THERE have been tremendous advances in anesthesia for thoracic surgery in the past few years. With these improvements in anesthesia, many surgical procedures which at one time were not possible can now be done with ease. In my opinion, three of the most important technical advances are: first, the routine use of the endotracheal tube; secondly, the use of controlled respiration; and thirdly, adequate blood or fluid replacement.
In discussing anesthesia for thoracic surgery I shall limit my remarks to two main types of operations: namely, lobectomy and pneumonectomy. These patients usually differ from those in the average surgical case. They usually show prolonged toxemia of amyloid disease and require an anesthetic of low toxicity and high oxygen concentration. Their vital capacity is usually seriously decreased, and there is usually much sputum and often blood in their tracheobronchial tree.
The anesthetist is then concerned with the following problems: