14. Assaad S, et al. Extravascular lung water and tissue perfusion biomarkers after lung resection surgery under a normovolemic fluid protocol. J Cardiothorac Vasc Anesth. 2015;29(4):977–83. Web. 15 Mar 2017.

    Article  PubMed  Google Scholar 

  15. Lee J, Jeon Y, Bahk J, Gil N, Hong D, Kim J, Kim H. Pulse pressure variation as a predictor of fluid responsiveness during one-lung ventilation for lung surgery using thoracotomy: randomised controlled study. Eur J Anaesthesiol. 2011;28:39–44.

    Article  PubMed  Google Scholar 

  16. Fu Q, et al. Evaluation of stroke volume variation and pulse pressure variation as predictors of fluid responsiveness in patients undergoing protective one-lung ventilation. Drug Discov Ther. 2015;9(4):296–302. Web. 15 Mar 2017.

    Article  PubMed  CAS  Google Scholar 

  17. Jeong D, Ahn H, Park H, Yang M, Kim J, Park J. Stroke volume variation and pulse pressure variation are not useful for predicting fluid responsiveness in thoracic surgery. Anesth Analg. 2017;125(4):1158–65.

    Article  PubMed  Google Scholar 

  18. Schilling T, et al. Effects of volatile and intravenous anesthesia on the alveolar and systemic inflammatory response in thoracic surgical patients. Anesthesiology. 2011;115(1):65–74. Web. 15 Mar 2017.

    Article  PubMed  CAS  Google Scholar 

  19. Módolo NSP, et al. Intravenous versus inhalation anaesthesia for one-lung ventilation. Cochrane Database Syst Rev. 2013: CD006313. Web. 15 Mar 2017.

    Google Scholar 

  20. Campos J. Lung isolation techniques for patients with difficult airway. Curr Opin Anaesthesiol. 2010;23:12–7.

    Article  PubMed  Google Scholar 

  21. Campos J. An update on bronchial blockers during lung separation techniques in adults. Anesth Analg. 2003;94(5):1266–74.

    Article  Google Scholar 

  22. Roscoe A, et al. Pressures exerted by endobronchial devices. Anesth Analg. 2007;104(3):655–8. Web. 15 Mar 2017.

    Article  PubMed  Google Scholar 

  23. Liu H, Jahr JS, Sullivan E, Waters PF. Tracheobronchial rupture after double-lumen endotracheal intubation. J Cardiothorac Vasc Anesth. 2004;18:228–33.

    Article  PubMed  Google Scholar 

  24. Pedoto A. How to choose the double-lumen tube size and side. Anesthesiol Clin. 2012;30(4):671–81. Web.

    Article  PubMed  Google Scholar 

  25. Brodsky JB, Macario A, Mark JB. Tracheal diameter predicts double-lumen tube size: a method for selecting left double-lumen tubes. Anesth Analg. 1996;82:861–4.

    PubMed  CAS  Google Scholar 

  26. Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301–8. Web. 15 Mar 2017.

    Article  Google Scholar 

  27. Blank RS, et al. Management of one-lung ventilation. Anesthesiology. 2016;124(6):1286–95. Web. 15 Mar 2017.

    Article  PubMed  Google Scholar 

  28. Licker M, de Perrot M, Spiliopoulos A, et al. Risk factors for acute lung injury after thoracic surgery for lung cancer. Anesth Analg. 2003;97:1558–65.

    Article  PubMed  Google Scholar 

  29. Yang M, Ahn HJ, Kim K, et al. Does a protective ventilation strategy reduce the risk of pulmonary complications after lung cancer surgery?: a randomized controlled trial. Chest. 2011;139:530–7.

    Article  PubMed  Google Scholar 

  30. Ferrando C, Mugarra A, Gutierrez A, et al. Setting individualized positive end-expiratory pressure level with a positive end-expiratory pressure decrement trial after a recruitment maneuver improves oxygenation and lung mechanics during one-lung ventilation. Anesth Analg. 2014;118:657–65.

    Article  PubMed  Google Scholar 

  31. Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation: prediction, prevention, and treatment. Anesthesiology. 2009;110(6):1402–11.

    Article  PubMed  Google Scholar 

  32. Hogue CW Jr. Effectiveness of low levels of nonventilated lung continuous positive airway pressure in improving arterial oxygenation during one-lung ventilation. Anesth Analg. 1994;79:364–7.

