Search Results (98)

Background and Objectives: The prediction of difficult laryngoscopic view remains an important component of preoperative airway assessment. Conventional bedside tests are widely used, but their diagnostic performance may be limited by subjectivity and interobserver variability. Focused upper airway ultrasonography may provide objective anatomical information and complement standard clinical evaluation. This study aimed to evaluate the diagnostic accuracy of focused upper airway ultrasonographic and conventional anthropometric measurements for predicting difficult laryngoscopic view in adult patients scheduled for tracheal intubation. Materials and Methods: This single-center, prospective, observational study included 212 adult patients with American Society of Anesthesiologists physical status I–III who were scheduled for elective surgery under general anesthesia requiring tracheal intubation. Preoperative airway assessment included the Modified Mallampati classification, upper lip bite test, mouth opening, thyromental distance, and sternomental distance. Focused ultrasonographic measurements included hyoid–skin distance and epiglottis–skin distance. Difficult laryngoscopic view was defined as a Cormack–Lehane grade III–IV view recorded during the initial direct laryngoscopic assessment. Diagnostic performance was evaluated using receiver operating characteristic curve analysis, and independent predictors were assessed using multivariable logistic regression. Results: Difficult laryngoscopic view was identified in 44 of 212 patients (20.8%). Patients with difficult laryngoscopic view had significantly higher body weight and body mass index, smaller mouth opening, and greater hyoid–skin distance. Hyoid–skin distance was significantly greater in patients with difficult laryngoscopic view than in those without difficult laryngoscopic view (12.00 ± 2.79 mm vs. 10.33 ± 3.16 mm; p = 0.002). Mouth opening was significantly smaller in patients with difficult laryngoscopic view (4.39 ± 0.72 cm vs. 4.74 ± 0.99 cm; p = 0.030). Epiglottis–skin distance did not differ significantly between groups. In receiver operating characteristic analysis, hyoid–skin distance showed an area under the curve of 0.682, with a cut-off value of ≥12.05 mm, sensitivity of 47.73%, and specificity of 83.33%. In multivariable logistic regression analysis, body mass index and hyoid–skin distance were independently associated with difficult laryngoscopic view, whereas greater mouth opening had a protective effect. The combined multivariable model showed an area under the curve of 0.734; however, at a probability cut-off value of 0.5, its sensitivity was low at 15.9%, despite high specificity of 97.0%. Conclusions: Focused upper airway ultrasonography may provide complementary objective information when used together with conventional preoperative airway assessment. Hyoid–skin distance was independently associated with difficult laryngoscopic view and demonstrated relatively high specificity; however, its discriminatory performance was modest and its sensitivity was limited. Therefore, hyoid–skin distance and the combined model should not be interpreted as standalone screening tools for excluding difficult laryngoscopic view. Their main clinical value may be as adjunctive parameters that support risk stratification and advance airway management planning in selected patients. Full article

The work of anesthesiologists–intensivists, critical care specialists, and medical emergency teams is multifaceted and complex, with airway management representing a cornerstone and a common denominator of many procedures and interventions. Tracheal intubation has represented and still represents today the gold standard for airway control. This narrative review, conducted through a comprehensive search of PubMed/MEDLINE, EMBASE, and the Cochrane Library from database inception to December 2025 and supplemented by manual reference searches and retrieval of key historical sources, aims to trace the evolution of laryngoscopy for airway management and tracheal intubation—from its nineteenth-century origins to the current state of the art—while simultaneously addressing the clinical, educational, and safety implications of this evolution. Laryngoscopy evolution progressed in parallel with technological development and innovation, resulting in the expansion of clinical possibilities and in the improvement of patient safety. The evolution of laryngoscopy essentially took place between the late 1800s and the first half of the 1900s, culminating in the widespread adoption of the Macintosh laryngoscope. Almost 50 years later, a pivotal turning point occurred around the 2000s with the introduction of videolaryngoscopes. Along this path, the devices that succeeded one another introduced new problems, driving the search for new solutions. At present, tracheal intubation with videolaryngoscopy has achieved success and safety standards substantially superior to those of the early days of the technique. In this review we retrace the historical milestones of laryngoscopy, analyze the problems that emerged over time with various devices and the solutions adopted, examine the evolution of videolaryngoscopes and the impact of these devices on both technical and non-technical skills, discuss the ongoing debate surrounding their routine use (universal videolaryngoscopy) and the selection of optimal adjunct devices, and outline the emerging role of artificial intelligence in improving success rates and facilitating the learning curve. This journey, after 150 years of evolution, has reached a high level of maturity in terms of safety and efficacy. Full article

