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Background: The incidence of hypoxemia during one-lung ventilation (OLV) is as high as 10%. It is also partially determined by the distribution of perfusion. During thoracic surgery, different body positions are used, such as the supine, semilateral, lateral, and prone positions, with such positions potentially influencing the distribution of perfusion. Furthermore, hypovolemia can impair hypoxic vasoconstriction. However, the effects of body position and hypovolemia on the distribution of perfusion remain poorly defined. We hypothesized that, during OLV, the relative perfusion of the ventilated lung is higher in the lateral decubitus position and that hypovolemia impairs the redistribution of pulmonary blood flow. Methods: Sixteen juvenile pigs were anesthetized, mechanically ventilated, submitted to a right-sided thoracotomy, and randomly assigned to one of two groups: (1) intravascular normovolemia or (2) intravascular hypovolemia, as achieved by drawing ~25% of the estimated blood volume (n = 8/group). Furthermore, to mimic thoracic surgery inflammatory conditions, Escherichia coli lipopolysaccharide was continuously infused at 0.5 μg kg−1 h−1. Under left-sided OLV conditions, the animals were further randomized to one of the four sequences of supine, left semilateral, left lateral, and prone positioning. Measurements of pulmonary perfusion distribution with fluorescence-marked microspheres, ventilation distribution by electrical impedance tomography, and gas exchange were then performed during two-lung ventilation in a supine position and after 30 min in each position and intravascular volume status during OLV. Results: During one-lung ventilation, the relative perfusion of the ventilated lung was higher in the lateral than the supine position. The relative perfusion of the non-ventilated lung was lower in the lateral than the supine and prone positions and in semilateral compared with the prone position. During OLV, the highest arterial partial pressure of oxygen/inspiratory fraction of oxygen (PaO2/FIO2) was achieved in the lateral position as compared with all the other positions. The distribution of perfusion, ventilation, and oxygenation did not differ significantly between normovolemia and hypovolemia. Conclusions: During one-lung ventilation in endotoxemic pigs, the relative perfusion of the ventilated lung and oxygenation were higher in the lateral than in the supine position and not impaired by hypovolemia.

Coronavirus disease 2019 (COVID-19) has quickly spread globally, causing a real pandemic. In this critical scenario, lung cancer patients scheduled for surgical treatment need to continue to receive optimal care while protecting them from an eventual severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Adequate use of personal protective equipment (PPE) during aerosol-generating procedures (AGPs) and a COVID-19 specific intraoperative management are paramount in order to prevent cross infections. New suggestions or improvement of existing contagion control guidance are needed, even in case of non-symptomatic patients, possibly responsible for virus spread.

Pectus excavatum (PE) repair is burdened by severe postoperative pain. This retrospective study aimed to determine whether the analgesic effect of ultrasound-guided erector spinae plane block (ESPB) plus standard intravenous analgesia (SIVA) might be superior to SIVA alone in pain control after PE surgical repair via Ravitch or Nuss technique.A retrospective cohort study.At a university hospital.All participants were scheduled for surgical repair of PE.From January 2017 to December 2019, all patients who received ESPB plus SIVA or SIVA alone were investigated retrospectively. A 2:1 propensity-score matching analysis considering preoperative variables was used to compare analgesia efficacy in 2 groups. All patients received a 24-hour continuous infusion of tramadol, 0.1 mg/kg/h, and ketorolac, 0.05 mg/kg/h, via elastomeric pump, and morphine, 2 mg, intravenously as a rescue drug. The ESPB group received preoperative bilateral ESPB block. Postoperative pain, reported using a numerical rating scale at 1, 12, 24, and 48 hours after surgery; the number of required rescue doses; total postoperative morphine milligram equivalents consumption; and the incidence of postoperative nausea and vomit were analyzed.A total of 105 patients were identified for analysis. Propensity-score matching resulted in 38 patients in the SIVA group and 19 patients in the ESPB group. Postoperative pain, the number of rescue doses, and postoperative nausea and vomit incidences were lower in the ESPB group (p0.005).Erector spinae plane block may be an effective option for pain management after surgical repair of PE as part of a multimodal approach. This study showed good perioperative analgesia, opioid sparing, and reduced opioid-related adverse effects.

