ABSTRACT
References 27
1. INTRODUCTION
When minimal access surgery (MAS) was first introduced into the mainstream of adult
surgery in the 1980s, anesthesiologists found themselves needing to adjust to a new set
of variables in order to provide optimal intraoperative care for their patients. It became
necessary to minimize the amount of air in the patient’s gastrointestinal tract to
improve surgical visualization, to continue neuromuscular blockade throughout surgery,
to consider hemodynamic consequences of intra-abdominal insufflation and the sitting
position, and to anticipate longer operative times. Thoracoscopy added the challenge of
single-lung ventilation with double-lumen tubes or bronchial blockers in cases which
otherwise did not require lung isolation. Intrathoracic insufflation of gas further
shifts the mediastinum into the dependent, ventilated lung. Because of the additional
burdens and duration of surgery, many patients were excluded from these novel
approaches. Patients with significant cardiopulmonary disease were considered to be at
very high risk and, therefore, could not reap the benefits of reduced postoperative pain,
improved cosmetic appearance, and in some cases, superior surgical outcome.
