[Pneumonectomy and lobectomy]

Thoracic surgery developed remarkably in tandem with anesthetic management and post-operative intensive care since 1990. The innovations in these fields include wide spread use of one-lung ventilation, advances in clarification of pathophysiology of postoperative acute lung injury as well as its treatment, initiation of lung protective ventilation strategy, advancement of chest physiotherapy, and wide use of non-invasive ventilation in the last two decades. Current guidelines support strongly the use of lower tidal volume in patients with acute lung injury and acute respiratory distress syndrome. Under the influence of this new lung protective ventilation strategy, perioperative managements such as setting of tidal volume changed drastically in nearly ten years. The purpose of this article is to review the innovations and the transitions in anesthetic management and post-operative intensive care in thoracic surgery, and to propose up-to-date peri-operative respiratory strategies for patients undergoing thoracic surgery, especially pneumonectomy.