Thoracic Anesthesia: A Review of Current Topics and Debates

Thoracic anesthesia is a continually evolving field due to the development of new surgical and anesthetic technologies. Advances in lung isolation techniques, ventilation strategies, and postoperative pain management have improved patient outcomes. Airway management continues to progress as different devices provide advantages and disadvantages for lung isolation, surgical visualization, and access to the operative lung. Optimal ventilation strategies are moving toward lung protection, where oxygenation and ventilation are maintained with lower, more physiologic lung volumes with judicious use of alveolar recruitment, positive end-expiratory pressure, and lower FiO₂. Neuraxial and regional anesthetics are the mainstays of postoperative analgesia, with adjuvants having roles in the acute period, but chronic post-thoracotomy pain remains challenging to treat. The role of perioperative inflammation has grown in importance, and volatile anesthetics have protective effects at the cellular and molecular levels, however the debate between the use of volatiles versus a total intravenous anesthetic technique continues.