Cohen’s Comprehensive Thoracic Anesthesia

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IFC
Cohen's Comprehensive Thoracic Anesthesia
Cohen's Comprehensive Thoracic Anesthesia
Copyright
Dedication
Preface
Foreword
Contributors
Contents
1 - The Development of Thoracic Anesthesia and Surgery
	Introduction
	Early History of Thoracic Anesthesia
	Differential Pressure Breathing
	Tracheal Insufflation and Endotracheal Anesthesia
	Endotracheal Intubation and Laryngoscopy
	Milestones in Thoracic Surgery
	Thoracic Surgery Under Regional Anesthesia
	Emergence of One-Lung Ventilation
	Bronchial Blockade
	Double-Lumen Endobronchial Tubes
	Mechanical Ventilation
	Improvements in Intraoperative Monitoring
	Improvements in Ventilation
	Development of Postoperative Analgesia
	Broadened Horizons: The Current Scope of Anesthesia for Thoracic Surgery
	Conclusion
	References
2 - Anatomic Correlates of Physiologic Function
	The Muscle-Powered Air Pump
	Lung Volumes: Anatomic Determinants
	The Upper Airway
	The Larynx
	The Lower Airway
	The Gas Spaces and Gas Exchange
	Pulmonary Vasculature
	Innervation
	References
3 - Radiology of the Thorax
	Introduction
	Normal Tracheobronchial Anatomy
	Chest Radiographs
	Chest Radiographs and Pulmonary Disease
	Lung Mass and Chest X-Rays
	Mediastinal Mass and Chest X-Rays
	Bullae
	Pneumothorax
	Pleural Effusion
	Chest Tube Placement
	Previous Lobectomy
	Pneumonectomy
	Single-Lumen Endotracheal Tubes
	Double-Lumen Endotracheal Tubes
	Postoperative Acute Lung Injury
	Computed Tomography Scan and Pulmonary Disease
	Computed Tomography Scan and Lung Mass, Mediastinal Mass, Pleural Effusion, and Pericardial Effusion
	Multidetector Computed Tomography Scan of the Chest
	Magnetic Resonance Imaging and Pulmonary Disease
	Thoracic Ultrasound
	Conclusion
	References
4 - Intrathoracic Tumors: Current Status and Classification
	Introduction
	General Diagnostic Principles
	Lung Cancer
	Esophageal Cancer
	Mediastinal Tumors
		Thymic Tumors
		Germ Cell Tumors
	Malignant Pleural Mesothelioma
	Airway Tumors (see Chapter 42)
	Chest Wall Tumors
	Conclusion
	Acknowledgments
	References
5 - Pulmonary Pathophysiology and Lung Mechanics in Anesthesiology
	Introduction
	Essentials of Lung Structure
		Tracheobronchial Structure
		Respiratory Airways
	Lung Volumes
		Nomenclature
		Tidal Volume
		Residual Volume
		Expiratory and Inspiratory Reserve Volumes
		Functional Residual Capacity
		Total Lung Capacity
		Closing Capacity and Closing Volume
		Effects of Anesthesia
	Respiratory Mechanics
		Transpulmonary Pressure
		Driving Pressure
		Elastance and Compliance
		Resistance
		Stress and Strain
		Mechanical Power
		Measures of Derecruitment and Overdistension
		Effects of Anesthesia
	Pulmonary Gas Exchange
		Ventilation
		Perfusion
		Ventilation Perfusion Matching
		Pulmonary Blood Flow
		Pulmonary Vascular Resistance
		Measurement of Ventilation-Perfusion Matching
			Ventilation-Perfusion Scans
		Diffusion
		Measurement of Hypoxemia and Hypercapnia
			Oxygen Saturation (SpO2)
			Shunt
			PaO2/FiO2 Ratios
			A-a Gradient
			Dead Space
	Pulmonary Function Tests
		Forced Expiratory Volume in 1 Second
		Forced Vital Capacity
		Forced Vital Capacity25%–75%
		Diffusing Capacity of Carbon Monoxide
		Cardiopulmonary Exercise Testing
		Recommendations for Preoperative Assessment
	Conclusion
	References
6 - Physiology of the Lateral Position and One-Lung Ventilation
	Introduction
	Hypoxemia
	Ventilation Prefusion Upright Position
		Distribution of Perfusion7,8
