One hundred years have passed since the first report by Charles Elsberg
on the use of tracheal insufflation anesthesia for thoracic surgical
procedures. The progress that has been made in the delivery of anesthesia
for thoracic surgery over the past century has been remarkable. In fact, it
may be argued that no other surgical subspecialty has depended so heavily on
the progress of anesthesia practice to evolve. The field of thoracic
anesthesiology has grown dramatically: our understanding on the mechanisms
of thoracic pain, the biology of the different diseases of the chest such as
lung and esophageal cancer, the physiology of one lung ventilation and the
development of multiple lung isolation techniques are but a few examples of
the expanding scope of this fascinating discipline.
The goal of this textbook is to provide the reader with an updated review on
the core concepts of thoracic anesthesia practice, together with some very
practical management suggestions for the most commonly encountered problems.
The work is intended for physicians in training and for those who do not
practice thoracic anesthesia exclusively. Each chapter, written by
specialists in the topic, provides a review of the key concepts needed to
understand the disease at hand and summarizes the different anesthetic
management strategies that will allow the delivery of safe, high quality
perioperative care to thoracic surgical patients.
Our work is not an exhaustive review of the literature on thoracic
anesthesiology, but a practical handbook designed for everyday use. Despite
this, we include a chapter on the history of thoracic anesthesia practice.
We share GK Chesterton's view that "history is a hill or high point of
vantage, from which alone men see the town in which they live or the age in
which they are living." We felt we could not tell the reader where we are
without describing how we got here. We also include a chapter on practice
improvement and patient safety, which contains important concepts for the
delivery of modern, high-quality thoracic surgical care using a
multidisciplinary, team approach. The remainder of the first section
includes chapters on the scientific principles of the subspecialty of
thoracic anesthesiology: chest physiology, mechanisms of pain, biology of
chest malignancies and lung separation techniques.
The second section includes chapters on the most commonly performed invasive
thoracic procedures, with up to date information on pathophysiology and
management. Each chapter begins with a short clinical vignette, aimed at
providing the reader with a concrete example of the application of the
contents of the particular chapter.
section in the book pertains to routine and complicated post-operative care
of the thoracic surgical patient. We hope the reader finds this material of
practical use in their occasional thoracic anesthetic practice.
This book is the result of the dedication and hard work of
our many contributors; it represents their accomplishment more than ours,
and we are grateful to every one of them. We would also like to thank
Melinda Macalino for her logistical and administrative assistance. Lastly,
we extend our gratitude to the Department of Anesthesiology at Duke
University, our chairman Dr. Mark Newman, and our teachers and trainees for
their unwavering support to this project.
Andrew D. Shaw, MB, FRCA, FCCM
Grichnik, MD, MS, FASE