Double lumen tubes (DLTs) are most commonly used to achieve one lung ventilation (OLV) in most thoracic surgical procedures unless contraindicated. Left-sided DLT (LDLT) is most commonly used nowadays for most thoracic surgical procedures. Though, the use of LDLT dates long back in history, two clinical and technical issues are yet to be resolved. The first issue is the ideal size of DLT which is defined as that which provides near-complete seal of the bronchial lumen without cuff inflation. There are no guidelines in literature which help in selecting the size of DLT. However, general consensus among thoracic anesthesiologists recommends the use of smaller sizes to avoid airway trauma. In our practice and for the last few years, we are using smaller size LDLT 35 F for females and 37 F for males with minimal airway trauma and had encouraging results. The second issue is the insertion depth of the LDLT. We have introduced a height-based formula to predict the insertion depth of LDLT with encouraging results. However, even with the use of the formula, we still recommend the use of fiberoptic bronchoscopic confirmation method for final positioning of the LDLT.

Background: The incidence of hypoxemia during one-lung ventilation (OLV) is as high as 10%. It is also partially determined by the distribution of perfusion. During thoracic surgery, different body positions are used, such as the supine, semilateral, lateral, and prone positions, with such positions potentially influencing the distribution of perfusion. Furthermore, hypovolemia can impair hypoxic vasoconstriction. However, the effects of body position and hypovolemia on the distribution of perfusion remain poorly defined. We hypothesized that, during OLV, the relative perfusion of the ventilated lung is higher in the lateral decubitus position and that hypovolemia impairs the redistribution of pulmonary blood flow. Methods: Sixteen juvenile pigs were anesthetized, mechanically ventilated, submitted to a right-sided thoracotomy, and randomly assigned to one of two groups: (1) intravascular normovolemia or (2) intravascular hypovolemia, as achieved by drawing ~25% of the estimated blood volume (n = 8/group). Furthermore, to mimic thoracic surgery inflammatory conditions, Escherichia coli lipopolysaccharide was continuously infused at 0.5 μg kg−1 h−1. Under left-sided OLV conditions, the animals were further randomized to one of the four sequences of supine, left semilateral, left lateral, and prone positioning. Measurements of pulmonary perfusion distribution with fluorescence-marked microspheres, ventilation distribution by electrical impedance tomography, and gas exchange were then performed during two-lung ventilation in a supine position and after 30 min in each position and intravascular volume status during OLV. Results: During one-lung ventilation, the relative perfusion of the ventilated lung was higher in the lateral than the supine position. The relative perfusion of the non-ventilated lung was lower in the lateral than the supine and prone positions and in semilateral compared with the prone position. During OLV, the highest arterial partial pressure of oxygen/inspiratory fraction of oxygen (PaO2/FIO2) was achieved in the lateral position as compared with all the other positions. The distribution of perfusion, ventilation, and oxygenation did not differ significantly between normovolemia and hypovolemia. Conclusions: During one-lung ventilation in endotoxemic pigs, the relative perfusion of the ventilated lung and oxygenation were higher in the lateral than in the supine position and not impaired by hypovolemia.

Background: The incidence of hypoxemia during one-lung ventilation (OLV) is as high as 10%. It is also partially determined by the distribution of perfusion. During thoracic surgery, different body positions are used, such as the supine, semilateral, lateral, and prone positions, with such positions potentially influencing the distribution of perfusion. Furthermore, hypovolemia can impair hypoxic vasoconstriction. However, the effects of body position and hypovolemia on the distribution of perfusion remain poorly defined. We hypothesized that, during OLV, the relative perfusion of the ventilated lung is higher in the lateral decubitus position and that hypovolemia impairs the redistribution of pulmonary blood flow.Methods: Sixteen juvenile pigs were anesthetized, mechanically ventilated, submitted to a right-sided thoracotomy, and randomly assigned to one of two groups: (1) intravascular normovolemia or (2) intravascular hypovolemia, as achieved by drawing ~25% of the estimated blood volume (n = 8/group). Furthermore, to mimic thoracic surgery inflammatory conditions, Escherichia coli lipopolysaccharide was continuously infused at 0.5 μg kg−1 h−1. Under left-sided OLV conditions, the animals were further randomized to one of the four sequences of supine, left semilateral, left lateral, and prone positioning. Measurements of pulmonary perfusion distribution with fluorescence-marked microspheres, ventilation distribution by electrical impedance tomography, and gas exchange were then performed during two-lung ventilation in a supine position and after 30 min in each position and intravascular volume status during OLV.Results: During one-lung ventilation, the relative perfusion of the ventilated lung was higher in the lateral than the supine position. The relative perfusion of the non-ventilated lung was lower in the lateral than the supine and prone positions and in semilateral compared with the prone position. During OLV, the highest arterial partial pressure of oxygen/inspiratory fraction of oxygen (PaO2/FIO2) was achieved in the lateral position as compared with all the other positions. The distribution of perfusion, ventilation, and oxygenation did not differ significantly between normovolemia and hypovolemia.Conclusions: During one-lung ventilation in endotoxemic pigs, the relative perfusion of the ventilated lung and oxygenation were higher in the lateral than in the supine position and not impaired by hypovolemia.

