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From "awake" to "monitored anesthesia care" thoracic surgery: A 15 year evolution
Tommaso C Mineo1, Federico Tacconi1
1Division and Department of Thoracic Surgery, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata University Rome, Italy.
Thoracic Cancer
|January 15, 2016
Summary
Monitored anesthesia care (MAC) offers an alternative to general anesthesia for thoracic surgery, potentially reducing complications and costs. This approach is effective for various oncologic and non-oncologic conditions, especially in high-risk patients.
Area of Science:
- Thoracic Surgery
- Anesthesiology
- Pulmonary Medicine
Background:
- General anesthesia is the standard for thoracic surgery but carries significant risks.
- Alternative methods like awake thoracic surgery and monitored anesthesia care (MAC) are gaining interest.
- MAC aims to prevent complications associated with general anesthesia and selective ventilation.
Purpose of the Study:
- To explore the utility and benefits of monitored anesthesia care in thoracic surgery.
- To evaluate MAC's efficacy and safety for oncologic and non-oncologic thoracic conditions.
- To assess MAC's potential in high-risk patient populations.
Main Methods:
- Review of current practices involving conscious sedation and spontaneous ventilation in thoracic procedures.
- Application of MAC protocols for diverse thoracic conditions, including oncologic and non-oncologic diagnoses.
- Comparison of MAC outcomes with traditional general anesthesia, particularly in high-risk individuals.
Main Results:
- MAC is successfully employed for malignant pleural effusion, lung nodules, mediastinal tumors, pneumothorax, emphysema, and interstitial lung disease.
- Increasing familiarity allows for major thoracic operations under MAC.
- Preliminary evidence suggests MAC is non-inferior in efficacy to general anesthesia for high-risk patients.
Conclusions:
- Monitored anesthesia care is a viable and potentially beneficial alternative to general anesthesia in thoracic surgery.
- MAC offers advantages such as reduced complications, shorter hospital stays, and lower costs.
- Adequate training in MAC for thoracic surgery should be integrated into residency programs.
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