Cohen’s Comprehensive Thoracic Anesthesia

1st Edition - September 3, 2021
Editor: Edmond Cohen
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 7 1 3 0 1 - 6
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 7 2 0 9 1 - 5

Ideal for clinicians at all levels of experience—from the resident to the subspecialist—Cohen’s Comprehensive Thoracic Anesthesia compiles the many recent advances in thoracic anes… Read more

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Ideal for clinicians at all levels of experience—from the resident to the subspecialist—Cohen’s Comprehensive Thoracic Anesthesia compiles the many recent advances in thoracic anesthesiology into one convenient, easy-to-use reference. Concise, clinically focused chapters written by international authorities in the field cover all facets of anesthesia practice for thoracic procedures, logically organized by preoperative, intraoperative, and postoperative considerations.

Cover Image
Title Page
Copyright
Dedication
Preface
Foreword
Contributors
Table of Contents
Section 1 Preoperative Assessment
1 The Development of Thoracic Anesthesia and Surgery
Abstract
Introduction
Early History of Thoracic Anesthesia
Differential Pressure Breathing
Tracheal Insufflation and Endotracheal Anesthesia
Endotracheal Intubation and Laryngoscopy
Milestones in Thoracic Surgery
Thoracic Surgery Under Regional Anesthesia
Emergence of One-Lung Ventilation
Bronchial Blockade
Double-Lumen Endobronchial Tubes
Mechanical Ventilation
Improvements in Intraoperative Monitoring
Improvements in Ventilation
Development of Postoperative Analgesia
Broadened Horizons: The Current Scope of Anesthesia for Thoracic Surgery
Conclusion
References
2 Anatomic Correlates of Physiologic Function
Abstract
Lung Volumes: Anatomic Determinants
The Upper Airway
The Larynx
The Lower Airway
The Gas Spaces and Gas Exchange
Pulmonary Vasculature
Innervation
References
3 Radiology of the Thorax
Abstract
Introduction
Normal Tracheobronchial Anatomy
Chest Radiographs
Chest Radiographs and Pulmonary Disease
Lung Mass and Chest X-Rays
Mediastinal Mass and Chest X-Rays
Bullae
Pneumothorax
Pleural Effusion
Chest Tube Placement
Previous Lobectomy
Pneumonectomy
Single-Lumen Endotracheal Tubes
Double-Lumen Endotracheal Tubes
Postoperative Acute Lung Injury
Computed Tomography Scan and Pulmonary Disease
Computed Tomography Scan and Lung Mass, Mediastinal Mass, Pleural Effusion, and Pericardial Effusion
Multidetector Computed Tomography Scan of the Chest
Magnetic Resonance Imaging and Pulmonary Disease
Thoracic Ultrasound
Conclusion
References
4 Intrathoracic Tumors: Current Status and Classification
Abstract
Introduction
General Diagnostic Principles
Lung Cancer
Esophageal Cancer
Mediastinal Tumors
Malignant Pleural Mesothelioma
Airway Tumors (see Chapter 42)
Chest Wall Tumors
Conclusion
Acknowledgments
References
5 Pulmonary Pathophysiology and Lung Mechanics in Anesthesiology
Abstract
Introduction
Essentials of Lung Structure
Lung Volumes
Respiratory Mechanics
Pulmonary Gas Exchange
Pulmonary Function Tests
Conclusion
References
6 Physiology of the Lateral Position andOne-Lung Ventilation
Abstract
Introduction
Hypoxemia
Ventilation Prefusion Upright Position
Distribution of Ventilation
Ventilation-Perfusion Matching
Fractal Distribution of Perfusion and Ventilation
The Lateral Decubitus Position
The Lateral Decubitus Position, Awake, Spontaneously Breathing Patients
Lateral Position, Anesthetized Patients
Physiology of One-Lung Ventilation
Dependent Lung Atelectasis
Hypoxic Pulmonary Vasoconstriction (See Chapter 15)
Surgical Manipulation
Carbon Dioxide During One-Lung Ventilation