Contains fulltext : 244115.pdf (Publisher’s version ) (Closed access) The novel coronavirus pandemic has radically changed the landscape of normal surgical practice. Lifesaving cancer surgery, however, remains a clinical priority, and there is an increasing need to fully define the optimal oncologic management of patients with varying stages of lung cancer, allowing prioritization of which thoracic procedures should be performed in the current era. Healthcare providers and managers should not ignore the risk of a bimodal peak of mortality in patients with lung cancer; an imminent spike due to mortality from acute coronavirus disease 2019 (COVID-19) infection, and a secondary peak reflecting an excess of cancer-related mortality among patients whose treatments were deemed less urgent, delayed, or cancelled. The European Association of Cardiothoracic Anaesthesiology and Intensive Care Thoracic Anesthesia Subspecialty group has considered these challenges and developed an updated set of expert recommendations concerning the infectious period, timing of surgery, vaccination, preoperative screening and evaluation, airway management, and ventilation of thoracic surgical patients during the COVID-19 pandemic.

Purpose of Review Hypoxemia during one-lung ventilation, while decreasing in frequency, persists as an intraoperative challenge for anesthesiologists. Discerning when desaturation and resultant hypoxemia correlates to tissue hypoxia is challenging in the perioperative setting and requires a thorough understanding of the physiology of oxygen delivery and tissue utilization. Recent Findings Oxygen delivery is not directly correlated with peripheral oxygen saturation in patients undergoing one-lung ventilation, emphasizing the importance of hemoglobin concentration and cardiac output in avoiding tissue hypoxia. While healthy humans can tolerate acute hypoxemia without long-term consequences, there is a paucity of evidence from patients undergoing thoracic surgery. Increasingly recognized is the potential harm of hyperoxic states, particularly in the setting of complex patients with comorbid diseases. Summary Anesthesiologists are left to determine an acceptable oxygen saturation nadir that is individualized to the patient and procedure based on an understanding of oxygen supply, demand, and the consequences of interventions.

Surgical resection and tracheal reconstruction are the most effective treatment options for airway stenosis. Tracheal surgery is challenging and requires a multidisciplinary approach and a highly specialized team of anesthesiologists and thoracic surgeons that are “sharing the airways”. Several airway management tools, different devices, and various approaches can be required to ensure ventilation and gas exchange. We describe the case of a patient affected by tight tracheal stenosis, submitted to tracheal resection and reconstruction via combined cervicotomy and sternotomy surgical approach. Airway management was successfully performed by i-gel® (Intersurgical, UK) supraglottic device.