		Other Factors That Influence the Distribution of Blood Flow
	Distribution of Ventilation1,2,7,8
	Ventilation-Perfusion Matching
	Fractal Distribution of Perfusion and Ventilation
		Fractal Distribution of Perfusion
	The Lateral Decubitus Position
		Distribution of Perfusion inthe Lateral Position
		Distribution of Ventilation in the Supine andLateral Positions
	The Lateral Decubitus Position, Awake, Spontaneously Breathing Patients
		Chest Closed
		Chest Open
	Lateral Position, Anesthetized Patients
		Chest Closed
		Chest Open
	Physiology of One-Lung Ventilation
	Dependent Lung Atelectasis
	Hypoxic Pulmonary Vasoconstriction (See  Chapter 15)
	Surgical Manipulation
	Carbon Dioxide During One-Lung Ventilation
	References
7 - Modulating the Pulmonary Circulation: Nitric Oxide and Beyond
	Introduction
	Applied Physiology of Pulmonary Circulation
		General Considerations
		Intraoperative Monitoring of Pulmonary Circulation
		Pulmonary Vascular Resistance
		Ventilation-Induced Changes in Pulmonary Hemodynamics
		Regulation of Pulmonary Vascular Resistance
	Administration of Pulmonary Vasodilators (See Chapter 36)
		Prostacyclins
		Inhaled Nitric Oxide
		Almitrine
		Phosphodiesterase-5 Inhibitors
		Endothelin Receptor Antagonists
		Calcium Channel Blockers
	Administration of Different Vasoactive Substances
		Drugs to Improve Right Heart Function That May Affect Pulmonary Circulation
	Conclusion
	Acknowledgments
	References
8 - Preoperative Evaluation: Assessment of Preoperative Risk
	Introduction
	Preoperative Medical Assessment
		Age (see Chapter 38)
		Cardiovascular Disease
		Assessment for Risk of Atrial Fibrillation(see Chapter 22)
		Asthma
		Chronic Obstructive Pulmonary Disease
		Obstructive Sleep Apnea
		Smoking
		Obesity
		Malnutrition
	Preoperative Evaluation of Patients Undergoing Lung Resection
		Pulmonary Function Testing: Spirometry and Diffusing Capacity
		Predicted Postoperative Lung Function
		Ergometric Testing
		Cardiopulmonary Exercise Testing
	Split Lung Function Testing
		Quantitative Lung Perfusion Scintigraphy (Ventilation-Perfusion Scan)
		Unilateral Pulmonary Artery Occlusion
	Prediction of Desaturation During One-lung Ventilation
	Conclusion
	References
9 - Prehabilitation for Thoracic Surgery
	Introduction
	Risk Prediction
	Shared Decision Making Versus Consent
	Prehabilitation
		Exercise
		Nutrition
		Psychology
		Smoking Cessation and Respiratory Optimization
		Anemia
		Diabetes
		Cardiac
		Frailty and Comprehensive Geriatric Assessment
		Oral Hygiene
	The Ideal Thoracic Perioperative Pathway
	Conclusion
	Acknowledgments
	References
10 - Positioning in Thoracic Surgery
	Introduction
	Positions for Thoracic NoncardiacSurgery
		Supine Position
		Lateral Decubitus
		Flexion
		Reverse Trendelenburg
		Prone
	Robotic Surgery and Position
	Complications Related to Patient Positioning
	Special Considerations
		Changes in Position During Emergency
		Position for Extracorporeal Mechanical Oxygenation During Thoracic Cases (see Chapter 28)
		Position in Obese Patients (see Chapter 49)
	Conclusion
	References
11 - Monitoring of Oxygenation and Ventilation
	Introduction
		American Society of Anesthesiologists Standards for Basic Anesthetic Monitoring
	Oxygenation
		Oxygen Cascade
		Oxygen Analyzers
		Monitoring Blood Oxygenation
		Pulse Oximetry
			Principles of Operation
			Advantages and Disadvantages
			Complications
			Spurious Readings and Sources of Error
				Inadequate Waveform.
				Spuriously Normal and Increased Oxygen Saturation Readings.
				Spuriously Low Oxygen Saturation Readings.