References
7 Modulating the Pulmonary Circulation: Nitric Oxide and Beyond
Abstract
Introduction
Applied Physiology of Pulmonary Circulation
Administration of Pulmonary Vasodilators (See Chapter 36)
Administration of Different Vasoactive Substances
Conclusion
Acknowledgments
References
Section 2 Preoperative Preparation
8 Preoperative Evaluation: Assessment of Preoperative Risk
Introduction
Preoperative Medical Assessment
Preoperative Evaluation of Patients Undergoing Lung Resection
Ergometric Testing
Cardiopulmonary Exercise Testing
Split Lung Function Testing
Prediction of Desaturation During One-lung Ventilation
Conclusion
References
9 Prehabilitation for Thoracic Surgery
Abstract
Introduction
Risk Prediction
Shared Decision Making Versus Consent
Prehabilitation
Nutrition
Psychology
Smoking Cessation and Respiratory Optimization
Anemia
Diabetes
Cardiac
Frailty and Comprehensive Geriatric Assessment
Oral Hygiene
The Ideal Thoracic Perioperative Pathway
Conclusion
Acknowledgments
References
Section 3 Intraoperative Preparation
10 Positioning in Thoracic Surgery
Abstract
Introduction
Positions for Thoracic NoncardiacSurgery
Robotic Surgery and Position
Special Considerations
Conclusion
References
11 Monitoring of Oxygenation and Ventilation
Abstract
Introduction
Oxygenation
Ventilation
Conclusion
References
12 Hemodynamic Monitoring in Thoracic Surgical Patients
Abstract
Introduction
Blood Pressure Monitoring
Central Venous Pressure
Pulmonary Artery Pressure
Cardiac Output Monitoring
Fluid Responsiveness
Extravascular Lung Water
Conclusion
References
13 Flexible and Rigid Bronchoscopy in Thoracic Anesthesia
Abstract
Introduction
Rigid Bronchoscopy
Flexible Bronchoscopy
Flexible Bronchoscopy in Thoracic Surgery
Interventional Pneumology
Conclusion
References
14 High-Frequency Ventilation: Applications in Thoracic Anesthesia
Abstract
Introduction
Types, Application, and Equipment of High-Frequency Ventilation
Application
Equipment
Indications for High-Frequency Ventilation in Thoracic Procedures
Anesthetic Considerations
Risks and Benefits
Conclusion
References
Section 4 Intraoperative Management
15 Anesthesia, Mechanical Ventilation, and Hypoxic Pulmonary Vasoconstriction
Abstract
Introduction
Physiology of Hypoxic Pulmonary Vasoconstriction
Variations of Hypoxic Pulmonary Vasoconstriction in Pathologic Conditions
Effects of Anesthesia and Mechanical Ventilation in Gas Exchange
One-Lung Ventilation in Thoracic Surgery and Gas Exchange
References
16 Separation of the Lung: Double-Lumen Endotracheal Tubes and Endobronchial Blockers
Abstract
Introduction
Double-Lumen Endotracheal Tubes
Size Selection of the Double-Lumen Endotracheal Tubes
Methods of Insertion of Double-Lumen Endotracheal Tubes
Left-Sided Double-Lumen Endotracheal Tubes
Placement Technique for a Left-Sided Double-Lumen Endotracheal Tube
VivaSight Double-Lumen Tube
Right-Sided Double-Lumen Endotracheal Tubes
Placement Technique for a Right-Sided Double-Lumen Endotracheal Tube
Auscultation, Flexible Fiberoptic Bronchoscopy, and Ultrasonography When Placing Double-Lumen Endotracheal Tubes
Use of Ultrasonography in the Assessment of Double-Lumen Endotracheal Tube Position and Function
Newer Technology With Double-Lumen Endotracheal Tubes
The Cliny Right-Sided Double-Lumen Endotracheal Tube
Complications Associated With Double-Lumen Endotracheal Tube Placement
Bronchial Blockers
Independent Bronchial Blockers During Lung Separation
The Arndt blocker
Methods of Placement
Cohen® Flexitip Endobronchial Blocker
Methods of Placement
Fuji Uniblocker®
The EZ-Blocker
Methods of Placement
VivaSight® Single-Lumen Tube With Guided Bronchial Blocker
