Anesthesia for Thoracic Surgery

The preoperative evaluation of children scheduled to undergo thoracic surgery should include an assessment of whether the surgical condition is likely to result in either hemodynamic or pulmonary compromise. Infants and small children have compliant chest walls and high oxygen consumption. This makes them less able to tolerate lateral positioning and one lung ventilation than older children or adults. There now exists a variety of devices such as bronchial blockers and smaller double lumen tracheal tubes which makes one lung ventilation possible in most pediatric patients, particularly in the older age groups. However anesthesia care providers must be prepared to evaluate and treat hypoxemia during one-lung ventilation if it occurs. Carbon dioxide insufflation to provide exposure is also being used more frequently to provide exposure, and often eliminates the need for a bronchial blocker or double lumen tracheal tube. Postoperatively epidural analgesia, paravertebral catheters, chest wall infusion and patient controlled intravenous analgesia are being utilized to benefit infants undergoing these painful procedures.