Thoracic Anesthesia

Currently I'm on a thoracic anesthesia rotation. We don't have a huge volume of thoracic surgery cases so this rotation is our primary opportunity to learn techniques and intricacies specific to lung surgeries. Most surgeries fall into three categories. First, a surgeon may need to look at and operate on the airways such as dilation for bronchial mainstem stenosis. The anesthetic challenges are inducing and maintaining anesthesia and gas exchange as well as sharing the airway with the proceduralist. Second, a surgeon may need to operate on the lungs to resect a lesion like cancer. Unfortunately, patients with lung cancer are often smokers and have poor lungs and other comorbidities to begin with. Lastly, a surgeon may need to operate within the thoracic cavity to resect a mass like a thymoma. Our main concern here is to isolate the lungs so that we can deflate one to allow the surgeon access while maintaining adequate oxygenation, ventilation, and anesthetic depth.

These unique surgeries share a vital organ and the space it inhabits. Over this month, I will gain a much deeper knowledge of the pulmonary anatomy and physiology, techniques in thoracic epidural pain control, devices to allow lung isolation, and management of the airway and ventilator in high risk patients.