Torque Control Blocker Univent
Complications With the Use of Bronchial Blockers
Lung Collapse During Lung Isolation
Future Trends in Lung Isolation
Conclusion
References
17 Lung Isolation in Patients With a Difficult Airway in Thoracic Anesthesia
Abstract
Introduction
Preoperative Assessment of the Difficult Airway
Difficult Airways and Lung Isolation: Primary Objective to Secure the Airway
Upper Airway Abnormalities and Lung Isolation
Use of Laryngeal Mask Airway and a Bronchial Blocker During Difficult Airways
Use of a Double-Lumen Endotracheal Tube in Patients With Difficult Airways
Tube Exchanger Technique for a Double-Lumen Endotracheal Tube
Exchange of a Double-Lumen Endotracheal Tube for a Single-Lumen Endotracheal Tube
Lung Isolation Techniques in Patients With Tracheostomies
Lung Isolation in Patients With Lower Airway Abnormalities
Extubation or Mechanical Ventilation After Surgery
Conclusion
References
18 Pathophysiology of Perioperative Lung Injury
Introduction
The Normal Lung
Pathophysiology of the Injured Lung
Translation Into the Operating Room
Conclusion
References
19 Intraoperative Lung Injury During One-Lung Ventilation: Causes and Prevention
Abstract
Introduction
Characterizing Postoperative Pulmonary Complication
The Incidence of Postoperative Morbidity and Mortality in Thoracic Surgery
Predisposing Condition for Postoperative Pulmonary Complication
Intraoperative Lung Injury and Postoperative Pulmonary Complications
Surgical Causes of Lung Injury
Anesthesiologic Causes of Lung Injury
Pathogenesis of Intraoperative Lung Injury Through Mechanical Ventilation
Mechanical Ventilation During Anesthesia and Lung Injury
Protective Ventilation and Postoperative Pulmonary Complications
Protective Ventilation During One-Lung Ventilation
Protective Ventilation Strategy and Postoperative Pulmonary Complication During One-Lung Ventilation
Modulating the Inflammatory Response During Ventilation With Anesthetics
Injury in the Nondependent Lung
Oxygen Toxicity
Conclusion
References
20 Management of One-Lung Ventilation: Protective Lung Ventilation
Abstract
Introduction
Ventilator-Induced Lung Injury
Protective One-Lung Ventilation
Tidal Volume
Respiratory Rate
Positive End-Expiratory Pressure and Recruitment Maneuvers
Driving, Plateau, and Peak Pressures
Inspiratory-to-Expiratory Ratio
Mechanical Power
Inspiratory Oxygen Concentration
Mechanical Ventilation Mode
Rescue Maneuvers in Case of Hypoxemia
The Nonventilated Lung
Equipment (See Chapter 16)
Risks Assessment
Conclusion
References
21 Fluid Management During Lung Resection
Abstract
Introduction
From Postpneumonectomy Pulmonary Edema to Acute Lung Injury
Definitions and Epidemiology
Physiopathology
Fluid Administration Strategies
Choice of Fluids: Crystalloids Versus Colloid Solutions
References
22 Perioperative Arrhythmias During Thoracic Surgery
Abstract
Introduction
Key Points
Core Chapter
Conclusion
References
23 Anesthesia for Pediatric Thoracic Surgery
Abstract
Introduction
Pediatric Anatomy and Physiology
Anesthetic Techniques
Two-Lung Ventilation With Manual Retraction
Lung Isolation and One-Lung Ventilation
Providing Lung Separation in the Pediatric Patients (Table 23.1)
Pain Management (see Chapters 25, 26)
Regional Modalities
Intravenous Modalities
Conclusion
References
Section 5 Postoperative Management
24 Postoperative Management of Acute Pain
Abstract
Introduction
Description of Pain in Thoracic Surgery
Multimodal Analgesia and Perioperative Analgesic Strategies
Opioids
Acetaminophen
Nonsteroidal Antiinflammatory Drugs
N-Methyl-D-Aspartate-Receptor Antagonists
Gabapentinoids
Glucocorticoids
