Anesthetic considerations for lung resection: preoperative assessment, intraoperative challenges and postoperative analgesia.

This article is intended to provide a general overview of the anesthetic management for lung resection surgery including the preoperative evaluation of the patient, factors influencing the intraoperative anesthetic management and options for postoperative analgesia. Lung cancer is the leading cause of death among cancer patients in the United States. In patients undergoing lung resection, perioperative pulmonary complications are the major etiology of morbidity and mortality. Risk stratification of patients should be part of the preoperative assessment to predict their risk of short-term vs. long-term pulmonary complications. Improvements in surgical technique and equipment have made video assisted thoracoscopy and robotically assisted thoracoscopy the procedures of choice for thoracic surgeries. General anesthesia including lung isolation has become essential for optimizing visualization of the operative lung but may itself contribute to pulmonary complications. Protective lung ventilation strategies may not prevent acute lung injury from one-lung ventilation, but it may decrease the amount of overall lung injury by using small tidal volumes, positive end expiratory pressure, low peak and plateau airway pressures and low inspired oxygen fraction, as well as by keeping surgical time as short as possible. Because of the high incidence of chronic post-thoracotomy pain syndrome following thoracic surgery, which can impact a patient's normal daily activities for months to years after surgery, postoperative analgesia is a necessary part of the anesthetic plan. Multiple options such as thoracic epidural analgesia, intravenous narcotics and several nerve blocks can be considered in order to prevent or attenuate chronic pain syndromes. Enhanced recovery after thoracic surgery is a relatively new topic with many elements taken from the experience with colorectal surgery. The goal of enhanced recovery is to improve patient outcome by improving organ function and decreasing postoperative complications, and therefore decreasing length of hospital stay.

An unusual foreign body aspiration requiring an unusual retrieval technique.

Foreign body aspiration during medical procedures has been reported in the literature. These iatrogenic incidents could be related to instruments malfunction or to accidental occurrences during medical treatment. In this paper, we present a report of a woman coming for a laparoscopic abdominal hysterectomy who developed intraoperative bronchospasm. In an attempt to administer aerosolized albuterol, the resident anesthesia provider fractured the Luer-lock tip of the 60-cc syringe, which he was using to hold the albuterol nebulizer. The plastic tip was dislodged into the endotracheal tube (ETT). On further inspection with a fiberoptic instrument the plastic tip was located loosely adherent to the distal part of the ETT and was held in place by the moisture, which had precipitated in the distal tube. An intraoperative consult with interventional pulmonary medicine was obtained after unsuccessfully attempting to retrieve the foreign body with a grasper. The syringe tip was then removed using a Fogarty balloon catheter that was threaded through the hole of the plastic tip.