Background/Objectives: Unanticipated difficult airway remains a critical patient safety concern in perioperative care. Despite routine preoperative assessment, difficult intubation may still occur in patients without obvious high-risk findings. This study aimed to evaluate perioperative factors associated with unanticipated difficult intubation and to examine the relationship between preoperative assessment and intraoperative intubation difficulty in routine clinical practice. Methods: This retrospective case–control study included adult patients undergoing general anesthesia with tracheal intubation between 2015 and 2020 at a tertiary care hospital. Unanticipated difficult intubation was defined as requiring ≥3 intubation attempts without documented preoperative suspicion of difficult airway. Patients with anticipated difficult airway or preoperative mechanical ventilation were excluded. A total of 95 cases and 429 controls were analyzed. Associations were explored using multivariable logistic regression. Results: Among 524 patients, cases more frequently had ASA physical status III and airway/neck/oral deformity. Notably, intubation difficulty became evident only at laryngoscopy, characterized by poorer visualization, increased intubation attempts (median 4 vs. 1), and frequent escalation to video laryngoscopy. Severe laryngoscopic views (Cormack–Lehane grade III–IV: 74.8% vs. 3.0%) were markedly overrepresented among cases. In multivariable analysis, ASA III and airway deformity remained independently associated with unanticipated difficult intubation. The model demonstrated modest discrimination (AUC 0.685). Conclusions: Unanticipated difficult intubation was uncommon but clinically important and frequently became apparent only during airway management. Although several associated factors were identified, routine bedside airway assessment alone may not reliably predict all cases of intraoperative difficult intubation. These findings highlight the limitations of routine bedside airway assessment in identifying all patients who subsequently experience difficult intubation and support the need for improved strategies to identify patients at risk. Full article

Background/Objectives: Metabolic and bariatric surgery (MBS) is increasingly performed worldwide and requires specific anesthetic management due to the complex physiological alterations associated with severe obesity. Although several international guidelines provide recommendations for perioperative care in bariatric patients, their implementation in routine clinical practice may vary. This study aimed to report anesthetic practices among Polish anesthesiologists providing anesthesia for bariatric procedures. Methods: A cross-sectional survey study was conducted in October 2025 among Polish anesthesiologists. The questionnaire consisted of 13 closed-ended questions addressing demographic characteristics, anesthetic management and blood pressure management, including preoperative thresholds for postponement of elective surgery and intraoperative thresholds for pharmacological treatment of hypotension. The survey was distributed via social media platforms. Participation was anonymous and voluntary. Results: A total of 71 anesthesiologists participated in the study. The most commonly used intubation device was the Macintosh laryngoscope (57.7%), while videolaryngoscopy was used by 42.2% of respondents. Positive end-expiratory pressure (PEEP) was routinely applied by most respondents, with 63.4% adjusting its level according to patient body weight. Multimodal analgesia components were commonly used, with paracetamol (95.8%), dexamethasone (91.5%), metamizole (90.1%), and lignocaine (84.5%) being the most frequently administered drugs. Most anesthesiologists reported postponing elective surgery when blood pressure exceeded 180/110 mmHg. More experienced anesthesiologists more often considered lower thresholds for postponement of elective surgery (p = 0.006). Conclusions: Reported practices among surveyed anesthesiologists for MBS in Poland are generally consistent with international recommendations, particularly regarding the use of PEEP. However, variability remains in airway management strategies and the use of videolaryngoscopy, highlighting the need for continued education and broader implementation of evidence-based perioperative protocols. Full article

Background: Arytenoid cartilage dislocation (ACD) is a rare but clinically significant complication of endotracheal intubation that may be misdiagnosed as transient vocal cord paralysis. The potential role of prolonged surgical positioning in ACD remains underrecognized. Methods: A 63-year-old male developed left posterior ACD following robot-assisted radical prostatectomy (RARP) performed in a steep Trendelenburg position for 3.5 h. Intubation was successfully achieved on the first attempt using a video laryngoscope with full glottic visualization and no apparent airway trauma. Postoperatively, the patient developed persistent dysphonia, dysphagia, aspiration, and tongue deviation. Initial flexible laryngoscopy suggested left vocal cord paralysis, whereas direct laryngoscopy on postoperative day 6 confirmed posterior arytenoid dislocation. Urgent closed reduction was performed, followed by structured voice therapy, which resulted in substantial functional recovery. Discussion: This case illustrates that ACD may occur despite technically optimal and atraumatic intubation and should be interpreted as reflecting a temporal association rather than a definitive causal relationship. Prolonged steep Trendelenburg positioning and extended operative duration may be considered potential contributing biomechanical factors, possibly mediated by venous congestion, mucosal edema, altered endotracheal tube dynamics, and cumulative shear stress on the cricoarytenoid joint. However, these mechanisms remain interpretive and hypothesis-generating. Conclusions: Prolonged steep Trendelenburg positioning and extended operative duration may represent possible contributing biomechanical factors in ACD, even in the setting of atraumatic intubation. Early laryngeal evaluation and timely reduction remain essential for optimal functional recovery. Full article