		Cooximetry
		Oxygen Reserve Index
	Ventilation
		Carbon Dioxide Cascade
		Respiratory Rate and Volume Measurement
			Dead Space
		Spirometry
		Airway Pressures
		Capnography and Capnometry
	Conclusion
	References
12 - Hemodynamic Monitoring in Thoracic Surgical Patients
	Introduction
	Blood Pressure Monitoring
		Oscillometry
		Tonometry
		Volume Clamp Technique
		Intraarterial Catheterization
	Central Venous Pressure
	Pulmonary Artery Pressure
	Cardiac Output Monitoring
		Pulmonary Artery and Transpulmonary Thermodilution
		Arterial Waveform Analysis
		Doppler-Based Techniques
		Bioimpedance and Bioreactance
	Fluid Responsiveness
		Respiratory Variation
		Microbolus Technique
	Extravascular Lung Water
	Conclusion
	References
13 - Flexible and Rigid Bronchoscopy in Thoracic Anesthesia
	Introduction
	Rigid Bronchoscopy
		Composition
		Indications
	Flexible Bronchoscopy
		Composition
		Indications
		Contraindications
	Flexible Bronchoscopy in Thoracic Surgery
		Presurgical Diagnostics
		Airway Management
			Use of Flexible Bronchoscopy in Difficult Airways
			Use of Flexible Bronchoscopy for the Correct Positioning of Double-Lumen Tubes (See Chapters 16 and 17)
			Use of Flexible Bronchoscopy With Bronchial Blockers
		Postoperative Thoracic Surgery
			Hemoptysis
			Atelectasis
			Treatment of Air Leaks
			Treatment of Bronchopleural Fistulas (see Chapter 45)
			Tracheal Lacerations
			Lobe or Lung Segment Torsions
	Interventional Pneumology
		Diagnostic and Therapeutic Techniques
		Anesthesia Applied to the Use of a Bronchoscope
			Flexible Bronchoscopy
			Rigid Bronchoscopy
		Ventilation Techniques
			Flexible Bronchoscopy
			Rigid Bronchoscopy
	Conclusion
	References
14 - High-Frequency Ventilation: Applications in Thoracic Anesthesia
	Introduction
	Types, Application, and Equipment of High-Frequency Ventilation
		High-Frequency Jet Ventilation
		Superimposed High-Frequency Jet Ventilation
		Sanders Jet Ventilation (Manual Jet Ventilation)
		High-Frequency Oscillatory Ventilation
		High-Frequency Percussive Ventilation
		High-Frequency Positive Pressure Ventilation
	Application
	Equipment
		Hunsaker Mon-Jet tube
	Indications for High-Frequency Ventilation in Thoracic Procedures
		Rigid Bronchoscopy
		Airway Obstructing Tumor
		Tracheal and Carinal Resection
		Cannot Ventilate Cannot Intubate Situation
		Ventilation of the Nondependent Lung
		Imaging, Stereotactic Procedures, and Catheter Ablation
		Bronchopleural Fistula
		Postcardiac Surgery Use
		Contraindications
		Setup and Monitoring
		Driving Pressure
		Tidal Volume
		Respiratory Rate
		Fraction of Inspired Oxygen
		Inspiratory Fraction, I:E
		Bias Flow
		Mean Airway Pressure
	Anesthetic Considerations
	Risks and Benefits
	Conclusion
	References
15 - Anesthesia, Mechanical Ventilation, and Hypoxic Pulmonary Vasoconstriction
	Introduction
	Physiology of Hypoxic Pulmonary Vasoconstriction
		The Hypoxic Signal in Different Tissues
		Time Course of Hypoxic Pulmonary Vasoconstriction
		The Oxygen Sensing and Effector Mechanisms of Hypoxic Pulmonary Vasoconstriction
		Neurohumoral Modulation of Hypoxic Pulmonary Vasoconstriction
		Modulation of Hypoxic Pulmonary Vasoconstriction by the Endothelium
		Physiologic Variations in Hypoxic Pulmonary Vasoconstriction Responses
		Pulmonary Circulation
		Physical Factors: Calcium, CO2, pH, Temperature
		Senescence
		Altitude
		Genetics
	Variations of Hypoxic Pulmonary Vasoconstriction in Pathologic Conditions
		Chronic Lung Diseases
		Asthma
		Obstructive Sleep Apnea
		Acute Respiratory Distress Syndrome (ARDS)
	Effects of Anesthesia and Mechanical Ventilation in Gas Exchange
		Lung Perfusion (see Chapter 6)
		Lung Volume Ventilation
		Integrated Ventilatory and Perfusion Changes
	One-Lung Ventilation in Thoracic Surgery and Gas Exchange
		Body Position
		Chest Opening, Lung Exclusion, and One-Lung Ventilation
		Effects of Cardiovascular Drugs
		Thoracic epidural anesthesia
		Choice of General Anesthetics
	References
