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2 results

  • Chapter 17 - Anesthesia for pleural and chest wall surgery

  • from Section 2 - Anesthesia for operative procedures
  • Edited by Cait P. Searl, Sameena T. Ahmed
  • Book:
    Core Topics in Thoracic Anesthesia
    Published online:
    10 December 2009
    Print publication:
    02 April 2009, pp 114-117

  • Summary

    Rigid bronchoscopy (RB) was a necessary art of assessment of fitness for lung resection surgery and placing lung separator devices (LSD). For RB, general anesthesia is the norm. For short procedures a propofol and opioid supplemented induction is a usual regimen, followed by a short-acting non-depolarizing agent such as mivacurium. Manufacturers of positive pressure ventilation equipment pay little attention to the needs of patient ventilation during operation of their devices. Intrinsic and extrinsic lesions of the trachea can present as life-threatening emergencies. The erosion of a major vessel in the bronchial tree occasionally results in unstoppable hemoptysis. With much of the cardiac output coming up an RB, it is impossible to do anything to intervene. The advent of self-expanding devices has considerably eased the burden of sharing access to the airway with surgeons or physicians.

  • Chapter 18 - Anesthetic implications for management of thoracic trauma

  • from Section 2 - Anesthesia for operative procedures
  • Edited by Cait P. Searl, Sameena T. Ahmed
  • Book:
    Core Topics in Thoracic Anesthesia
    Published online:
    10 December 2009
    Print publication:
    02 April 2009, pp 118-128

  • Summary

    The development of modern anesthesia techniques involving the ventilation of the patient's lungs and the use of tracheal tubes in intensive care and anesthesia was a great impetus to the development of surgery in general. The types of procedures carried out on the trachea that require general anesthesia are rigid bronchoscopy, tracheal stenting and excision of tracheal stenosis or tumors. Rigid bronchoscopy can be used for diagnostic purposes by examining and assessing the tracheobronchial tree anatomy and by the taking of a biopsy for histology. Silicone rubber stents require general anesthesia for placement while metallic expandable stents can be placed fluoroscopically or under general anesthesia. The indications for tracheal resection are symptomatic stenosis or benign and malignant tumors. Tracheal stenosis is most often caused by trauma such as prolonged intubation of the trachea in the intensive care unit.