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Thoracic Anaesthesia (Oxford Specialist Handbooks In Anaesthesia)

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Thoracic anaesthesia is a specialized branch of anaesthesia that deals with the administration of anaesthesia for surgical and non-surgical procedures involving the thoracic cavity. It requires a comprehensive understanding of the anatomy, physiology, and pathophysiology of the thoracic structures. This article provides an overview of thoracic anaesthesia, including the indications, techniques, and complications associated with it.

Indications for Thoracic Anaesthesia

Thoracic anaesthesia is indicated for a wide range of thoracic surgeries and procedures, including:

Lung resection (e.g., lobectomy, pneumonectomy)
Mediastinal tumour resection
Oesophagectomy
Thoracotomy
Thoracoscopy
Pleural effusion drainage
Chest wall reconstruction
Lung transplantation

Techniques of Thoracic Anaesthesia

The choice of anaesthetic technique for thoracic surgery depends on the type of procedure, the patient's condition, and the anaesthetist's preference. Common techniques used in thoracic anaesthesia include:

Thoracic Anaesthesia (Oxford Specialist Handbooks in Anaesthesia)

by Tom Wolfe

5 out of 5

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1. General Anaesthesia

General anaesthesia involves the administration of inhaled or intravenous anaesthetic drugs to induce a state of unconsciousness and analgesia. It provides the most complete control over the patient's airway and allows for muscle relaxation.

2. Regional Anaesthesia

Regional anaesthesia involves the injection of local anaesthetics to block pain signals from a specific region of the body. Common techniques used in thoracic anaesthesia include:

Thoracic epidural anaesthesia: This involves placing a catheter in the epidural space to deliver local anaesthetics to the nerves supplying the thorax.
Paravertebral block: This involves injecting local anaesthetics directly into the paravertebral space alongside the thoracic vertebrae.

3. Combined Anaesthesia

Combined anaesthesia involves the use of both general and regional anaesthesia. This combination can provide optimal pain relief and reduce the overall requirement for general anaesthetic drugs.

Monitoring During Thoracic Anaesthesia

During thoracic anaesthesia, the patient is closely monitored using a variety of devices and techniques to assess physiological parameters such as:

Heart rate and rhythm
Blood pressure
Respiratory rate and oxygen saturation
End-tidal carbon dioxide (EtCO2)
Neuromuscular function

Complications of Thoracic Anaesthesia

Thoracic anaesthesia is generally a safe procedure, but potential complications can occur, including:

Hypoxia (low oxygen levels)
Hypotension (low blood pressure)
Cardiac arrhythmias
Pulmonary oedema
Pneumothorax (collapsed lung)
Postoperative pain
Phrenic nerve palsy

Postoperative Care

After thoracic surgery, the patient is transferred to a recovery room or intensive care unit for monitoring and pain management. Chest tubes may be inserted to drain any fluid or air that accumulates in the pleural space. Physical therapy may be required to help the patient regain lung function and mobility.

Thoracic anaesthesia is a complex and challenging specialty that requires a high level of expertise and knowledge. It plays a crucial role in the management of patients undergoing thoracic surgeries and procedures. By understanding the indications, techniques, and potential complications of thoracic anaesthesia, healthcare professionals can optimize patient outcomes and ensure a safe and successful anaesthesia.

Thoracic Anaesthesia (Oxford Specialist Handbooks in Anaesthesia)

by Tom Wolfe

5 out of 5