16 - Separation of the Lung: Double-Lumen Endotracheal Tubes and Endobronchial Blockers
	Introduction
	Double-Lumen Endotracheal Tubes
	Size Selection of the Double-Lumen Endotracheal Tubes
	Methods of Insertion of Double-Lumen Endotracheal Tubes
	Left-Sided Double-Lumen Endotracheal Tubes
	Placement Technique for a Left-Sided Double-Lumen Endotracheal Tube
	VivaSight Double-Lumen Tube
	Right-Sided Double-Lumen Endotracheal Tubes
	Placement Technique for a Right-Sided Double-Lumen Endotracheal Tube
	Auscultation, Flexible Fiberoptic Bronchoscopy, and Ultrasonography When Placing Double-Lumen Endotracheal Tubes
	Use of Ultrasonography in the Assessment of Double-Lumen Endotracheal Tube Position and Function
	Newer Technology With Double-Lumen Endotracheal Tubes
	The Cliny Right-Sided Double-Lumen Endotracheal Tube
	Complications Associated With Double-Lumen Endotracheal Tube Placement
	Bronchial Blockers
	Independent Bronchial Blockers During Lung Separation
	The Arndt blocker
	Methods of Placement
	Cohen® Flexitip Endobronchial Blocker
	Methods of Placement
	Fuji Uniblocker®
	The EZ-Blocker
	Methods of Placement
	VivaSight® Single-Lumen Tube With Guided Bronchial Blocker
	Torque Control Blocker Univent
	Complications With the Use of Bronchial Blockers
	Lung Collapse During Lung Isolation
	Future Trends in Lung Isolation
	Conclusion
	References
17 - Lung Isolation in Patients With a Difficult Airway in Thoracic Anesthesia
	Introduction
	Preoperative Assessment of the Difficult Airway
	Difficult Airways and Lung Isolation: Primary Objective to Secure the Airway
	Upper Airway Abnormalities and Lung Isolation
	Use of Laryngeal Mask Airway and a Bronchial Blocker During Difficult Airways
	Use of a Double-Lumen Endotracheal Tube in Patients With Difficult Airways
	Tube Exchanger Technique for a Double-Lumen Endotracheal Tube
	Exchange of a Double-Lumen Endotracheal Tube for a Single-Lumen Endotracheal Tube
	Lung Isolation Techniques in Patients With Tracheostomies
	Lung Isolation in Patients With Lower Airway Abnormalities
	Extubation or Mechanical Ventilation After Surgery
	Conclusion
	References
18 - Pathophysiology of Perioperative Lung Injury
	Introduction
		Epidemiology
		Imaging
	The Normal Lung
	Pathophysiology of the Injured Lung
		Genotype
		Pathologic Phenotype
		Edema Formation
		Surfactant Production
		Humoral Factors
		Microthrombosis
		Fibroproliferative Recovery Phase
	Translation Into the Operating Room
		Ventilator-Induced Lung Injury
		Volutrauma
		Atelectrauma
		Biotrauma
		Protective Ventilation (See Chapters 19, 20)
	Conclusion
	References
19 - Intraoperative Lung Injury During One-Lung Ventilation: Causes and Prevention
	Introduction
	Characterizing Postoperative Pulmonary Complication
	The Incidence of Postoperative Morbidity and Mortality in Thoracic Surgery
	Predisposing Condition for Postoperative Pulmonary Complication
	Intraoperative Lung Injury and Postoperative Pulmonary Complications
	Surgical Causes of Lung Injury
	Anesthesiologic Causes of Lung Injury
	Pathogenesis of Intraoperative Lung Injury Through Mechanical Ventilation
	Mechanical Ventilation During Anesthesia and Lung Injury
	Protective Ventilation and Postoperative Pulmonary Complications
	Protective Ventilation During One-Lung Ventilation
	Protective Ventilation Strategy and Postoperative Pulmonary Complication During One-Lung Ventilation
	Modulating the Inflammatory Response During Ventilation With Anesthetics
	Injury in the Nondependent Lung
	Oxygen Toxicity
	Conclusion
	References
20 - Management of One-Lung Ventilation: Protective Lung Ventilation
	Introduction
	Ventilator-Induced Lung Injury
	Protective One-Lung Ventilation
	Tidal Volume
	Respiratory Rate
	Positive End-Expiratory Pressure and Recruitment Maneuvers
	Driving, Plateau, and Peak Pressures
	Inspiratory-to-Expiratory Ratio
	Mechanical Power
	Inspiratory Oxygen Concentration
	Mechanical Ventilation Mode
	Rescue Maneuvers in Case of Hypoxemia
	The Nonventilated Lung
	Equipment (See Chapter 16)
