Principles and practice of thoracic anaesthesia

Thoracic anaesthesia is a large field. This article concentrates on anaesthesia for major thoracotomy and lung resection, which is most usually carried out for malignant disease. This is a relatively small patient population, but procedures carry significant mortality of up to 6% for pneumonectomy. Physiological changes that occur during anaesthesia and one lung ventilation (OLV) are discussed, and the optimal ventilatory management of these patients is covered. Postoperative management of analgesia and chest drains is also discussed, as is the pathophysiology of acute lung injury (ALI) which may occur after lobectomy or pneumonectomy. Aspects of video-assisted thoracoscopy (VATS) and lung volume reduction surgery (LVRS) are also mentioned.