Anesthesia for video-assisted thoracoscopic surgery (VATS) for pulmonary resection
- Philip Hartigan, MD
Philip Hartigan, MD
- Assistant Professor of Anesthesia
- Harvard Medical School
The term video-assisted thoracoscopic surgery (VATS) describes minimally invasive thoracic surgical procedures performed with the aid of a video camera to avoid more invasive open thoracotomy. VATS typically involves one small, 4- to 8-cm incision for the camera, plus up to three additional small incisions for insertion of other instruments (figure 1). This approach is used in selected patients to diagnose or treat intrathoracic or chest wall masses and other abnormalities, such as pericardial or pleural effusions. Compared with a thoracotomy, postoperative pain is minimized and other early outcomes may be improved by avoiding use of a rib spreader, severing of the intercostal nerves, or division of muscle tissue [1-3].
This topic will review anesthetic care for patients undergoing VATS for pulmonary resection. Anesthetic management for other VATS procedures (eg, pericardial window, drainage of pleural effusion, esophageal procedures) is similar. Anesthetic considerations for open thoracotomy with pulmonary resection as well as details regarding principles of one lung ventilation (OLV) and lung isolation techniques that are necessary for many VATS procedures are found in other topics:
●(See "Lung isolation techniques".)
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- PREANESTHESIA PREPARATION
- INTRAOPERATIVE ANESTHETIC MANAGEMENT
- Induction and maintenance
- Airway management and surgical bronchoscopy
- Fluid management
- Intraoperative technical considerations
- Final bronchoscopy and emergence
- ROBOTIC-ASSISTED THORACOSCOPIC SURGERY
- NONINTUBATED THORACOSCOPIC SURGERY
- POSTOPERATIVE PAIN MANAGEMENT
- Causes of pain
- - Incisional and local surgical trauma
- - Ipsilateral shoulder pain
- Options for pain control
- SUMMARY AND RECOMMENDATIONS