Thoracic anaesthesia

The uniqueness of thoracic anaesthesia is that it is conducted concurrently with operative surgery on, or in the vicinity of, those very organs which are receiving the anaesthetic gases. Although some procedures do not directly involve the lungs, e.g. oesophageal surgery, all consist of breaches in the integrity of one or both pleural cavities, whether in open thoracotomies or thoracoscopic procedures. Thus, hypoxia and hypercarbia are a constant threat. This is compounded by the fact that the patients are frequently elderly with chronic health problems and, consequently, poor anaesthetic risks. In view of this, an overview of respiratory anatomy and physiology will be given, followed by consideration of some of the anaesthetic strategies applied to meet the particular challenges of this surgical specialty.