Background: Difficult intubation is an important clinical problem faced by anesthesiologists and is one of the most important causes of anesthesia-related morbidity. According to various sources, the frequency of encountering a difficult airway is stated as 1–4%. Aim: We thought that difficult tracheal intubation could be predicted by photographic analysis using artificial intelligence. Methods: Sixteen photographs were taken in the preoperative period in the sitting and lying positions anteriorly, laterally, with the mouth open, with the mouth closed, with the neck straight, and with the neck extended. Intubations performed without intervention for the first time were considered easy. Intubations with external tracheal intervention and with more than one attempt were evaluated as medium. Intubations requiring more than three attempts; intubation with stylets, fiberoptic bronchoscopes, or video laryngoscopes; or cases in which patients could not be intubated and provided airway with a laryngeal mask were considered difficult. Results: In our study, the CNN (convolutional neural network) model performed well overall, with the best results generally obtained using batch sizes of 32 and 128 and learning rates ranging from 0.1 to 0.001. Conclusions: The prominent aspects of our study are that it can be conducted with an easily accessible mobile phone, can be performed at the bedside, and is successful in predicting difficult intubation. The sensitivity of methods currently used to assess difficult airways is generally low, and the likelihood of clinicians successfully identifying this condition using available information varies widely; thus far, there is no gold standard for prediction. We believe that our study will bring a different perspective to estimating the difficulty of intubation, which occupies a very important place in anesthesia practice. Full article

Background/Objectives: Effective airway management during pediatric cardiopulmonary resuscitation (CPR) is crucial but technically challenging, especially during continuous chest compressions. While direct laryngoscopy with Macintosh (MAC) or Miller (MIL) blades remains the standard, optical devices such as the VieScope (VSL) may enhance performance under dynamic resuscitation conditions. This study compared first-pass success and intubation time, as well as procedural difficulty and glottic visualization, of MAC, MIL, and VSL during simulated pediatric cardiopulmonary resuscitation. Methods: This prospective, randomized crossover simulation study involved 53 medical students. Participants performed endotracheal intubation on a high-fidelity manikin simulating a 5-year-old pediatric patient using MAC, MIL, and the Bebé VieScope laryngoscope. Each technique was evaluated in two scenarios: with and without continuous chest compressions. Results: Without chest compressions, first-pass success (FPS) and intubation time varied significantly between techniques. VSL achieved the highest FPS (100%; p = 0.032) and the shortest intubation time (27.9 ± 9.2 s; p = 0.040), performing faster than MIL and achieving higher FPS than MAC. Visualization quality, ease of intubation, and optimization maneuvers were similar across techniques. During continuous chest compressions, all outcomes differed significantly. FPS increased from MAC to MIL and VSL (p = 0.001), with MAC showing the lowest success rate. VSL showed the shortest intubation time (35.9 ± 13.0 s; p < 0.001), better glottic visualization, easier intubation, and fewer optimization maneuvers, followed by MIL. Conclusions: In this simulated pediatric cardiac arrest model, the VieScope laryngoscope demonstrated superior overall performance, especially during uninterrupted chest compressions. Optical tubular laryngoscopy may therefore provide clinically relevant benefits in pediatric resuscitation where maintaining high-quality chest compressions is crucial. Given the manikin-based design of this study, confirmation of these findings in clinical pediatric cardiac arrest settings will require further prospective clinical investigation. Full article

