ABSTRACT
Tailoring of anesthetic management to specific physiological goals is more important than are the specific agents or techniques utilized. Anesthesia for lung volume reduction surgery (LVRS) is no exception to this principle. Several investigations have reported their anesthetic approaches in case series (1-3), but to date, no studies have sought prospectively to compare anesthetic regimens for LVRS. Although consensus on optimal anesthetic techniques for such patients has not yet been established, there is general agreement on management goals. Paramount among those goals is rapid postoperative extubation, which is based on the appreciation that positivepressure ventilation (PPV) may lead to dynamic pulmonary hyperinflation, cardiovascular instability, alveolar barotrauma, disruption of surgical staple lines, impaired gas exchange, and chronic ventilator dependence. Opposing the goal of early extubation are the adverse respiratory effects of anesthesia, thoracic surgery, and severe chronic obstructive pulmonary disease (COPD). The intraoperative requirement for PPV (including single-lung ventilation) requires balancing those adverse effects against the goals of
hemodynamic stability, adequate gas exchange, and the minimization of intrinsic positive end-expiratory pressure (PEEPI) and barotrauma. Equally important are the needs for excellent analgesia, prompt return of cerebral function, prevention of myocardial ischemia, and avoidance of other organ dysfunction.
