Toraks Cerrahisinde Anestezi
Synopsis
Thoracic surgery anesthesia management directly affects surgical success through monitoring vital functions, managing hemodynamics, and achieving successful lung isolation. While the frequently preferred lateral decubitus position impairs the ventilation-perfusion (V/Q) ratio and increases the risk of hypoxemia, hypoxic pulmonary vasoconstriction (HPV) occurring during one-lung ventilation (OLV) is a key physiological adaptation that reduces intrapulmonary shunt. Preoperative evaluation assesses respiratory mechanics (ppoFEV1), gas exchange (DLCO), arterial blood gases, and exercise capacity (stair climbing, maximum oxygen consumption); values of ppoFEV1 and DLCO below 40% significantly increase the risk of post-resection complications, mortality, and morbidity. Double-lumen tubes (DLT) are the standard method for lung isolation, whereas bronchial blockers or mainstem intubation provide alternatives in difficult airways or specific scenarios. Fiberoptic bronchoscopy is considered the gold standard for confirming tube placement. Intraoperatively, protective lung ventilation (low tidal volume of 6-8 mL/kg, plateau pressure <25 cmH2O) and restrictive fluid therapy should be implemented to prevent acute lung injury (ALI) and pulmonary edema. While specialized procedures such as lung transplantation, video-assisted thoracoscopic surgery (VATS), and major airway surgery require specific anesthetic approaches, post-operative complications such as airway injuries, pneumothorax, and life-threatening cardiac herniation must be closely monitored.
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