    PubMed  Google Scholar 

  33. Chigurupati K, Raman SP, Pappu UK, et al. Effectiveness of ventilation of nondependent lung for a brief period in improving arterial oxygenation during one-lung ventilation: a prospective study. Ann Card Anaesth. 2017;20(1):72–5.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Lee S, Kim N, Lee C, Ban M, Oh Y. Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery. Eur J Anaesthesiol. 2016;33:275–82.

    Article  PubMed  CAS  Google Scholar 

  35. Joshi G, Bonnet F, Shah R, et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg. 2008;107:1026–40.

    Article  PubMed  CAS  Google Scholar 

  36. Yeung J, Melody T, Kerr A, Naidu B, Middleton L, Tryposkiadis K, Daniels J, Gao F. Randomised controlled pilot study to investigate the effectiveness of thoracic epidural and paravertebral blockade in reducing chronic post-thoracotomy pain: TOPIC feasibility study protocol. BMJ Open. 2016;6:e012735.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Andreae MH, Andreae DA. Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery. Cochrane Database Syst Rev. 2012;10:CD007105. https://doi.org/10.1002/14651858.CD007105.pub2.

    Article  PubMed  Google Scholar 

  38. Zakkar M, Frazer S, Hunt I. Is there a role for Gabapentin in preventing or treating pain following thoracic surgery? Interact Cardiovasc Thorac Surg. 2013;17(4):716–9. https://doi.org/10.1093/icvts/ivt301.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Park S, Kang C, Hwang Y, Seong Y, Lee H, Park I, Kim Y. Risk factors for postoperative anxiety and depression after surgical treatment for lung cancer. Eur J Cardiothorac Surg. 2015;49:e16–21.

    Article  PubMed  Google Scholar 

  40. Khalil K, Boutrous M, Irani A, Miller C, Pawelek T, Estrera A, Safi H. Operative intercostal nerve blocks with long-acting bupivacaine liposome for pain control after thoracotomy. Ann Thorac Surg. 2015;100:2013–8.

    Article  PubMed  Google Scholar 

  41. Sengupta S. Post-operative pulmonary complications after thoracotomy. Indian J Anaesth. 2015;59(9):618–26.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Park S, Park I, Hwang Y, Byun C, Bae M, Lee C. Immediate postoperative care in the general thoracic ward is safe for low-risk patients after lobectomy for lung cancer. Korean J Thorac Cardiovasc Surg. 2011;44:229–35.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Lee S, Ahn H, Yeon S, Yang M, Kim J, Jung D, Park J. Potentially modifiable risk factors for atrial fibrillation following lung resection surgery: a retrospective cohort study. Anaesthesia. 2016;71:1424–30.

    Article  PubMed  CAS  Google Scholar 

  44. Garner M, Routledge T, King J, Pilling J, Veres L, Harrison-Phipps K, Bille A, Harling L. New-onset atrial fibrillation after anatomic lung resection: predictive factors, treatment and follow-up in a UK thoracic centre. Interact Cardiovasc Thorac Surg. 2016;24(2):260–4.

    Google Scholar 

  45. Ishikawa S, Griesdale DEG, Lohser J. Acute kidney injury after lung resection surgery. Anesth Analg. 2012;114(6):1256–62. Web. 15 Mar 2017.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA

    Allison Bechtel M.D.

Authors
  1. Allison Bechtel M.D.
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Correspondence to Allison Bechtel M.D. .

Editor information

Editors and Affiliations

  1. Hospital University Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA

    Basavana G. Goudra

  2. Department of Anesthesiology, Emory University, Atlanta, Georgia, USA

    Michael Duggan

  3. Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA

    Vidya Chidambaran

  4. University Hospitals Birmingham, Birmingham, United Kingdom

    Hari Prasad Krovvidi Venkata

  5. Emory University Hospital, Atlanta, Georgia, USA

    Elizabeth Duggan

  6. University of Alabama at Birmingham, Birmingham, Alabama, USA

    Mark Powell

  7. All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India

    Preet Mohinder Singh

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Bechtel, A. (2018). Anesthesia for Lung Resection. In: Goudra, B., et al. Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-74766-8_10

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  • DOI: https://doi.org/10.1007/978-3-319-74766-8_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74765-1

  • Online ISBN: 978-3-319-74766-8

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