Thoracic surgery in patients with previous lung resection

Abstract

Thoracic surgery in patients with a previous lung resection is a very difficult challenge for thoracic surgeons and anesthesiologists. Before to start the anesthetic induction we have to assess the anatomic airway changes, the cardiopulmonary fitness, lung mechanical function and lung parenchymal function. Chest radiograph and CT scan preoperative assessment it’s necessary to decide which is the optimal airway devices including DLT, bronchial blockers or both to perform a lung isolation or a selective lobar blockade guided by fiberscope to avoid tracheobronchial damage. Protective ventilation and permissive hypercapnia is very important to manage these patients. Moreover, it’s necessary to apply a protective ventilation but if anesthesiologists needed have to be ready to use other methods to improve the gas exchange as high frequency ventilation and extracorporeal ventilatory assistance among others.