Background There is a major paradigm shift for intraoperative mechanical ventilator support by the introduction of lung protective ventilation strategies to reduce postoperative pulmonary complications and improve overall clinical outcomes in non-thoracic surgeries. However, there is currently a lack of standardized practice guideline for lung protection during thoracic surgeries that require one-lung ventilation (OLV). This study aimed to collect the expert opinions of the thoracic anesthesiologists in perioperative care for OLV surgery in Taiwan. Methods This prospective cross-sectional study was undertaken in 16 tertiary hospitals in Taiwan from January to February 2019. A structured survey form was distributed across the participating hospitals and the thoracic anesthesiologists were invited to complete the form voluntarily. The survey form consisted of three parts, including the basic information of the institutional anesthesia care standards, ventilatory settings for a proposed patient receiving OLV surgery and expert opinions on OLV. Results A total of 71 thoracic anesthesiologists responded to the survey. Double-lumen tubes are the most commonly used (93.8%) airway devices for OLV. The most commonly recommended ventilator setting during OLV is a tidal volume of 6–7 ml/kg PBW (67.6%) and a PEEP level of 4–6 cmH2O (73.5%). Dual controlled ventilator modes are used by 44.1% of the anesthesiologists. During OLV, high oxygen fraction (FiO2 > 0.8) is more commonly supplemented to achieve an oxygen saturation higher than 94%. The consensus of anesthesiologists on the indices for lung protection in thoracic surgery is considerably low. Large majority of the anesthesiologists (91.5%) highly recommend that an international clinical practice guideline on the protective lung ventilation strategy for thoracic anesthesia should be established. Conclusions This study found that the thoracic anesthesiologists in Taiwan share certain common practices in ventilator support during OLV. However, they are concerned about the lack of fundamental clinical evidences to support the beneficial outcomes of the current lung protective strategies applicable to OLV. Large-scale trials are needed to form an evidence-based clinical practice guideline for thoracic anesthesia.

Contains fulltext : 225360.pdf (Publisher’s version ) (Closed access) The novel coronavirus has caused a pandemic around the world. Management of patients with suspected or confirmed coronavirus infection who have to undergo thoracic surgery will be a challenge for the anesthesiologists. The thoracic subspecialty committee of European Association of Cardiothoracic Anaesthesiology (EACTA) has conducted a survey of opinion in order to create recommendations for the anesthetic approach to these challenging patients. It should be emphasized that both the management of the infected patient with COVID-19 and the self-protection of the anesthesia team constitute a complicated challenge. The text focuses therefore on both important topics.

Background: Accurate positioning of a right-sided double-lumen tube is essential but challenging due to the location and the potential obstruction of the right upper lobe bronchus. Fiberoptic bronchoscopy is, therefore, necessary but requires a specific training period for the anesthesiologist and might not always be available. Objective: We describe an original backup technique to assess the correct placement of these tubes in cases a fiberopetic bronchoscopy is lacking. Design: Prospective pilot feasibility study with 10 adult patients scheduled for a left thoracic surgery. Setting: Operating theater in a universitary hospital. Materials and Methods: The new technique uses a fluoroscopy and an adult central venous catheter wire. The time needed to perform the new technique, its success rate and its efficacy in properly exclude the left lung were evaluated. Any oxygen desaturation episode (SpO2

Background: In the field of thoracic anesthesia, it is well-established practice that the insertion depth of left-sided double-lumen tube (LDLT) is achieved after checking its position via fiberoptic bronchoscopy (FOB). Several studies have shown positive correlation between body height (BH) and the optimal insertion depth of a LDLT. Each of these studies has developed a formula for proper insertion depth of the LDLT. In this study, we prospectively studied our patients whose tracheas were intubated correctly with LDLT using FOB confirmation and examined the optimal insertion depth of LDLT aiming at finding a formula suitable for our patients. Methods: After obtaining the institutional review board approval of College of Medicine Research Centre, King Saud University, we recruited 41 adult patients who underwent thoracic surgery with one-lung ventilation (OLV). The study included patients whose procedure required placement of a LDLT. The optimal insertion depth of the LDLT was confirmed using FOB. The following variables were recorded, the patient's sex, age, BH, and the final correct insertion depth of the LDLT (cm) measured from the corner of the mouth. The results of LDLT insertion depth in our study were compared to another published five studies. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22 software (SPSS Inc., Chicago, IL, USA). Results: Positive correlation was found between BH (cm) and insertion depth of LDLT (cm) since r = 0.744 (P < 0.05). Also, positive correlation was found between the LDLT size (Fr) and insertion depth of LDLT (cm) since r = 0.792 (P < 0.05) where r is Pearson's correlation coefficient. By fit curve (Curve Estimation), we were able to get the predicted equation for our cases as follow: the insertion depth of LDLT (cm) =0.249 × (BH)0.916 with significant correlation to the other five formulae (P < 0.05). Conclusion: In the present study we have obtained a novel formula to predict the insertion depth of LDLT. Currently we are conducting a verification study on a larger sample size to attest its validity. However at this stage and till the results are released we cannot judge on it. We believe time will tell about the validity of our formula for our patients.

