Thoracic Anesthesia, An Issue of Anesthesiology Clinics , livre ebook

Anesthesiology Clinics
Thoracic Anesthesia
Peter Slinger, MD, FRCPC
Professor of Anesthesia, University of Toronto, Toronto, Ontario, Canada M5G 2C4
ISSN  1932-2275
Volume 30 • Number 4 • December 2012
Table of Contents
Cover image
Title page
Contributors
Forthcoming Issues
Foreword
Thoracic Anesthesia
The Pathophysiology of Perioperative Lung Injury
Introduction
Diagnostic criteria
Anatomy of ARDS: endothelial and epithelial injury
Mechanical ventilation and ALI
Imaging findings
Differential diagnosis of ALI
Pathophysiology
Phases of ALI/ARDS
Resolution
Translation into the operating room
Summary: future directions?
Perioperative Oxygen Toxicity
Oxygen toxicity
Perioperative hyperoxia
Physiologic effects of hyperoxia
Clinical effects of hyperoxia
Summary
Perioperative Lung Protection Strategies in Cardiothoracic Anesthesia
Introduction
Mechanical ventilation
Ventilator-induced lung injury
Perioperative surgical environment factors
Patients with chronic obstructive pulmonary disease
Perioperative therapy of COPD to decrease lung injury
One-lung ventilation
Role of volatile anesthetic agents in lung protection
Transfusion-related lung injury
Cardiopulmonary bypass
Ultraprotective lung ventilation
Fluids, inflammation, and the glycocalyx
Other therapies for lung protection
Summary
Advances in Therapy for Acute Lung Injury
Introduction
Extracorporeal lung support
Indications for ECMO
Technical aspects of ECMO
ECMO cannulation
Ventilator settings during veno-venous ECMO
Weaning ECMO (according to Deja and colleagues and von Dossow-Hanfstingl and colleagues)
Complications associated with ECMO
iLA
Weaning criteria iLA (according to Deja and colleagues and von Dossow-Hanfstingl and colleagues)
Other therapeutic recommendations
Perspectives
Fluid Management in Thoracic Surgery
The starting point: fluid balance in the perioperative period
Strategies of fluid management: avoiding ALI
Fluid management and the kidneys
Fluid management and the heart
Individualized, goal-directed fluid management
Summary
Transesophageal Echocardiography in Noncardiac Thoracic Surgery
Introduction
Current monitoring practices in thoracic surgery
TEE for acute pulmonary hypertension
Lung resection surgery and pneumonectomy
Lung transplantation
TEE for thoracic aortic surgery
Echocardiographic considerations for the interrogation of the thoracic aorta during thoracic surgery
Initiation of ECMO
Summary
Supplementary data
Supplementary data
How to Choose the Double-Lumen Tube Size and Side
Introduction
The conundrum of the size
Left versus right: which side to use?
Managing Hypoxemia During Minimally Invasive Thoracic Surgery
Introduction
Thoracoscopy: what is different?
Predictors for hypoxemia during OLV
Preventative measures to avoid hypoxemia
Treatment of hypoxemia during thoracoscopy
Identify and treat common causes
Advanced interventions with no impact on exposure
Advanced interventions with potential impact on exposure
Risk of hypoxia
Advancements in Robotic-Assisted Thoracic Surgery
Video-assisted thoracoscopic surgery
RATS
Drawbacks to RATS
Description of operative approaches for thoracic surgery
Anesthesia for RATS
Venous return impairment
Patient immobility
Positioning neuropathy
Prophylaxis considerations
Single-lung ventilation
Bladder catheterization
Temperature management
Learning curve
Emergency planning
Summary
Anesthesia for Tracheal Resection and Reconstruction
Introduction
Anatomy and physiology
Surgical indications
Preoperative evaluation
Intraoperative management
Postoperative care
Complications
Departures from the basic case
Summary
Anesthetic Management for Esophageal Resection
Introduction
Pulmonary morbidity
Ventilatory management
Thoracic epidural analgesia
Intraoperative fluid management
The esophagogastric anastomosis and gastric conduit perfusion
Vasopressor therapy
Anastomotic leak
Other intrathoracic complications: atelectasis, pneumonia, pleural effusions, and chylothorax
Cardiac arrhythmias
Venous thromboembolism
Nutrition and gastrointestinal function
Summary
Perioperative Management of the Pregnant Patient with an Anterior Mediastinal Mass
Objectives
Symptoms
Perioperative management
Anesthetic management
Case summary
Pulmonary Pathophysiology and Lung Mechanics in Anesthesiology
Introduction
Case I: lung resection in a patient with COPD
Case II: cardiac surgery
Summary
Index
Contributors
CONSULTING EDITOR

