Longnecker's Anesthesiology > Part 4. Managing Anesthesia Care > Section E. Specialty Areas of Anesthetic Practice > Chapter 53. Thoracic Anesthesia Stuart J. Weiss, MD, PhD, and E. Andrew Ochroch, MD, MSCE

Key Points

"1. Thoracic surgery is being performed on patients with more severe pulmonary disease than performed in earlier years. Previous exclusion criteria for undergoing general anesthesia now are considered overly conservative.

2. Because the mortality rate of untreated lung cancer approaches 100%, assigning definitive exclusion criteria for lung resection is difficult. Parameters used to predict patients at increased risk for postoperative complications include forced vital capacity, forced expiratory volume in 1 second, split lung functions, and exercise tolerance.

3. Patients undergoing thoracic surgical procedures often have preexisting pulmonary and cardiac disease.

4. Preoperative symptoms of dyspnea, shortness of breath, and hoarseness of voice may be related to thoracic tumor pathology. Possible etiologies include superior vena cava obstruction, mediastinal mass, tracheal compression, tracheomalacia, and malignancy.

5. One goal of preoperative preparation is to improve pulmonary function by use of bronchodilators for reactive airway disease, antibiotics for infection, and education to promote the cessation of smoking. Smoking should stop at least 4–8 weeks preoperatively.

6. Routine diagnostic procedures that are performed to confirm and evaluate the extent of pulmonary and thoracic disease include bronchoscopy, mediastinoscopy, and video-assisted..."