Department of Anesthesiology, The Mount Sinai School of Medicine, New York, New York 10029, USA.
Curr Opin Anaesthesiol. 2010 Feb;23(1):7-11. doi: 10.1097/ACO.0b013e3283346c6d.
The surgical management of patients partly determines the anesthetic management. A shift has taken place in thoracic surgery, with a large portion of procedures now being performed through a video-assisted thoracoscopic surgery (VATS) approach. This review is intended to provide the anesthesiologist with an update on the management of thoracic surgical patients presenting for VATS.
Although there are cosmetic and economical advantages to the VATS approach, large randomized controlled trials are still lacking documenting the benefit of VATS versus conventional 'thoracotomy'. The classic division in absolute and relative indications for one-lung ventilation (OLV) should be viewed as antiquated. All VATS procedures represent an indication for OLV. A better classification is to divide the purpose of OLV: separation versus isolation. Treatment for hypoxemia during OLV also needs to be modified. Patient expectations are also different as a minimal invasive approach is often falsely associated with minimal risk. This leads to an additional stress factor imposed upon the anesthesiologist.
Minimal invasive VATS is gaining widespread popularity among our surgical colleagues. The anesthesiologist must recognize the impact that this change in surgical philosophy will have upon the anesthetic management of these complex patients.
手术治疗方案在一定程度上决定了麻醉管理方案。胸外科的手术方式已经发生了转变，大部分手术现在通过电视辅助胸腔镜手术（VATS）进行。本篇综述旨在为麻醉医师提供 VATS 手术治疗患者的麻醉管理更新信息。
虽然 VATS 方法具有美容和经济优势，但仍缺乏大型随机对照试验来证明 VATS 与传统的“开胸术”相比具有优势。对于单肺通气（OLV）的绝对和相对适应证的经典划分应被视为过时。所有 VATS 手术均代表 OLV 的适应证。更好的分类是将 OLV 的目的分为分离和隔离。OLV 期间低氧血症的治疗也需要进行修改。患者的期望也不同，因为微创方法通常与最小风险相关联，这会给麻醉师带来额外的压力因素。
微创 VATS 在我们的外科同事中越来越受欢迎。麻醉医师必须认识到这种手术理念的变化将对这些复杂患者的麻醉管理产生影响。