Objective: To develop and evaluate artificial intelligence (AI)-based models for detecting laryngeal cancer using laryngoscope images. Methods: Two deep learning models were designed. The first identified and selected vocal cord images from laryngoscope datasets; the second localized laryngeal cancer within the selected images. Both employed FCN–ResNet101. Datasets were annotated by otolaryngologists, preprocessed (cropping, normalization), and augmented (horizontal/vertical flip, grid distortion, color jitter). Performance was assessed using Intersection over Union (IoU), Dice score, accuracy, precision, recall, F1 score, and per-image inference time. Results: The vocal cord selection model achieved a mean IoU of 0.6534 and mean Dice score of 0.7692, with image-level accuracy of 0.9972. The laryngeal cancer model achieved a mean IoU of 0.6469 and mean Dice score of 0.7515, with accuracy of 0.9860. Real-time inference was observed (0.0244–0.0284 s/image). Conclusions: By integrating a vocal cord selection model with a lesion detection model, the proposed platform enables accurate and fast detection of laryngeal cancer from laryngoscope images under the current experimental setting. Full article

Background: Chronic rhinosinusitis with or without nasal polyps (CRSwNPs/CRSsNPs) is an inflammatory disease that is becoming increasingly associated with laryngopharyngeal reflux disease (LPRD). Although symptom-based questionnaires, such as the Reflux Symptom Index (RSI) and Reflux Symptom Score (RSS), are widely used, there is a lack of objective endoscopic tools for assessing the nasopharyngeal and nasal manifestations of reflux. The Nasopharyngeal Reflux Endoscopic Score (NRES) is a novel endoscopic scoring system that was developed to address this issue. Objective: The objective of this study was to evaluate the diagnostic accuracy of the NRES in identifying LPRD in patients with CRS, compared with a clinical reference standard. Methods: A prospective diagnostic accuracy cohort study was conducted at two tertiary care centers in Astana, Kazakhstan, from September 2023 to February 2025. A total of 216 adults were enrolled and divided into three groups: CRS with suspected LPRD (n = 116), CRS without LPRD (n = 69), and healthy controls (n = 31). CRS was diagnosed according to the EPOS 2020 criteria. LPRD was defined using a composite reference standard comprising clinical assessment, RSS > 13, RSI, and selective 24 h pH monitoring and gastrointestinal endoscopy. All participants underwent nasopharyngeal and laryngeal endoscopy, with NRES, L-K, RFS, RSI, and RSS assessments at baseline and at 6 and 12 months. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance, and Wilcoxon tests were used to analyze the changes in scores. Correlation and regression analyses were used to explore associations between scales and predictive factors. Results: At baseline, NRES scores were significantly higher in the CRS with LPRD group (mean: 11.59) than in the CRS without LPRD group (mean: 3.10) and the healthy control group (mean: 2.16) (p < 0.001). ROC analysis demonstrated excellent diagnostic accuracy, with an area under the curve (AUC) of 0.998 (95% confidence interval (CI): 0.994–1.000), a sensitivity of 98% (95% CI: 94–100%) and a specificity of 96% (95% CI: 91–99%) at an optimal cut-off point of 8.5. NRES scores showed strong correlations with RSI, RSS, and RFS scores (r > 0.76, p < 0.001). A longitudinal assessment revealed significant reductions in all scores after treatment with proton pump inhibitors and lifestyle modifications, with sustained improvement at 12 months. Regression analysis found no significant effect of age, gender, or GERD severity (LA classification) on NRES scores. Conclusions: The NRES is a highly sensitive and specific endoscopic tool for identifying nasopharyngeal changes associated with LPRD in CRS patients. It demonstrates strong correlations with established symptom-based and laryngoscopic reflux assessments and responds to anti-reflux therapy over time. The NRES may, therefore, be a valuable objective adjunct in the comprehensive evaluation and longitudinal monitoring of LPRD-associated CRS. Full article

