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Current Trends and Future Challenges in Thoracic Anesthesia
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Current Trends and Future Challenges in Thoracic Anesthesia

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: 31 October 2024 | Viewed by 7620

Special Issue Editors

Prof. Dr. Manuel Granell Gil

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Guest Editor
1. Department of Surgery (Anesthesiology), Faculty of Medicine, University of València, 46010 Valencia, Spain
2. Department of Anesthesia, Critical Care and Pain Medicine, Consortium General University Hospital of València, 46014 Valencia, Spain
Interests: thoracic anaesthesia; airway management; mechanical ventilation; robotic surgery; locoregional blocks
Special Issues, Collections and Topics in MDPI journals
Dr. Izumi Kawagoe

E-Mail Website
Guest Editor
Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
Interests: anesthesiology; pain medicine; thoracic anesthesia
Prof. Dr. Edmond Cohen

E-Mail Website
Guest Editor
Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
Interests: anesthesiology; pain medicine; thoracic surgery

Special Issue Information

Dear Colleagues,

Advances in thoracic surgery have been facilitated by improvements in anaesthetic techniques and perioperative care. This has evolved from knowledge based on evidence-based medicine to personalised and precision medicine.

The concept of perioperative medicine is highly applicable to thoracic surgery, given its advantages observed in other types of surgery; this has led to the application of enhanced recovery after surgery (ERAS) and prehabilitation.  

Methods of airway management include lung isolation and separation techniques checked by fiberscope or orotracheal tubes or double-lumen tubes with built-in camera permitting to reduce the incidence of intraoperative hypoxaemia and tracheobronchial tree damage. The airway is complex to manage in patients undergoing thoracic surgery.

Lung protective ventilation has become especially important during thoracic surgery, both during one-lung and two-lung ventilation. These techniques have been based on tidal volume adjustments, optimal PEEP, and alveolar recruitment manoeuvres, always limiting airway pressures to acceptable values.

Analgesia methods are based on locoregional techniques adapted to the type of surgical approach; today, techniques such as paravertebral block and erector spinae block allow a faster and safer recovery. Of course, chronic pain is a particularly relevant aspect associated with this surgical speciality.

Finally, the evolution of the surgical approach in thoracic surgery from thoracotomy to VATS has been remarkably interesting; currently, robotic thoracic surgery is being incorporated into clinical practice and requires important adjustments in the anaesthetic technique due to the difficulty of access to the patient and the application of capnothorax, among other relevant aspects.

Prof. Dr. Manuel Granell Gil
Dr. Izumi Kawagoe
Prof. Dr. Edmond Cohen
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • thoracic surgery: VATS, robotic thoracic surgery
  • airway management: lung isolation/separation, difficult airway
  • analgesia: Acute and chronic after thoracic surgery, locoregional blocks
  • perioperative medicine: ERAS prehabilitation

Published Papers (4 papers)

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Research

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13 pages, 911 KiB  
Article
Analgesic Efficacy and Safety of Intrathecal Morphine or Intercostal Levobupivacaine in Lung Cancer Patients after Major Lung Resection Surgery by Videothoracoscopy: A Prospective Randomized Controlled Trial
by Silvia González-Santos, Borja Mugabure, Manuel Granell, Borja Aguinagalde, Iker J. López, Ainhoa Aginaga, Inmaculada Zubelzu, Haritz Iraeta, Jon Zabaleta, Jose Miguel Izquierdo, Nuria González-Jorrín, Cristina Sarasqueta and Alejandro Herreros-Pomares
J. Clin. Med. 2024, 13(7), 1972; https://doi.org/10.3390/jcm13071972 - 28 Mar 2024
Viewed by 550
Abstract
Background: Lung resection using video-assisted thoracoscopic surgery (VATS) improves surgical accuracy and postoperative recovery. Unfortunately, moderate-to-severe acute postoperative pain is still inherent to the procedure, and a technique of choice has not been established for the appropriate control of pain. In this [...] Read more.
Background: Lung resection using video-assisted thoracoscopic surgery (VATS) improves surgical accuracy and postoperative recovery. Unfortunately, moderate-to-severe acute postoperative pain is still inherent to the procedure, and a technique of choice has not been established for the appropriate control of pain. In this study, we aimed to compare the efficacy and safety of intrathecal morphine (ITM) with that of intercostal levobupivacaine (ICL). Methods: We conducted a single-center, prospective, randomized, observer-blinded, controlled trial among 181 adult patients undergoing VATS (ISRCTN12771155). Participants were randomized to receive ITM or ICL. Primary outcomes were the intensity of pain, assessed by a numeric rating scale (NRS) over the first 48 h after surgery, and the amount of intravenous morphine used. Secondary outcomes included the incidence of adverse effects, length of hospital stay, mortality, and chronic post-surgical pain at 6 and 12 months after surgery. Results: There are no statistically significant differences between ITM and ICL groups in pain intensity and evolution at rest. In cough-related pain, differences in pain trajectories over time are observed. Upon admission to the PACU, cough-related pain was higher in the ITM group, but the trend reversed after 6 h. There are no significant differences in adverse effects. The rate of chronic pain was low and did not differ significantly between groups. Conclusions: ITM can be considered an adequate and satisfactory regional technique for the control of acute postoperative pain in VATS, compatible with the multimodal rehabilitation and early discharge protocols used in these types of surgeries. Full article
(This article belongs to the Special Issue Current Trends and Future Challenges in Thoracic Anesthesia)
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Review

