Anesthesia for Special Operations

by Brian Warriner, MD

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    We're now going to move to Thoracic Anesthesia. And this is one of the most challenging areas of Anesthesiology. It's also potentially one of the most dangerous areas. And the reason for this is, when a surgeon is going to remove a portion of lung because of tumor, or abscess, or any other reason whatsoever, the anesthesiologist has to provide one-lung anesthesia. We need to provide ventilation of one lung while allowing the surgical side to deflate and remain quiet and immobile for the surgeon to do his or her job on it. This is very challenging because some of these patients, particularly more elderly patients with lung cancers, have very bad lungs. And we have to ventilate them with one lung in a situation where they've got a bad lung that's being operated on, and you're working with a bad lung and try to keep them going with that bad lung. And it's, it can be very challenging. So, the endotracheal tube that we commonly use for things like general surgery, orthopedic surgery, etc. is replaced in thoracic surgery by the tubes that you can see in the diagram. These are endobronchial tubes. The tube nearest to me is a right sided endobronchial tube. And because the right mainstem bronchus is short compared to the left and the take off for the right upper lobe bronchus occurs very soon after you've passed the carina, this tube needs to be specially designed to allow gas to go through a hole that's created in the distal cuff that allows one to ventilate the right upper lobe. The left side is somewhat easier, because the left mainstem bronchus is shorter than the, excuse me, longer than the right mainstem bronchus, so there's more room to place a tube in it. And you...

    About the Lecture

    The lecture Anesthesia for Special Operations by Brian Warriner, MD is from the course Anesthesia in special situations. It contains the following chapters:

    • Thoracic Anesthesia
    • Positioning the Endobronchial Tube
    • Complications and Other Issues
    • Neuro Anesthesia

    Included Quiz Questions

    1. Often associated with the need for one-lung ventilation during surgery.
    2. Is really just like anesthesia for other high risk procedures.
    3. Requires one-lung anesthesia even in patients with no respiratory reserve.
    4. Is often associated with the need for one lung ventilation during surgery which is best accomplished by utilizing an extra long, standard endotracheal tube.
    1. Often requires isolation of the heart and lungs by cardio-pulmonary bypass.
    2. Is associated with a high incidence of “death on the table“.
    3. Has never been complicated with “recall”.
    4. Uses anticoagulation to prevent bleeding during surgery.
    1. Can often be done under local anesthesia and sedation.
    2. Always requires general anesthesia for adequate control of pain and awareness.
    3. Like cardiac surgery, requires intra-operative anti-coagulation.
    4. Is never associated with failure to awaken.

    Author of lecture Anesthesia for Special Operations

     Brian Warriner, MD

    Brian Warriner, MD

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