[A role of thoracic epidural anesthesia in pulmonary resection surgery]

This article presents a review of current literature on impact of thoracic epidural anesthesia on functions of organs and systems. Its role in anesthetic management of pulmonary resection is discussed. Thoracotomy is one of the most painful surgical procedures followed by intense, acute, and chronic pain associated with post-thoracotomy. Thoracic epidural anesthesia ensures adequate analgesia in postoperative period and assists in solving problem of chronic pain. Thoracic epidural anesthesia reduces systemic stress response by inducing sensory and sympathetic blockade. Pulmonary resection produces changes in respiratory function which may result in respiratory insufficiency and other pulmonary complications. During one lung ventilation, thoracic epidural anesthesia reduces pulmonary blood shunt and improves oxygenation. Postoperatively due to effective pain relief and improvement of diaphragm function, thoracic epidural anesthesia improves respiratory function, and rate of pulmonary complications is decreased. Sympathetic blockade during thoracic epidural anesthesia reduces the rate of perioperative myocardial ischemia and cardiac mortality. It also reduces the number of thromboembolic and gastrointestinal complications and has a positive effect on immune function. Due to numerous benefits, thoracic epidural anesthesia can be recommended as a standard in pulmonary resection surgery.