	Risks Assessment
	Conclusion
	References
21 - Fluid Management During Lung Resection
	Introduction
	From Postpneumonectomy Pulmonary Edema to Acute Lung Injury
	Definitions and Epidemiology
		Postthoracotomy Acute Lung Injury
		Acute Kidney Insufficiency
		Ventilator-Induced Lung Injury
		Transfusion-Related to Acute Lung Injury
	Physiopathology
		Acute Lung Injury
			Starling Forces
			Hydrostatic Edema
			Revised Starling and Role of Endothelial Glycocalyx Layer
			Risk Factors for Acute Lung Injury and Multiple-Hit Hypothesis
			The Role of Fluid Overload
		Acute Kidney Injury
		Ventilator-Induced Lung Injury
		Transfusion-Related to Acute Lung Injury
			Immune Transfusion-Related to Acute Lung Injury
			Transfusion-Related to Acute Lung Injury Not Immune or of Two Events
	Fluid Administration Strategies
		Liberal Versus Restrictive
		Normovolemia as a Target
		Goal-Directed Strategies
			The Goal-Directed Therapy Role
			Fluid Responsiveness and Its Prediction
			Static Variables
			Dynamic Variables
			Passive Leg Raising
			End-Expiratory Occlusion Test
			Fluid Challenge
			Clinical Practice
	Choice of Fluids: Crystalloids Versus Colloid Solutions
	References
22 - Perioperative Arrhythmias During Thoracic Surgery
	Introduction
	Key Points
	Core Chapter
		Predictive Factors
		Monitoring
		Prevention
		Treatment of Postoperative Atrial Fibrillation
		Rate Control
		Rhythm Control
		Anticoagulation
		Other Arrhythmias
		Case Discussion
	Conclusion
	References
23 - Anesthesia for Pediatric Thoracic Surgery
	Introduction
	Pediatric Anatomy and Physiology
		Anatomy
		Physiology
			Preoperative Evaluation
	Anesthetic Techniques
		Bronchoscopy
		Sternotomy
	Two-Lung Ventilation With Manual Retraction
	Lung Isolation and One-Lung Ventilation
	Providing Lung Separation in the Pediatric Patients (Table 23.1)
		Selective Bronchial Intubation
		Bronchial Blocker (Fig. 23.1)
		Univent Tube
		Double-Lumen Tube
			Hypoxemia Management During One-Lung Ventilation
			Monitoring
			Postoperative Period
	Pain Management (see Chapters 25, 26)
	Regional Modalities
	Intravenous Modalities
	Conclusion
	References
24 - Postoperative Management of Acute Pain
	Introduction
	Description of Pain in Thoracic Surgery
	Multimodal Analgesia and Perioperative Analgesic Strategies
	Opioids
	Acetaminophen
	Nonsteroidal Antiinflammatory Drugs
	N-Methyl-D-Aspartate-Receptor Antagonists
	Gabapentinoids
	Glucocorticoids
	Intravenous Lidocaine
	Regional Anesthesia
	Thoracic Epidural Analgesia
	Technique
	Complications and Safety Considerations
	Clinical Advantages
	Controversies
	Thoracic Paravertebral Block
	Anatomy of the Paravertebral Space
	Mechanism of Blockade and Distribution of Spread
	Technique
	Complications and Safety Considerations
	Choosing Between Thoracic Epidural Analgesia and Paravertebral Block
	Intercostal Nerve Block
		Anatomy and Mechanism of Blockade
	Technique and Technical Considerations
	Complications and Safety Considerations
	Erector Spinae Plane Block
	Mechanism of Blockade and Distribution of Spread
	Technique and Technical Considerations
	Single-Shot Erector Spinae Plane Versus Continuous Erector Spinae Plane
	Complications and Safety Considerations
	Serratus Anterior Plane Block
	Technique and Technical Considerations
	Complications and Safety Considerations
	Conclusion
	References
25 - Postthoracotomy Chronic Pain
	Introduction
	Pathophysiology
	Clinical Presentation
	Prevention
	Treatment
		Gabapentin and Pregabalin
		Acetaminophen
		Nonsteroidal Antiinflammatory Drugs
		Ketamine
		Opioid Analgesic Medications
		Cryoablation
		Transcutaneous Electrical Nerve Stimulation
		Intercostal Nerve Approach
		Serratus Anterior Plane Approach
		Paravertebral Analgesia
		Thoracic Epidural Analgesia
		Neuromodulation
	Conclusion
	References
26 - Postoperative Care of the Thoracic Patient
	Introduction
	Location and Structure of Postoperative Care: Intensive Care Unit, High-Dependency Unit or Postanesthetic Care Unit?