Effective communication is crucial in assuring a good patient experience during an in-hospital stay. In some settings, such as thoracic anaesthesia, patients are given a heavy load of new complex information, in a very limited space of time. Written information, such as patient information booklets, could help as an aid memoir and improve patient’s subjective understanding and preparedness for procedures. This study aims to produce a booklet, specifically targeted at thoracic anaesthesia, and to evaluate it using a linguistics framework in relation to the patient experience and clinical communication. For the study, a booklet was produced in the context of thoracic anaesthesia – a setting where the doctor-patient interaction is limited by time factors. The booklet was produced with reference to the BALD criteria. A questionnaire was given to patients with the booklet, focussing on patient’s subjective reflections on the effects of the booklet. The patient questionnaires showed that readability and comprehensibility of the booklet were high (96% and 93%, respectively). After having read the booklet, there was a statistically significant increase in patients feeling well informed, knowing about side-effects, what would happen in the anaesthetic room, and who to contact regarding any questions, compared to before. According to patients, giving information booklets at the time of admission could benefit patients. They are seen as an effective way of enhancing doctor-patient communication, in a setting where time could limit this interaction. They can be used effectively as a means of increasing patient’s perceived knowledge and thus improving the patient experience.

The main goal of enhanced recovery program after thoracic surgery is to minimize stress response, reduce postoperative pulmonary complications, and improve patient outcome, which will in addition decrease hospital stay and reduce hospital costs. As minimally invasive technique, video-assisted thoracoscopic surgery represents an important element of enhanced recovery program in thoracic surgery. Anesthetic management during preoperative, intraoperative and postoperative period is essential for the enhanced recovery. In the era of enhanced recovery protocols, non-intubated thoracoscopic procedures present a step forward. This article focuses on the key elements of the enhanced recovery program in thoracic surgery. Having reviewed recent literature, the authors highlight potential procedures and techniques that might be incorporated into the program.

compressed the left bronchial tree. The tumor completely surrounded large blood vessels and the heart, as confirmed by echocardiography. The systolic function of the heart was preserved. Flexible fiberoptic bronchoscopy (FFB) under sedation determined that the lumen of the left bronchial tree was narrowed to one-third of its normal size due to external compression. The type of the tumor was not determined by transtracheal and ultrasound-guided transthoracic puncture, and the patient presented for biopsy. The patient was ASA class IV due to position and extension of the tumor. The high risk of the procedure including TPVB was explained to the patient, and she signed an informed consent for both surgery and the nerve block. Methylprednisolone, pantoprazole, cefazolin, and 5 mg of oral diazepam were administered preoperatively. It was elected to use TPVB repeated at each dermatome level. With the patient in a sitting position, 8 mL of 2% lidocaine was administered subcutaneously. Using a 10-cm long 22-gauge Tuohy spinal needle and a loss of resistance technique, single punctures of the 4 left paravertebral spaces from T2-T5 were performed. After careful aspiration, 5 mL of 0.5% bupivacaine per segment was administered. 10-13 The onset of sensory loss occurred approximately 25 minutes after the injections. Before starting the incision, 0.05 mg of alfentanil and 1 mg of midazolam were administered intravenously, and 100 mg of 2% lidocaine was injected under the skin. The patient was lying on her back but in the right semilateral position, and the surgical access was an anterior mediastinotomy carried out through the third left intercostal space. A 5-cm transverse parasternal skin incision, just lateral to the sternal border, removing the underlying costal cartilage, was used. Electrocautery was used to divide intercostal muscles, and after removing costal cartilage, the internal mammary vessels were ligated. Abundant biopsy specimens were taken. Excellent analgesic effect was achieved. During the operation, the patient was awake, did not experience pain, and was hemodynamically stable and spontaneously breathing. After surgery, she was observed for 24 hours. The pathohistologic examination was unable to determine the precise type of the tumor, and the procedure was repeated 5 days later. Under TPVB, the wound was reopened, and several large biopsy specimens were taken. The postoperative course was uneventful after both procedures. The pathologic diagnosis was eosinophilic granuloma.