LEE A. FLEISHER, MD
Robert D. Dripps Professor and Chair of Anesthesiology and Critical Care, Professor of Medicine, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
GUEST EDITOR

PETER SLINGER, MD, FRCPC
Professor of Anesthesia, Department of Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
AUTHORS

KAYODE ADENIJI, BMedSci, MBBS, MRCP, DICM
Clinical Fellow, Interdepartmental Division of Critical Care, Faculty of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada

PAUL H. ALFILLE, MD
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts

RANDAL S. BLANK, MD, PhD
Associate Professor, Chief, Thoracic Anesthesia, Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia

SANJEEV V. CHHANGANI, MD, MBA, FCCM
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts

STEPHEN R. COLLINS, MD
Assistant Professor, Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia

ANA FERNANDEZ-BUSTAMANTE, MD, PhD
Assistant Professor, Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado

ION A. HOBAI, MD, PhD
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts

J. MICHAEL JAEGER, MD, PhD
Co-Medical Director, TCV Surgical ICU, Division of Critical Care Medicine, Associate Professor, Departments of Anesthesiology and Surgery, University of Virginia Health System, Charlottesville, Virginia

DAVID W. KACZKA, MD, PhD
Assistant Professor, Harvard Medical School; Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts

GEORGE W. KANELLAKOS, MD, FRCPC
Chief, Thoracic Anesthesia, Assistant Professor, Dalhousie Department of Anesthesia, Pain Management and Perioperative Medicine, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada

BRUCE KILPATRICK, MBBCh, FCA(SA)
Anaesthesiologist, Department of Anaesthesia, Royal Inland Hospital, Kamloops, British Columbia, Canada

JENS LOHSER, MD, MSc, FRCPC
Associate Professor, Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada

ANDREW B. LUMB, MBBS, FRCA
Consultant Anaesthetist, Department of Anaesthesia, St James s University Hospital; Lecturer in Anaesthesia, University of Leeds, Leeds, United Kingdom

RALPH LYERLY III
Assistant Professor of Anesthesiology, Department of Anesthesiology, University of Alabama School of Medicine, Birmingham, Alabama

GUIDO MUSCH, MD
Associate Professor, Harvard Medical School; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts

ALESSIA PEDOTO, MD
Assistant Clinical Attending, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York

ALBERT PERRINO, MD
Jr Professor of Anesthesiology, Yale University School of Medicine, New Haven

FERENC PUSKAS, MD, PhD
Associate Professor, Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado

CAIT P. SEARL, BSc, MA, MBChB, MRCP, FRCA
Consultant Cardiothoracic Anaesthetist and Intensivist, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom

PETER SLINGER, MD, FRCPC
Professor of Anesthesia, Department of Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada

ANDREW C. STEEL, BSc, MBBS, MRCP, FRCA, FRCPC, EDICM
Assistant Professor, Interdepartmental Division of Critical Care, Faculty of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada

BRAD STEENWYK, MD
Associate Professor of Anesthesiology, Department of Anesthesiology, University of Alabama School of Medicine, Birmingham, Alabama

BREANDAN SULLIVAN, MD
Assistant Professor, Anesthesiology and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado

MARCOS F. VIDAL MELO, MD, PhD
Associate Professor, Harvard Medical School; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts

VERA VON DOSSOW-HANFSTINGL, MD
Department of Anesthesiology, Ludwig Maximilian University, Munich, Germany

LAURA J. WALTON, MBChB, FRCA
Specialist Trainee in Anaesthesia, Department of Anaesthesia, St James s University Hospital, Leeds, United Kingdom
ANESTHESIOLOGY CLINICS
FORTHCOMING ISSUES
March 2013 Trauma Yoram Weiss, MD and Micha Shamir, MD, Guest Editors
June 2013 Cardiac Anesthesia Colleen Koch, MD, Guest Editor
RECENT ISSUES
September 2012 Postanesthesia Care Unit Scott A. Falk, MD, Guest Editor
June 2012 Neurosurgical Anesthesia Ansgar M. Brambrink, MD, PhD, and Jeffrey R. Kirsch, MD, Guest Editors
March 2012 Surgical Palliative Care and Pain Management Geoffrey P. Dunn, MD, Sugantha Ganapathy, MBBS, and Vincent Chan, MD, Guest Editors

RELATED INTEREST
Chest Surgery Clinics, Februa