"Lung resection asks two questions at once — can the patient survive the operation, and can they live with the lung that remains? This topic is split into short, focused tabs; read them in order or jump to what you need."
How to use this topic — CritCare.in.Why Pneumonectomy Is High-Risk Thoracic Anaesthesia
"Thoracic anaesthesia for lung resection asks two questions at once: can this patient survive the operation, and can they live with the lung that remains? Add one-lung ventilation, a lateral thoracotomy, large fluid shifts and a population of heavy smokers with limited reserve, and pneumonectomy becomes one of the highest-risk elective operations in general surgery."
Synthesised from Miller's Anesthesia (Slinger) & Morgan & Mikhail's Clinical Anesthesiology.A 35-year-old man with carcinoma of the lung, PFTs showing FEV₁ 78% and FVC 65%, planned for VATS lobectomy / pneumonectomy. The task: assess & optimise, and formulate an anaesthetic plan. The framework below applies to any major lung resection.
- Identify the patient's ability to tolerate the procedure.
- Identify the high-risk patient.
- Stratify peri-operative management and focus resources on high-risk patients to improve outcome.
Pre-operative Assessment
The 4 Ms, Hoover's sign, investigations, the three-legged stool, ppoFEV₁ and the exercise tests.
💪02 · OPTIMISATION & PLANOptimisation, Plan & Monitoring
The 5-pronged optimisation, GA + controlled ventilation + thoracic epidural, monitoring and induction.
🫁03 · LUNG ISOLATIONLung Isolation
DLT / bronchial blocker / endobronchial tube, DLT sizing & depth, FOB confirmation and positioning.
💨04 · ONE-LUNG VENTILATIONOne-Lung Ventilation
Maintenance, lung-protective OLV settings, the approach to hypoxaemia and judicious fluids.
🛏️05 · ANALGESIA & RECOVERYAnalgesia, Extubation & Complications
Thoracic epidural, intra-op complications, awake extubation and the post-operative complications.
🎓06 · PEARLSMistakes, Pearls & References
Common mistakes, viva-ready exam pearls and references.