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19 pages, 2846 KiB  
Review
Multi-Modal Prehabilitation in Thoracic Surgery: From Basic Concepts to Practical Modalities
by Marc Licker, Diae El Manser, Eline Bonnardel, Sylvain Massias, Islem Mohamed Soualhi, Charlotte Saint-Leger and Adrien Koeltz
J. Clin. Med. 2024, 13(10), 2765; https://doi.org/10.3390/jcm13102765 - 8 May 2024
Viewed by 605
Abstract
Over the last two decades, the invasiveness of thoracic surgery has decreased along with technological advances and better diagnostic tools, whereas the patient’s comorbidities and frailty patterns have increased, as well as the number of early cancer stages that could benefit from curative [...] Read more.
Over the last two decades, the invasiveness of thoracic surgery has decreased along with technological advances and better diagnostic tools, whereas the patient’s comorbidities and frailty patterns have increased, as well as the number of early cancer stages that could benefit from curative resection. Poor aerobic fitness, nutritional defects, sarcopenia and “toxic” behaviors such as sedentary behavior, smoking and alcohol consumption are modifiable risk factors for major postoperative complications. The process of enhancing patients’ physiological reserve in anticipation for surgery is referred to as prehabilitation. Components of prehabilitation programs include optimization of medical treatment, prescription of structured exercise program, correction of nutritional deficits and patient’s education to adopt healthier behaviors. All patients may benefit from prehabilitation, which is part of the enhanced recovery after surgery (ERAS) programs. Faster functional recovery is expected in low-risk patients, whereas better clinical outcome and shorter hospital stay have been demonstrated in higher risk and physically unfit patients. Full article
(This article belongs to the Special Issue Current Trends and Future Challenges in Thoracic Anesthesia)
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14 pages, 5426 KiB  
Review
Innovations to Improve Lung Isolation Training for Thoracic Anesthesia: A Narrative Review
by Corinne Grandjean, Gabriele Casso, Leslie Noirez, Manuel Granell Gil, Georges L. Savoldelli and Patrick Schoettker
J. Clin. Med. 2024, 13(7), 1848; https://doi.org/10.3390/jcm13071848 - 23 Mar 2024
Viewed by 1140
Abstract
A double-lumen tube or bronchial blocker positioning using flexible bronchoscopy for lung isolation and one-lung ventilation requires specific technical competencies. Training to acquire and retain such skills remains a challenge in thoracic anesthesia. Recent technological and innovative developments in the field of simulation [...] Read more.
A double-lumen tube or bronchial blocker positioning using flexible bronchoscopy for lung isolation and one-lung ventilation requires specific technical competencies. Training to acquire and retain such skills remains a challenge in thoracic anesthesia. Recent technological and innovative developments in the field of simulation have opened up exciting new horizons and possibilities. In this narrative review, we examine the latest development of existing training modalities while investigating, in particular, the use of emergent techniques such as virtual reality bronchoscopy simulation, virtual airway endoscopy, or the preoperative 3D printing of airways. The goal of this article is, therefore, to summarize the role of existing and future applications of training models/simulators and virtual reality simulators for training flexible bronchoscopy and lung isolation for thoracic anesthesia. Full article
(This article belongs to the Special Issue Current Trends and Future Challenges in Thoracic Anesthesia)
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Other

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14 pages, 3139 KiB  
Systematic Review
Systematic Review and Meta-Analysis of Efficiency and Safety of Double-Lumen Tube and Bronchial Blocker for One-Lung Ventilation
by Piotr Palaczynski, Hanna Misiolek, Lukasz Szarpak, Jacek Smereka, Michal Pruc, Mateusz Rydel, Damian Czyzewski and Szymon Bialka
J. Clin. Med. 2023, 12(5), 1877; https://doi.org/10.3390/jcm12051877 - 27 Feb 2023
Cited by 10 | Viewed by 2371
Abstract
One-lung ventilation is also used in some thoracic or cardiac surgery, vascular surgery and oesophageal procedures. We conducted a search of the literature for relevant studies in PubMed, Web of Science, Embase, Scopus and Cochrane Library. The final literature search was performed on [...] Read more.
One-lung ventilation is also used in some thoracic or cardiac surgery, vascular surgery and oesophageal procedures. We conducted a search of the literature for relevant studies in PubMed, Web of Science, Embase, Scopus and Cochrane Library. The final literature search was performed on 10 December 2022. Primary outcomes included the quality of lung collapse. Secondary outcome measures included: the success of the first intubation attempt, malposition rate, time for device placement, lung collapse and adverse events occurrence. Twenty-five studies with 1636 patients were included. Excellent lung collapse among DLT and BB groups was 72.4% vs. 73.4%, respectively (OR = 1.20; 95%CI: 0.84 to 1.72; p = 0.31). The malposition rate was 25.3% vs. 31.9%, respectively (OR = 0.66; 95%CI: 0.49 to 0.88; p = 0.004). The use of DLT compared to BB was associated with a higher risk of hypoxemia (13.5% vs. 6.0%, respectively; OR = 2.27; 95%CI: 1.14 to 4.49; p = 0.02), hoarseness (25.2% vs. 13.0%; OR = 2.30; 95%CI: 1.39 to 3.82; p = 0.001), sore throat (40.3% vs. 23.3%; OR = 2.30; 95%CI: 1.68 to 3.14; p < 0.001), and bronchus/carina injuries (23.2% vs. 8.4%; OR = 3.45; 95%CI: 1.43 to 8.31; p = 0.006). The studies conducted so far on comparing DLT and BB are ambiguous. In the DLT compared to the BB group, the malposition rate was statistically significantly lower, and time to tube placement and lung collapse was shorter. However, the use of DLT compared to BB can be associated with a higher risk of hypoxemia, hoarseness, sore throat and bronchus/carina injuries. Multicenter randomized trials on larger groups of patients are needed to draw definitive conclusions regarding the superiority of any of these devices. Full article
(This article belongs to the Special Issue Current Trends and Future Challenges in Thoracic Anesthesia)
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