Current Trends and Future Challenges in Thoracic Anesthesia

Dear Colleagues,

Advances in thoracic surgery have been facilitated by improvements in anaesthetic techniques and perioperative care. This has evolved from knowledge based on evidence-based medicine to personalised and precision medicine.

The concept of perioperative medicine is highly applicable to thoracic surgery, given its advantages observed in other types of surgery; this has led to the application of enhanced recovery after surgery (ERAS) and prehabilitation.  

Methods of airway management include lung isolation and separation techniques checked by fiberscope or orotracheal tubes or double-lumen tubes with built-in camera permitting to reduce the incidence of intraoperative hypoxaemia and tracheobronchial tree damage. The airway is complex to manage in patients undergoing thoracic surgery.

Lung protective ventilation has become especially important during thoracic surgery, both during one-lung and two-lung ventilation. These techniques have been based on tidal volume adjustments, optimal PEEP, and alveolar recruitment manoeuvres, always limiting airway pressures to acceptable values.

Analgesia methods are based on locoregional techniques adapted to the type of surgical approach; today, techniques such as paravertebral block and erector spinae block allow a faster and safer recovery. Of course, chronic pain is a particularly relevant aspect associated with this surgical speciality.

Finally, the evolution of the surgical approach in thoracic surgery from thoracotomy to VATS has been remarkably interesting; currently, robotic thoracic surgery is being incorporated into clinical practice and requires important adjustments in the anaesthetic technique due to the difficulty of access to the patient and the application of capnothorax, among other relevant aspects.

Prof. Dr. Manuel Granell Gil
Dr. Izumi Kawagoe
Prof. Dr. Edmond Cohen
Guest Editors

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