Mineo Tommaso Claudio
Thoracic Surgery Division, Tor Vergata School of Thoracic Surgery, Policlinico Tor Vergata, Rome, Italy.
Eur J Cardiothorac Surg. 2007 Jul;32(1):13-9. doi: 10.1016/j.ejcts.2007.04.004. Epub 2007 Apr 27.
Despite the indisputable and well-known advantages of general anesthesia in thoracic surgery, this can trigger some adverse effects including an increased risk of pneumonia, impaired cardiac performance, neuromuscular problems, mechanical ventilation-induced injuries, which include barotrauma, volotrauma, atelectrauma, and biotrauma. In order to reduce the adverse effects of general anesthesia, thoracic epidural anesthesia has been recently employed to perform awake thoracic surgery procedures including coronary artery bypass, management of pneumothorax, resection of pulmonary nodules and solitary metastases, lung volume reduction surgery, and even transsternal thymectomy. The results achieved in this early series have been encouraging, although indications and many pathophysiologic aspects remain to be elucidated. In this review we have tried to provide a first-step analysis of the anecdotal reports available in the literature on this topic. We also desired to provide insights into the main physiologic effects of awake thoracic surgery with epidural anesthesia, with particular attention to the several issues raised by its application in patients with chronic obstructive pulmonary disease, which can represent one of the most stimulating challenges in this setting.
尽管全身麻醉在胸外科手术中具有无可争议且广为人知的优势，但它可能引发一些不良反应，包括肺炎风险增加、心脏功能受损、神经肌肉问题以及机械通气引起的损伤，其中包括气压伤、容积伤、肺不张伤和生物伤。为了减少全身麻醉的不良反应，近年来胸段硬膜外麻醉已被用于实施清醒胸外科手术，包括冠状动脉搭桥术、气胸处理、肺结节及孤立转移灶切除术、肺减容手术，甚至经胸骨胸腺切除术。尽管适应证和许多病理生理方面仍有待阐明，但在这一早期系列研究中取得的结果令人鼓舞。在本综述中，我们试图对该主题文献中现有的轶事性报道进行初步分析。我们还希望深入探讨硬膜外麻醉下清醒胸外科手术的主要生理效应，尤其关注其在慢性阻塞性肺疾病患者中应用所引发的若干问题，这可能是该领域最具挑战性的难题之一。
