Anaesthesia for thoracic surgery

Anaesthetic techniques Anaesthetic techniques for thoracic surgery (Table 10.1) are little different from those used in other forms of major surgery. Anaesthesia is induced intravenously and endobronchial intubation is performed following the administration of a non-depolarizing neuromuscular blocking drug. The depolarizing agent suxamethonium is indicated, however, if a difficult laryngeal intubation is likely, or if another airway problem, such as a bronchopleural fistula, is present. Maintenance of anaesthesia is usually with an inhalational agent such as isoflurane, combined with an intravenous opioid, but it is equally acceptable to use a total intravenous technique. If epidural opioids are to be used to provide postoperative pain relief, then it is preferable to avoid the use of intravenous opioids during surgery. Postoperative analgesia is discussed in Chapter 12. The choice between inhalational anaesthesia and intravenous techniques during one-lung ventilation is controversial. In practice, there is little difference in the oxygenation achieved with each technique.