Objective The object of this study was to conduct and analyze the output of a survey involving a cohort of all Italian hospitals performing thoracic surgery to gather data on anesthetic management, one-lung ventilation (OLV) management, and post-thoracotomy pain relief in thoracic anesthesia. Design Survey. Setting Italy. Participants An invitation to participate in the survey was e-mailed to all the members of the Italian Society of Anesthesia and Intensive Care Medicine. Intervention None. Measurements and Main Results A total of 62 responses were received from 47 centers. The key findings were: Double-lumen tube is still the first choice lung separation technique in current use; pressure-controlled ventilation and volume-controlled ventilation modes are homogenously distributed across the sample and, a tidal volumes (VT) of 4-6 mL/kg during OLV was preferred to all others; moderate or restrictive fluid management were the most used strategies of fluid administration in thoracic anesthesia; thoracic epidural analgesia represented the “gold standard” for post-thoracotomy pain relief in combination with intravenous analgesia. Conclusion The results of this survey showed that Italian anesthesiologist follow the recommended standard of care for anesthetic management during OLV.

Background: Many studies have shown Airtraq videolaryngoscope provided faster tracheal intubation and a higher success rate than other videolaryngoscopes. Recently, different types of videolaryngoscopes have been reported for use in double-lumen tube (DLT) intubation. However, the advantages and disadvantages between them remain undetermined for DLT intubation. In this study, we compared the Airtraq DL videolaryngoscope with the McGrath Series 5 videolaryngoscope for DLT intubation by experienced anesthesiologists. Methods: Ninety patients with expected normal airways were randomly allocated to either the Airtraq or McGrath group. The primary outcome was DLT intubation time. The secondary outcomes were glottic view, success rate, subjective ease of intubation (100-mm visual analog scale, 0 = easy; 100 = difficult), incidence of DLT malposition, and postoperative intubation-related complication. Results: The airway characteristics were comparable between the 2 groups. Cormack and Lehane grades significantly improved with the use of the McGrath and Airtraq videolaryngoscopes, compared with the Macintosh laryngoscope. The intubation success rate on the first attempt was 93% in the Airtraq group and 95% in the McGrath group (P > 0.05). The intubation time in the McGrath group is longer than that in the Airtraq group (39.9 [9.1]s vs 28.6 [13.6]s, P 0.05). Conclusions: When using videolaryngoscopes for DLT intubation, the Airtraq DL is superior to the McGrath Series 5 in intubation time, but it does not decrease intubation difficulty.

Purpose of the review An adequate cardiac preload is essential in the treatment of critically ill patients. During anesthesia for thoracic surgery, volume and vasoactive therapy to optimize cardiac output, oxygen delivery (tissue perfusion) and to avoid pulmonary edema is a central therapeutic aspect. Cardiac preload has been estimated with different techniques in clinical practice, even though studies performed on thoracic anesthesia are lacking. Recent findings We analyze the conventional pulmonary artery catheter, transesophageal echocardiography and the transpulmonary indicator dilution technique as preload monitoring devices with their indications and limits in thoracic anesthesia. Summary The pulmonary artery catheter is confirmed as a fundamental device particularly in patients with pulmonary hypertension. For transesophageal echocardiography monitoring, the dependency on operator experience, the low repeatability and the high costs limit its interpretation and diffusion in clinical practice. During lung transplantation, Swan Ganz catheter monitoring is recommended. The optimization of fluid balance and vasoactive drug administration based on volumetric monitoring makes the transpulmonary indicator dilution technique a new option as an effective monitoring system during anesthesia for thoracic surgery when intravascular volume management is a primary objective.

Purpose: The main objective of this survey is to describe the current practice of thoracic anesthesia in the Middle Eastern (ME) region. Methods: A prospective online survey. An invitation to participate was e-mailed to all members of the ME thoracic-anaesthesia group. A total of 58 members participated in the survey from 19 institutions in the Middle East. Questions concerned ventilation strategies during one-lung ventilation (OLV), anesthesia regimen, mode of postoperative analgesia, use of lung isolation techniques, and use of i.v. fluids. Results: Volume-controlled ventilation was favored over pressure-controlled ventilation (62% vs 38% of respondents, P