Intravenous Lidocaine
Regional Anesthesia
Thoracic Epidural Analgesia
Technique
Complications and Safety Considerations
Clinical Advantages
Controversies
Thoracic Paravertebral Block
Anatomy of the Paravertebral Space
Mechanism of Blockade and Distribution of Spread
Technique
Complications and Safety Considerations
Choosing Between Thoracic Epidural Analgesia and Paravertebral Block
Intercostal Nerve Block
Technique and Technical Considerations
Complications and Safety Considerations
Erector Spinae Plane Block
Mechanism of Blockade and Distribution of Spread
Technique and Technical Considerations
Single-Shot Erector Spinae Plane Versus Continuous Erector Spinae Plane
Complications and Safety Considerations
Serratus Anterior Plane Block
Technique and Technical Considerations
Complications and Safety Considerations
Conclusion
References
25 Postthoracotomy Chronic Pain
Abstract
Introduction
Pathophysiology
Clinical Presentation
Prevention
Treatment
Conclusion
References
26 Postoperative Care of the Thoracic Patient
Abstract
Introduction
Location and Structure of Postoperative Care: Intensive Care Unit, High-Dependency Unit or Postanesthetic Care Unit?
How Helpful Are the Scoring Systems to Predict the Postoperative Status Preoperatively?
Management of Chest Tubes
Specific Monitoring Tools
Ventilatory Support for Patients After Thoracic Surgery
Ventilator-Associated Pneumonia (VAP) and Its Prevention
Extracorporeal Ventilatory Support
Conclusion
References
27 Postthoracotomy Complications
Abstract
Introduction
Prediction of Postoperative Pulmonary Complications
Postoperative Thoracic Complications
Postthoracotomy Cardiac Complications
Postthoracotomy Pulmonary Complications
Conclusion
References
28 Extracorporeal Ventilatory Therapies
Abstract
Introduction
Development of Extracorporeal Ventilatory Therapies
Extracorporeal Membrane Oxygenation Circuit Operational Parameters
Physiologic Basis of Extracorporeal Lung Support
Clinical Management of Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome
Use of Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation
Extracorporeal Circulatory Support
Perioperative Management of the Extracorporeal Membrane Oxygenation Patient
Experimental Therapies and Future Directions
REFERENCES
Section 6 Specific Anesthetic Considerations
29 Lung Volume Reduction Surgery
Abstract
Introduction
Emphysema
Lung Volume Reduction Surgery
Patient Selection and Rehabilitation
Exclusion Criteria
Preoperative Rehabilitation
Anesthetic Considerations
The Value of BODE Index
Conclusion
References
30 The Patient With Cardiovascular Disease for Lung Resection Surgery
Abstract
Introduction
Incidence
Assessment of Risk
Ischemic Heart Disease
Hypertension
Heart Failure
Valvular Heart Disease
Prosthetic Valves
Pulmonary Hypertension
Arrhythmias
Congenital Heart Disease in Adults
Diagnostic Test
Cardiac Risk Stratification for Thoracic Procedures
Inclusion of Biomarkers
Electrocardiogram
Recommendation for Coronary Revascularization
Cardiac Implantable Devices and Left Ventricular Assist Devices
Recommendation for Perioperative Therapy
Hypoxemia and Coronary Artery Disease
Anesthetic Goals in Patients With Coronary Artery Disease
Cardiovascular Monitoring in Patients With Coronary Artery Disease
Conclusion
References
31 Video-Assisted Thoracoscopy: Multiportal Uniportal
Abstract
Introduction
History
Techniques of Video-Assisted Thoracoscopic Surgery and Its Advantages
Preoperative Evaluation and Prehabilitation
Lung Isolation (See Chapters 16,17)
One-Lung Ventilation During Video-Assisted Thoracoscopic Surgery
Monitoring: Hemodynamic Status, Tissue Oxygenation, and Fluid Management
