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 »

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

The second half of this century has seen refinements of the double-lumen tube (DLT) from that of Carlens1 to a tube specifically designed for intraoperative use (Robertshaw)2 with larger, D-shaped, lumens and without a carinal hook. Continue Reading »

There has been a revival of interest in the use of bronchial blockers for lung isolation particularly due to the problems which are encountered because of the limitations of double-lumen tubes in patients with abnormal upper or lower airway anatomy. The following is one of a series of articles and related links to the recently released Arndt Wire-guided Endobronchial Blockade(WEB)Catheter which can be very useful in many of these patients. Continue Reading »