[Per- and postoperative risk status in pulmonary surgery]

Better understanding of pulmonary physiology over the last few years has permitted a more effective control of gaz exchanges during pulmonary surgery. The introduction of one-lung anesthesia offers a greater margin of safety to the patient and improved surgical conditions, and helps avoid hypoxic episodes. Modern management of ventilation during pulmonary surgery unquestionably requires the use of full invasive monitoring: central venous pressure, pulmonary pressures (in specific situations) and radial arterial pressure (systolic, mean and diastolic pressures). Pulse oximetry and measurement of end-tidal carbon dioxide are also indispensable. Complete monitoring and frequent determinations of arterial blood gases allow continuous adjustments of the ventilation of the dependent and independent lungs. Placement of epidural thoracic catheters for postoperative analgesia represents another improvement. This technique alone permits rapid and complete recovery of pulmonary function after pulmonary surgery.