Mediastinal Surgery, Anesthesia in Thymectomy in Patients With Myasthenia Gravis (See Chapter 47)
Video-Assisted Thoracoscopic Surgery With Local or Regional Anesthesia: Nonintubated Video-Assisted Thoracoscopic Surgery
Postoperative Analgesia After Video-Assisted Thoracoscopic Surgery
Conclusion
References
32 Endoscopic Treatment of Chronic Obstructive Pulmonary Disease
Abstract
One Way Valves in the Treatment of Emphysema and Persistent Air Leaks
Alternative Bronchoscopic Lung Volume Reduction Procedures: Coils, Lung Sealant, Thermal Ablation, and Airway Bypass
The Future of Bronchoscopic Lung Volume Reduction
Anesthetic Management of Endoscopic Treatment of Chronic Obstructive Respiratory Disease
Types of Anesthesia for Endoscopic Treatment
Rigid Bronchoscopy
Conclusion
References
33 Thoracic Trauma
Abstract
Introduction
Categories of (Blunt) Thoracic Trauma
Tracheobronchial Injury
Injuries to the Larynx
Rib Fracture
Thoracic Instability
Pulmonary Contusion
Pneumothorax
Hemothorax
Mediastinal Widening
Thoracic Aortal Injury
Blunt Cardiac Trauma
Cardiac Contusion
Pericardial Tamponade
Diaphragmatic Rupture
Penetrating Thoracic Trauma
Preoperative Evaluation
Anesthesiologic Management
Postoperative Care
Conclusion
References
34 Mediastinal Mass and Superior Vena Cava Syndrome
Abstract
Introduction
Case Presentation
Review of the Literature
Managing Our Case
Conclusion
References
35 Mediastinoscopy
Abstract
Introduction
Case Presentation
Case Management
Review of Literature
Conclusion
References
36 Lung Resection and Pulmonary Hypertension
Abstract
Introduction
Definition
Classification/Pathophysiology
Preoperative Evaluation
Intraoperative Management
Hemodynamic Management
Conclusion
References
37 Tubeless Thoracic Procedures
Abstract
Preoperative Evaluation
Intraoperative Management
Advantages of Tubeless Thoracic Procedures
Ventilation/Perfusion With the Patient Breathing Spontaneously Withan Open Chest
Risk of Carbon Dioxide Insufflation
Monitoring
Anesthesia Sedation
Sedation and Amnesia
Analgesia
Potential Complications
Conversion to General Anesthesia
Expert Consensus on Tubeless Video-Assisted Thoracoscopic Surgery (Guangzhou)
Conclusion
References
38 Thoracic Anesthesia for the Geriatric Patient
Abstract
Introduction
Demographics
Physiology of Aging
Risk-Benefit Relationship of Surgical Intervention
Role of Surgical Techniques
Preoperative Assessment
Conclusion
References
39 Thoracic Aortic Aneurysm Resection
Abstract
Introduction
Case Presentation
Case Management
Alternative Methods
Acknowledgments
References
40 Wedge Resection, Lobectomy, Pneumonectomy
Abstract
Introduction
The Preoperative Evaluation of the Patient for Lung Resection Surgery (See Chapter 8)
Monitoring (See Chapters 11,12)
Methods of Lung Separation (See Chapter 16)
Fluid Management (See Chapter 21)
Intravenous Versus Inhaled Anesthesia
Methods of Ventilation (See Chapter 20)
Open Versus Video-Assisted Surgery
Possible Complications
Conclusion
References
41 Repair of Pectus Excavatum
Abstract
Introduction
Treatment Options
Optimal Age for Treatment
Case Presentation
Case Management
Surgical Complications
Anesthetic Techniques
Postoperative Care
Review on Postoperative Pain
Anxiety Reduction and Mindfulness
Conclusion
References
42 Tracheal Resection and Reconstruction
Abstract
Introduction
Historical Overview
Pertinent Anatomy of the Upper Airway and Trachea
Etiology of Tracheal Lesions
Preoperative Evaluation
History and Physical Examination
Diagnostic Studies
Intraoperative Management
Summary of the Surgical Procedure
Emergence and Extubation
Postoperative Care and Potential Complications
Conclusion
References
