Erschienen in:
28.10.2019 | Thoracic Anesthesia (T Schilling, Section Editor)
Which Anesthesia Regimen Should Be Used for Lung
Surgery?
verfasst von:
Andreas Pregernig, Beatrice Beck-Schimmer
Erschienen in:
Current Anesthesiology Reports
|
Ausgabe 4/2019
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Abstract
Purpose of Review
The aim of this review is to assess the particularities of general
anesthesia for patients undergoing lung surgery and one-lung ventilation (OLV),
and to suggest the ideal anesthesia regimen based on the current
literature.
Recent Findings
Pulmonary surgery is often performed using OLV. This is accompanied
by specific physiological challenges and risks, principally hypoxemia and acute
lung injury (ALI). Anesthetic strategies to prevent ALI include close adjustment
of mechanical ventilation settings using low tidal volumes (< 6 ml/kg for
OLV), positive end-expiratory pressure between 5 and 10 cmH2O, and the minimum
FiO2 required, as well as the use of volatile
anesthetics, which have anti-inflammatory properties. For thoracotomies,
combined general and neuraxial anesthesia are recommended. So far, there is
still no evidence if certain anesthetics have a beneficial effect on tumor
outcome in lung cancer surgery.
Summary
Protective ventilation and the use of volatile anesthetics are
recommended to diminish the occurrence of ALI in lung surgery patients, for
thoracotomies in combination with neuraxial anesthesia. Both general and local
anesthetics can have an effect on growth and recurrence of some cancer types,
and their specific effect on lung cancer must be further clarified.