Author
Karagoz HY. Sonmez B. Bakkaloglu B. Kurtoglu M. Erdinc M. Turkeli A. Bayazit K
Institution
Department of Cardiovascular Surgery, Guven Hospital, Ankara, Turkey. karagoz@tr-net.net.tr
Title
Coronary artery bypass grafting in the conscious patient without endotracheal general anesthesia.
Source
Annals of Thoracic Surgery, 70(1)1-96, 2000 July.
Abstract
BACKGROUND: Over the past several years, considerable experience has accumulated in performing coronary anastomoses on the beating heart, and various aspects of minimally invasive approaches have been simplified. Continue Reading »

The majority of studies of Nitric Oxide (NO) during one-lung ventilation over the past five years have shown that NO does not cause a significant increase in the mean PaO2. One recent study(1) shows that among patients with hypoxemia (defined here as PaO2/FiO2 <100) there was an increase in mean arterial oxygenation with NO 40ppm. Examining the data shows that a small minority of hypoxemic patients (approximately 25%)will have a clinically useful increase in PaO2 with NO. Examining the data of previous studies(2) it can be seen in other studies that a few patients with borderline hypoxemia will have an increase in PaO2 with NO. Although this does not make NO a useful therapy for hypoxemia during one-lung ventilation it does raise the possibility that it may be possible to identify the minority of patients who respond to NO. Continue Reading »

A previous study suggested that PaO2 during one-lung ventilation (OLV) was decreased when thoracic epidural anesthesia (TEA) was used in combination with general anesthesia compared to general anesthesia alone(1). A recent study suggests that TEA increases PaO2 during OLV(2). The most likely explanation for these opposite conclusions is that TEA has little direct effect on shunt and PaO2 during OLV. The differences are more likely related to changes in cardiac output and PvO2 related to differing anesthetic managment in the two studies. Continue Reading »

There has been a concern that thoracic epidural analgesia with local anesthetics could decrease lung mechanical function due to effects on the chest wall. A recent study shows that analgesic doses of local anesthetics in thoracic epidurals do not cause a reduction of lung mechanics in a group of patients with severe COPD. Continue Reading »

Several recent articles in the British Anesthesia literature detail the high risk of perioperative complications associated with esophagectomy. Some of the interest in this area is due to the British Report of the National Confidential Enquiry into Perioperative Deaths 1996/1997 . (London NCEPOD,1998) which pointed out the high rates of mortality associated with this operation. Continue Reading »

Adolphs J, Schmidt DK, Mousa SA et al. Thoracic Epidural Anesthesia Attenuates Hemorrhage-induced Impairment of Intestinal Perfusion in Rats. Anesthesiology 2003;99:685-92.

The authors used Sprague-Dawley rats with epidural catheters placed al L4 and threaded in to the T11/12 level. The rats were divided into 2 sets of 2 groups. Each set had a group that received 2% lidocaine for a T6-L4 blockade and the other (control) group received a corresponding amount of saline. On set of groups was used to examine the mucosa of the ileum and the other set the muscularis of the ileum. Continue Reading »

J Anesth. 2002;16(1):13-6
Thoracoscopic sympathectomy: endobronchial anesthesia vs endotracheal anesthesia with intrathoracic CO2 insufflation.

El-Dawlatly A, Al-Dohayan A, Riyad W, Thalaj A, Delvi B, Al-Saud S.

Department of Anesthesia and ICU, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461, Saudi Arabia.

PURPOSE: To compare clinical advantages and hemodynamic and respiratory changes during one lung-collapsed ventilation (OLCV) using a double-lumen tube (DLT) or a single-lumen tube (SLT) with intrathoracic CO(2) insufflation, in patients undergoing thoracic sympathectomy (TS) under general anesthesia. Continue Reading »

Peter D. Slinger, MD, FRCPC,
Associate Professor of Anesthesia , University of Toronto,
and The University Health Network

Michael R. Johnston, MD, FRCSC,
Associate Professor of Surgery, University of Toronto,
and The University Health Network
Key Words: Anesthesia, Thoracic. Preoperative assessment. Pulmonary function. Respiratory function. Surgery, Thoracic.

Preoperative anesthetic assessment prior to chest surgery is a continually evolving science and art. Recent advances in anesthetic management, surgical techniques and perioperative care have expanded the envelope of patients now considered to be “operable” (see Fig.1)1. This article is an update on pre-anesthetic assessment for pulmonary resection surgery in cancer patients. Continue Reading »

Peter Slinger MD, FRCP, Assoc. Prof., Dept. Anesthesia, University of Toronto
The objectives of this seminar are: 1) To update Anesthesiologists on the status of lung transplantation; 2) To examine recent and future advances in lung transplantation; 3) To highlight the lessons learned from lung transplantation that apply in general to anesthesia in patients with end-stage lung disease. The majority of recent advances in thoracic anesthesia have occurred because of experiences in lung transplantation. Continue Reading »

Peter Slinger MD, FRCPC
Assoc. Professor, Dept. Anesthesia, University of Toronto

The incidence of hypoxemia during one-lung ventilation (OLV) with an inspired oxygen concentration (FiO2) of 1.0 has declined from levels of 20-25% in the 1970’s to less than 10% today. Two advances in thoracic anaesthesia affect oxygenation. First, the routine use of fiberoptic bronchoscopy to position DLTs. Second, improved anesthetic techniques with lower doses of volatile agents. Continue Reading »