43 Lung Transplantation
Abstract
Introduction
Epidemiology
Recipient Selection
Interstitial Lung Disease
Cystic Fibrosis (See Chapter 50)
Pulmonary Vascular Disease
Recipient Preparation
Organ Allocation
Bridging to Transplantation
Organ Selection, Transport, and Preparation
Lung Transplant Procedure
Postoperative Care
Graft Dysfunction
Primary Graft Dysfunction
Long-Term Complications of Lung Transplant
Chronic Lung Allograft Dysfunction
References
44 Esophageal Procedures
Abstract
Introduction
Core Chapter
References
45 Airway Fistulas in Adults
Abstract
Introduction
Case Management
Alternative Methods
Risks and Benefits
Review of the Literature
Conclusion
References
46 Thoracic Approach to Spine Procedures
Abstract
Introduction
Case Presentation
Case Management
Risks, Benefits, and Alternatives
Conclusion
References
47 Myasthenia Gravis and Thymectomy
Abstract
Introduction
Etiology and Pathophysiology
Clinical Classification
Clinical and Differential Diagnosis
Medical Treatment
Thymectomy
Preoperative Evaluation and Management
Operative Approaches
Approach to Induction and Maintenance of Anesthesia
Utilization and Reversal ofNeuromuscular Blockade
Extubation
Postoperative Analgesia
Postoperative Myasthenic and Cholinergic Crises
Future Directions
References
48 Hemoptysis, Empyema
Abstract
Hemoptysis
Empyema
Conclusion
References
49 Thoracic Anesthesia inthe Morbidly Obese Patient: Obstructive Sleep Apnea
Abstract
Introduction
Preoperative Considerations
Intraoperative Management
Postoperative Management
Conclusion
References
50 Cystic Fibrosis
Abstract
Clinical Case
Definition
Anesthetic Considerations
Conclusion
References
51 Tracheal Stents
Abstract
Introduction
Case Presentations and Management
Alternative Methods
Risk/Benefit
Review of the Literature
References
52 Robotic Thoracic Surgery
Abstract
Introduction
Advantages, Disadvantages, Learning Curves
The Robot-Assisted Lobectomy
The Robot-Assisted Segmentectomy
The Robot-Assisted Thymectomy
Robotic-Assisted Esophagectomy (see Ch. 44)
Special Issues Concerning the Anesthetic Management
Conclusion
References
53 Enhanced Recovery After Thoracic Surgery
Abstract
Introduction
Background
Fast-Track Versus Enhanced Recovery After Surgery
Enhanced Recovery After Surgery General Overview
Enhanced Recovery After Surgery Thoracic Surgery: Justification and Applicability
Enhanced Recovery After Surgery Thoracic Surgery: Preoperative Components
Enhanced Recovery After Surgery Thoracic Surgery: Intraoperative Components
Postoperative Components
Barriers and Strategies With Implementation
Future Direction of Enhanced Recovery After Thoracic Surgery
References
54 Ultrasound of the Lung: Clinical Applications
Abstract
Introduction
Probe Selection and Scanning Protocols
Anatomic Correlation and Normal Physiologic Findings
Detection of Pneumothorax
Detection of Pleural Effusion
Interstitial Syndrome and Lung Consolidation
Conclusion
References
55 Transesophageal Echocardiography in Noncardiac Thoracic Surgery
Abstract
Introduction
Indications for Transesophageal Echocardiography Use
Transesophageal Echocardiography asa Monitor
Risks of Transesophageal Echocardiography
Intraoperative Hemodynamic Exam
Transesophageal Echocardiography Assessment of the Right Ventricle
Patent Foramen Ovale
Transesophageal Echocardiography Assessment of the Left Ventricle
Transesophageal Echocardiography for Acute Pulmonary Hypertension
Transesophageal Echocardiography forLung Ultrasound (see Ch. 54)
Transesophageal Echocardiography forLung Transplantation (see Ch. 43)
Conclusion
References
Index

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Edmond Cohen