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Eur J Cardiothorac Surg 2007;32:13-19. doi:10.1016/j.ejcts.2007.04.004
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Reviews

Epidural anesthesia in awake thoracic surgery

Tommaso Claudio Mineo*

Thoracic Surgery Division, Tor Vergata School of Thoracic Surgery, Policlinico Tor Vergata, Rome, Italy

Received 23 January 2007; received in revised form 19 March 2007; accepted 2 April 2007.

* Corresponding author. Address: Cattedra di Chirurgia Toracica, Università Tor Vergata, Policlinico Tor Vergata, V.le Oxford, 81, 00133 Rome, Italy. Tel.: +39 06 20902884; fax: +39 06 20902881. (Email: mineo{at}med.uniroma2.it).

Despite the indisputable and well-known advantages of general anesthesia in thoracic surgery, this can trigger some adverse effects including an increased risk of pneumonia, impaired cardiac performance, neuromuscular problems, mechanical ventilation-induced injuries, which include barotrauma, volotrauma, atelectrauma, and biotrauma. In order to reduce the adverse effects of general anesthesia, thoracic epidural anesthesia has been recently employed to perform awake thoracic surgery procedures including coronary artery bypass, management of pneumothorax, resection of pulmonary nodules and solitary metastases, lung volume reduction surgery, and even transsternal thymectomy. The results achieved in this early series have been encouraging, although indications and many pathophysiologic aspects remain to be elucidated. In this review we have tried to provide a first-step analysis of the anecdotal reports available in the literature on this topic. We also desired to provide insights into the main physiologic effects of awake thoracic surgery with epidural anesthesia, with particular attention to the several issues raised by its application in patients with chronic obstructive pulmonary disease, which can represent one of the most stimulating challenges in this setting.

Key Words: Epidural anesthesia • VATS • Thoracoscopy • LVRS • Pulmonary nodule • Thoracic surgery






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Copyright © 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.