Purpose: Hemodynamic response, particularly increased heart rate (HR) and blood pressure, can occur during tracheal intubation and is an adverse event to be avoided. The aim of this study was to use a network meta-analysis (NMA) to develop a ranking of hemodynamic responses (HR and mean blood pressure, MBP) after intubation of indirect and direct laryngoscopes in pediatric patients. Method: Studies were eligible for inclusion if they had a prospective randomized design, compared hemodynamic response (HR and MBP) to tracheal intubation between indirect and/or direct laryngoscopes, and were conducted in pediatric patients. The pooled difference between each intubation device’s intubation time is expressed as a weighted mean difference (WMD) of a 95% confidence interval (CI). The intubation time of the device was evaluated using P-scores calculated from the network point estimates and standard errors. A random-effects model was used when pooling effect sizes. We also analyzed intubation time as a related factor to hemodynamic responses. Results: From the electronic databases, we selected 16 trials for review. In a Macintosh-referenced analysis, Airtraq suppressed an increase of HR and MBP during tracheal intubation in pediatric patients significantly more than a Macintosh laryngoscope. (HR; WMD = −16.7, 95%CI −22.5 to −10.9, MBP; WMD = −8.57, 95%CI −10.9 to −6.27). Airtraq also topped the HR and MBP P-score rankings. The results of this study showed similar laryngoscopes in the top five rankings of P-scores (Airtraq, Coopdech video laryngoscope, Miller, C-MAC, Wis-Hipple) for HR and intubation time. Conclusions: We applied a network meta-analysis to create a consistent ranking of intubation devices that prevent hemodynamic changes during tracheal intubation in pediatric patients. In this NMA, Airtraq proved to be the best laryngoscope for preventing hemodynamic responses during tracheal intubation in pediatric patients. In the analysis of intubation time, Airtraq showed the shortest intubation time. Full article

Background/Objectives: Neonatal intubation is a complex procedure, often associated with low first-pass success rates and a high incidence of complications. Video laryngoscopes provide several advantages, including higher success rates, especially for novice clinicians, a magnified airway view that can be shared with supervisors, and the ability to record still or video images for debriefing and education. However, video laryngoscope devices vary, raising the possibility of differences in usability. Methods: The study used mixed methodology, including observations, semi-structured interviews, think-aloud techniques, high-fidelity simulations, function tests, and questionnaires to assess usability, defined by the clinician satisfaction, efficacy, and efficiency of six video laryngoscope devices; (1) C-MAC^® with Miller blade, (2) GlideScope^® Core^TM with Miller blade, (3) GlideScope^® Core^TM with hyperangle LoPro blade, (4) Koala^® Vision Ultra with Miller blade, (5) Koala^® Handheld with Miller blade, and (6) Parker Neonatal with Miller blade. Clinician satisfaction was determined by the System Usability Scale (SUS), National Aeronautics and Space Administration Task Load Index (NASA-TLX), and clinician preference. Device efficacy was determined by first-pass success, number of attempts, and overall success. Efficiency was assessed by time to successful intubation and function test completion rates. Results: Neonatal video laryngoscopes varied considerably in design, impacting usability. All devices were deemed suitable for neonatal intubation, with the Koala^® Handheld, C-MAC^®, and GlideScope^® Core ^TM Miller demonstrating the highest usability. Conclusions: This simulation-based study highlights substantial variability in neonatal video laryngoscope usability, indicating the need for further research into usability in the clinical setting. Full article

Background: Children generally face a higher incidence of airway management complications, intubation difficulties, and the risk of failed intubation. Currently, there is sufficient evidence in clinical practice for the use of videolaryngoscopes in pediatric airway management. However, there are a number of standard-blade videolaryngoscopes available for children. In addition, there is no clear recommendation on which videolaryngoscope is superior. The primary objective of this study is to compare the first pass success rate and the Percentage of Glottic Opening (POGO) scores with Cormack–Lehane (CML) scores obtained through direct and indirect laryngoscopy with HugeMed and McGrath Mac videolaryngoscopes in pediatric patients with an unanticipated, difficult airway. Materials and Methods: Following the Ethics Committee approval and written parental consents, a total of 40 elective surgical patients, aged 3 and under, with ASA 1–3 risk classification, and undergoing general anesthesia, were included in the study. After induction of general anesthesia, the first group of patients (Group McGrath, n = 20) was intubated with the McGrath Mac videolaryngoscope, and the second group (Group HugeMed, n = 20) with the HugeMed videolaryngoscope. Before intubation, CML and POGO scores were recorded for both groups using direct and indirect laryngoscopy with videolaryngoscopes. Intubation time, number of attempts, need for cricoid pressure, optimization maneuver requirement, and hemodynamic parameters were recorded for both groups. Results: There was no significant difference between groups in demographic data including age, gender, body mass index, ASA, and hemodynamic parameters. A significant improvement was observed in CML and POGO scores using indirect laryngoscopy (p < 0.001). CML scores obtained with the McGrath Mac were significantly lower than the HugeMed Group (p = 0.0034). The mean POGO value calculated with indirect laryngoscopy was significantly higher in the McGrath Group compared to the HugeMed Group (92.63 ± 6.09 vs. 88.75 ± 4.44, respectively). Conclusions: Videolaryngoscopes improved laryngeal visualization in children under 3 years old. Compared to HugeMed, in indirect laryngoscopy, the McGrath Mac videolaryngoscope was found to be superior, with better CML and POGO scores. However, number of tracheal intubation attempts, success rate, complication risk, and hemodynamic parameters did not show any significant difference between the groups. Clinical trial registration number was NCT06484517. Full article