	How Helpful Are the Scoring Systems to Predict the Postoperative Status Preoperatively?
	Management of Chest Tubes
	Specific Monitoring Tools
		Lung Ultrasound as a New Tool (See Chapter 54)
		Fluid Management and its Monitoring
		Monitoring of Right Ventricular Function
	Ventilatory Support for Patients After Thoracic Surgery
		Protective Ventilation After Thoracic Surgery
		Differential Lung Ventilation
		High-Frequency Ventilation
		Noninvasive Ventilation
		High-Flow Nasal Cannula Oxygen Therapy
		Weaning
	Ventilator-Associated Pneumonia (VAP) and Its Prevention
	Extracorporeal Ventilatory Support
	Conclusion
	References
27 - Postthoracotomy Complications
	Introduction
	Prediction of Postoperative Pulmonary Complications
		Postthoracotomy Complications in General and/or Specific to the Thoracic Procedure
		Risk Factors
		Postthoracotomy Complications
	Postoperative Thoracic Complications
		Bleeding
		Lobe Torsion
	Postthoracotomy Cardiac Complications
		Myocardial Ischemia
		Valvular Heart Disease
		Heart Failure
		Cardiac Arrhythmias (See Chapter 22)
		Patient-Related Risk Factors
		Surgery-Related Risk Factors
		Atrial Fibrillation and Other Supraventricular Arrhythmias
		Treatment of Atrial Fibrillation
		Ventricular Arrhythmia
		Bradyarrhythmias
	Postthoracotomy Pulmonary Complications
		Respiratory Insufficiency
		Pneumonia
		Atelectasis
		Pulmonary Hypertension
		Pulmonary Edema and Acute Respiratory Distress Syndrome
	Conclusion
	References
28 - Extracorporeal Ventilatory Therapies
	Introduction
	Development of Extracorporeal Ventilatory Therapies
		Historical Overview
		Hollow Fiber Membrane Devices andModern Oxygenators
		Pump Technology
		The Modern Extracorporeal Membrane Oxygenation Circuit
		Clinical Adoption of Extracorporeal Membrane Oxygenation Support
	Extracorporeal Membrane Oxygenation Circuit Operational Parameters
		Cannulation Approaches and Support Modality
		Circuit Operational Parameters
	Physiologic Basis of Extracorporeal Lung Support
		Motivation of Extracorporeal Membrane Oxygenation Use as Bridge to Recovery in Lung Failure
		Physiology of Hypoxic and Hypercapnic Respiratory Failure
		Cannulation Approaches to Provide Extracorporeal Lung Support
	Clinical Management of Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome
		Criteria to Initiate Extracorporeal Membrane Oxygenation Support
		Initial Management of Extracorporeal Support
		Management of Mechanical Ventilation
		Persistent Hypoxia in the Extracorporeal Membrane Oxygenation Supported Patient
		Approach to Right Ventricular Dysfunction
		Weaning of Extracorporeal Membrane Oxygenation Support
		Failure of Support and Goals of Care
	Use of Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation
		Candidate Selection for Extracorporeal Membrane Oxygenation Bridge to Transplant
		Clinical Criteria to Initiate Extracorporeal Membrane Oxygenation Support
		Cannulation of the Pretransplant Patient
		Clinical Management of the Prelung Transplant Patient on Extracorporeal Membrane Oxygenation Support
		Approaches to the Prelung Transplant Patient With Right Ventricular Failure
	Extracorporeal Circulatory Support
		Central Venoarterial Extracorporeal Membrane Oxygenation
		Peripheral Venoarterial Extracorporeal Membrane Oxygenation
	Perioperative Management of the Extracorporeal Membrane Oxygenation Patient
