One hundred years have passed since the first report by Charles Elsberg on the use of tracheal insufflation anesthesia for thoracic surgical procedures. The progress that has been made in the delivery of anesthesia for thoracic surgery over the past century has been remarkable. In fact, it may be argued that no other surgical sub-specialty has depended so heavily on the progress of anesthesia practice to evolve. The field of thoracic anesthesiology has grown dramatically: our understanding on the mechanisms of thoracic pain, the biology of the different diseases of the chest such as lung and esophageal cancer, the physiology of one lung ventilation and the development of multiple lung isolation techniques are but a few examples of the expanding scope of this fascinating discipline.
The goal of this textbook is to provide the reader with an updated review on the core concepts of thoracic anesthesia practice, together with some very practical management suggestions for the most commonly encountered problems. The work is intended for physicians in training and for those who do not practice thoracic anesthesia exclusively. Each chapter, written by specialists in the topic, provides a review of the key concepts needed to understand the disease at hand and summarizes the different anesthetic management strategies that will allow the delivery of safe, high quality perioperative care to thoracic surgical patients.
Our work is not an exhaustive review of the literature on thoracic anesthesiology, but a practical handbook designed for everyday use. Despite this, we include a chapter on the history of thoracic anesthesia practice. We share GK Chesterton’s view that “history is a hill or high point of vantage, from which alone men see the town in which they live or the age in which they are living.” We felt we could not tell the reader where we are without describing how we got here. We also include a chapter on practice improvement and patient safety, which contains important concepts for the delivery of modern, high-quality thoracic surgical care using a multidisciplinary, team approach. The remainder of the first section includes chapters on the scientific principles of the subspecialty of thoracic anesthesiology: chest physiology, mechanisms of pain, biology of chest malignancies and lung separation techniques.
The second section includes chapters on the most commonly performed invasive thoracic procedures, with up to date information on pathophysiology and management. Each chapter begins with a short clinical vignette, aimed at providing the reader with a concrete example of the application of the contents of the particular chapter.
The last section in the book pertains to routine and complicated post-operative care of the thoracic surgical patient. We hope the reader finds this material of practical use in their occasional thoracic anesthetic practice.
This book is the result of the dedication and hard work of our many contributors; it represents their accomplishment more than ours, and we are grateful to every one of them. We would also like to thank Melinda Macalino for her logistical and administrative assistance. Lastly, we extend our gratitude to the Department of Anesthesiology at Duke University, our chairman Dr. Mark Newman, and our teachers and trainees for their unwavering support to this project.
Atilio Barbeito, MD
Andrew D. Shaw, MB, FRCA, FCCM
Katherine Grichnik, MD, MS, FASE