RESUMO
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.
RESUMO
OBJECTIVE: The aim of this study was to review mortality rate pertinent to anesthesia in magnetic resonance imaging (MRI) settings and compare it with operating room (OR) mortality rate. MATERIALS AND METHODS: A total of 47,389 anesthetics have been administered to pediatric patients in the Montefiore Medical Center between February 1998 and September 2007, of which 11,700 (25%) were administered for procedures performed outside the OR. Our data collection system allows us to separate outside OR locations into 2 separate groups. One group includes MRI, computed tomography scan, and radiology, and the other includes gastrointestinal procedures, hematology-oncology, and all others. The data we present show the total number of cases, and demographic numbers reflect the total numbers as well. RESULTS: On the basis of the 3 deaths from general anesthesia occurring in the MRI suite, the resulting non-OR mortality rate at our institution was approximately 1 in 3900. Comparatively, in the same period, our mortality rate for procedures performed intraoperatively under general anesthesia was 1 in 7138. Therefore, there is almost a 2-fold increased risk in mortality associated with non-OR versus OR anesthetics at our institution. CONCLUSION: Our analysis shows that the administration of anesthesia in MRI suite possesses inherent risks that might be the same or even higher than those in the OR. BACKGROUND: Over the last 2 decades, the scope of anesthesia practice has expanded to include remote sites away from the operating room. As the number of diagnostic and therapeutic interventions performed outside the operating room continues to increase, anesthesiologists are being faced with challenges of providing care for more medically complex patients while adapting to fewer resources, with lack of support system commonly available in the operating room. In this article, we present three pediatric cases resulting in poor outcomes, all of which occurred in our MRI suite.