Background/Objectives: Difficult intubation is a significant clinical issue in emergency medicine as well as anesthesia practice, occurring more frequently in obese patients. Traditional assessment methods may not be sufficient to predict difficult intubation. This study aims to evaluate the ability of ultrasound-measured skin-to-epiglottis distance (SED) to predict difficult laryngoscopy in obese patients and investigate its applicability in clinical practice. Methods: This prospective observational study was conducted between February 2024 and January 2025 at Gaziantep City Hospital on obese patients undergoing bariatric surgery. Patients aged 18 years and older with an American Society of Anesthesiologists (ASA) classification of I-II-III were included in the study. Demographic data, standard airway assessment parameters (neck circumference, thyromental distance, sternomental distance, etc.), and ultrasound-measured skin-to-epiglottis distance were recorded. All intubation procedures were performed by a single experienced anesthesiologist following standard protocols, and laryngoscope view was assessed according to the Cormack–Lehane classification. Results: Among the 61 patients included in the study, 16.4% were classified as having a difficult airway, and 13.1% experienced difficult intubation. No significant correlation was found between standard airway assessment parameters and difficult intubation. However, ultrasound-measured skin-to-epiglottis distance (SED) was significantly higher in patients with difficult intubation (p = 0.004), making it a strong predictor. Additionally, modified Mallampati (p < 0.001), modified Cormack–Lehane (p = 0.003), and Wilson scores (p = 0.001) were significant in predicting difficult airway, although Wilson score was not significant for difficult intubation (p = 0.099). Conclusions: Our study suggests that ultrasound-measured skin-to-epiglottis distance may be a valuable predictor of difficult intubation in obese patients. Given the limitations of preoperative assessment methods, incorporating ultrasound into airway evaluation as a complementary tool provides significant benefits. Larger-scale studies in the future are necessary to further assess the clinical efficacy of this method. Full article

Introduction: Difficult airway management is a critical challenge in anesthesia, often necessitating advanced techniques to ensure patient safety. A patient presented with a malignant lesion on the epiglottis, significantly altering the airway anatomy. Flexible rhinolaryngoscopy revealed a laryngeal carcinoma affecting the entire epiglottis, causing thickening and displacement, which suggested the potential for difficult intubation. Methods: Given the expected feasibility of bag-mask ventilation and front-of-neck access, an asleep intubation technique was selected. The combined use of a McGrath video laryngoscope and C-MAC video stylet allowed for fast and easy atraumatic intubation on the first attempt. The anesthetic and surgical course was uneventful. Discussion: This case report highlights the successful use of a combined approach involving a video laryngoscope and video stylet for intubation in a patient with known difficulties in airway management, providing insights into the benefits of enhanced visualization and maneuverability. The rigid design and steerable tip of the C-MAC video stylet provide advantages over traditional flexible optics, offering better maneuverability and reducing the need for a second operator. Although this technique was successful in this case, its use in patients with complex airway pathologies warrants careful preoperative assessment and collaboration with an experienced airway management team. Full article

Thoracic surgery is a highly complex field requiring collaboration between surgeons, anesthesiologists, pulmonologists, and other specialists. Successful outcomes depend on thorough preoperative evaluations that consider the patient’s overall health, lifestyle habits, and surgical risks. Key elements include proper intraoperative anesthesia management, postoperative pain control, and the integration of enhanced recovery after surgery (ERAS) protocols to optimize recovery. Double-lumen tubes (DLTs) are essential for one-lung ventilation during thoracic procedures, although they can be invasive. Recent advancements, such as video-assisted laryngoscopes, have improved the success of DLTs and reduced the invasiveness of DLT intubation and extubation. Postoperative pain management is crucial for minimizing complications and enhancing recovery. Techniques like epidural analgesia, nerve blocks, and patient-controlled analgesia improve patient outcomes by allowing early mobility and deep breathing. Dexmedetomidine (DEX), a sedative with minimal respiratory impact, has shown promise in reducing delirium and aiding recovery. This review highlights the importance of teamwork, pain management, and emerging technologies in improving thoracic surgery outcomes. Advances in these areas, particularly within ERAS protocols, continue to enhance patient care and overall surgical success. Full article