		Effect of Extracorporeal Membrane Oxygenation Circuit on Pharmacokinetics
		Sedation Management
		Lung Disease and Altered Perfusion
		Approach to the Use of Extracorporeal Membrane Oxygenation for Procedural Support
	Experimental Therapies and Future Directions
	REFERENCES
29 - Lung Volume Reduction Surgery
	Introduction
	Emphysema
	Lung Volume Reduction Surgery
	Patient Selection and Rehabilitation
	Exclusion Criteria
	Preoperative Rehabilitation
	Anesthetic Considerations
		Preoperative Evaluation
		Intraoperative Management
		Maintenance and the Surgical Procedure
		Emergence
		Early Recovery in the Postanesthesia Care Unit
	The Value of BODE Index
	Conclusion
	References
30 - The Patient With Cardiovascular Disease for Lung Resection Surgery
	Introduction
	Incidence
	Assessment of Risk
	Ischemic Heart Disease
	Hypertension
	Heart Failure
	Valvular Heart Disease
	Prosthetic Valves
	Pulmonary Hypertension
	Arrhythmias
	Congenital Heart Disease in Adults
	Diagnostic Test
	Cardiac Risk Stratification for Thoracic Procedures
	Inclusion of Biomarkers
	Electrocardiogram
	Recommendation for Coronary Revascularization
	Cardiac Implantable Devices and Left Ventricular Assist Devices
	Recommendation for Perioperative Therapy
	Hypoxemia and Coronary Artery Disease
	Anesthetic Goals in Patients With Coronary Artery Disease
	Cardiovascular Monitoring in Patients With Coronary Artery Disease
	Conclusion
	References
31 - Video-Assisted Thoracoscopy: Multiportal Uniportal
	Introduction
	History
	Techniques of Video-Assisted Thoracoscopic Surgery and Its Advantages
		Video-Assisted Thoracoscopic Surgery Versus Open Thoracotomy
		Uniportal Video-Assisted Thoracoscopic Surgery
		Subxiphoid Uniportal Video-Assisted Thoracoscopic Surgery
		Robotic-Assisted Thoracic Surgery
	Preoperative Evaluation and Prehabilitation
		Preoperative Risk Stratification
		Preoperative Optimization and “Prehabilitation” (See Chapter 9)
	Lung Isolation (See Chapters 16,17)
		History
		Indications
		Challenges During Video-Assisted Thoracoscopic Surgery
		Double-Lumen Tubes Versus Bronchial Blockers (See Table 31.2)
			Bronchial Blockers
		Fiberoptic Bronchoscopy
		Total Collapse of the Nonventilated Lung
	One-Lung Ventilation During Video-Assisted Thoracoscopic Surgery
		Challenges of One-Lung Ventilation
			Mechanisms of Hypoxemia During One-Lung Ventilation
			Mechanisms of Lung Injury During One-Lung Ventilation
		Protective Ventilation
			Tidal Volume
			Lung Recruitment Maneuvers
			Positive End-Expiratory Pressure
		Inspiratory Oxygen Fraction
		Ventilatory Modes
		Continuous Positive Airway Pressure to the Nondependent Lung
		Inhalational Versus Intravenous Anesthetics
			Effects on Oxygenation
			Effects on Inflammatory Response
			Effects on Cancer Recurrence
	Monitoring: Hemodynamic Status, Tissue Oxygenation, and Fluid Management
		Questions About Functional Hemodynamic Monitors
		Monitoring of Tissue Oxygenation
		Fluid Management (See Chapter 21)
	Mediastinal Surgery, Anesthesia in Thymectomy in Patients With Myasthenia Gravis (See Chapter 47)
	Video-Assisted Thoracoscopic Surgery With Local or Regional Anesthesia: Nonintubated Video-Assisted Thoracoscopic Surgery
	Postoperative Analgesia After Video-Assisted Thoracoscopic Surgery
	Conclusion
	References
	IBC