Study Objective: To correlate tracheal width as measured by ultrasound with width measured by computed tomography (CT), and to evaluate the possible role of ultrasound in the selection of the proper size of left-sided double-lumen endotracheal tubes (LDLTs). Design: Two independent, prospective, observational clinical studies (Study 1 and Study 2). Setting: University hospital. Patients: Study 1 included 25 patients and Study 2 included 20 adult thoracic surgery patients who required a LDLT during anesthesia. Interventions and Measurements: In Study 1, CT measurements of tracheal width were made at the coronary plane 0.5 cm above the sternoclavicular joint ; CT measurements of the left main bronchus diameter were made 1 cm below the carina. Ultrasound measurement of tracheal width was performed just above the sternoclavicular joint in the transversal section. In Study 2, patients' tracheas were intubated with a LDLT based on ultrasound measurements. The frequencies of incorrect selections of LDLT and unsatisfactory lung collapse were analyzed. Main Results: There was a strong correlation between tracheal width as measured by ultrasound and tracheal width (r=0.882, P

Objetivo . Describir nuestra experiencia en el manejo anestesiológico de las pleuroscopías. Pacientes y métodos. Se consultó nuestra base de datos en un período comprendido entre julio de 2000 y julio de 2002. Revisamos 70 procedimientos de pleuroscopías con cirugía videoasistida (CVA), realizados con anestesia general e intubación con sonda de doble luz para ventilación unipulmonar. Resultados. Las indicaciones más frecuentes fueron derrames pleurales y neumotórax , los procedimientos más frecuentes fueron pleurodesis y biopsias. El porcentaje de reconversión de la técnica fue de 5.7%, en su mayoría por dificultades técnicas. No hubo hemorragias importantes ni muertes atribuibles a la técnica. De las complicaciones no quirúrgicas 4 pacientes presentaron broncoespasmo que retrocedió con tratamiento habitual y 5 presentaron hipoxemia que obligó a suspender transitoriamente la ventilación unipulmonar. En el postoperatorio un paciente presentó un cuadro de edema pulmonar con buena evolución en 24 horas. Los pacientes coordinados para aerostasis presentaron menos enfermedades asociadas y menor ASA, a diferencias de los que presentaban masas y tumores pulmonares. En 69 pacientes se logró una adecuada ventilación unipulmonar. La complicación más frecuente fue el desplazamiento distal de la sonda. El número de otras complicaciones fue bajo, fácilmente controlable y atribuible al terreno del paciente y al tipo de sonda utilizado. Conclusión. Las pleuroscopías realizadas con anestesia general y ventilación unipulmonar son procedimientos seguros, con complicaciones esperables y con buena respuesta al tratamiento. El diagnóstico quirúrgico y el tipo de procedimiento indicado, son datos importantes para evaluar el riesgo de enfermedades asociadas y de complicaciones. This article describes the authors´experience in the anesthetic management of pleuroscopies in a General Hospital in Montevideo, Uruguay. Patients and Methods Data were collected from Anesthesia Departament Database corresponding to a period of two years from july 2000 to july 2002. Seventy pleuroscopies were reviewed. All patients underwent general anesthesia and in all cases double lumen tubes were used for unipulmonar ventilation. Results Empyema and neumothorax were the most frequent preoperative diagnoses. Pleurodesis and pleural biopsies were the most frequently used procedures. Surgical technique was converted in 5.7% of all cases due to technical difficulties. No significant bleeding or deaths occurred during surgery or in the postoperative period in these serie of patients. Other incidents related to anesthesia were bronchospasm (4 patients, all of them fully recovered after usual treatment) and hypoxia (5 patients who required discontinuation of unipulmonar ventilation). In the postoperative period one patient suffered from pulmonar edema requiring admission in an intensive care unit. After 24 hours the patient fully recovered and was succesfully discharged from that Unit. All patients who underwent aerostatic procedures were in the preoperative period, in better physical conditions (lower ASA score) than those with lung tumors. Unipulmonar ventilation was succesfully performed in 60 of 70 total patients. Distal double lumen tube malposition was the most frequent complication. Other incidents were rare and in all cases easily solved. In most cases they were related to patients´ previous physical status or to characteristics or quality of double lumen tubes utilized. Conclusions In our experience Pleuroscopies under General Anesthesia and unipulmonar ventilation are safe procedures with well known complications and good response to usual treatment. Preoperative diagnose and procedure performed, are important data in order to assess the risk of associated illnesses and postoperative complications.