Preanesthetic Assessment for Thoracic Surgery

  • Peter Slinger
  • Gail Darling


All patients having pulmonary resections should have a preoperative assessment of their respiratory function in three areas: lung mechanical function, pulmonary parenchymal function, and cardiopulmonary reserve (the “three-legged stool” of respiratory assessment). Following pulmonary resection surgery, it is usually possible to wean and extubate patients with adequate predicted postoperative respiratory function in the operating room provided they are “AWaC” (alert, warm, and comfortable). Preoperative investigation and therapy of patients with coronary artery disease for noncardiac thoracic surgery are becoming a complex issue. An individualized strategy in consultation with the surgeon, cardiologist, and patient is required. Myocardial perfusion, CT coronary angiography, and other advances in imaging are used increasingly in these patients. Geriatric patients are at a high risk for cardiac complications, particularly arrhythmias, following large pulmonary resections. Preoperative exercise capacity is the best predictor of post-thoracotomy outcome in the elderly.


Surgery Thoracic Resection Complications Lung 

Supplementary material


  1. 1.
    Taylor MD, LaPar D, Isbell J, et al. Marginal pulmonary function should not preclude lobectomy in selected patients with non-small cell lung cancer. J Thorac Cardiovasc Surg. 2014;147:738–46.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Licker M, Widikker I, Robert J, et al. Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg. 2006;81:1830–8.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Paul S, Sedrakyan A, Ya-lin C, et al. Outcomes after lobectomy using thoracoscopy vs thoracotomy. Eur J Cardiothorac Surg. 2013;43:813–7.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Brunelli A, Kim A, Berger K, et al. Physiological evaluation of the patient with lung cancer being considered for resectional surgery. Chest. 2013;143:e166s–90s.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    British Thoracic Society. Guidelines on the selection of patients with lung cancer for surgery. Thorax. 2001;56:89–108.CrossRefGoogle Scholar
  6. 6.
    Cerfolio RJ, Allen MS, Trastak VF, et al. Lung resection in patients with compromised pulmonary function. Ann Thorac Surg. 1996;62:348–51.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Donahoe LL, de Valence M, Atenafu EG, et al. High risk for thoracotomy but not thoracoscopic lobectomy. Ann Thorac Surg. 2017;103(6):1730–5.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Choi H, Mazzone P. Preoperative evaluation of the patient with lung cancer being considered for lung resection. Curr Opin Anesthesiol. 2015;28:18–25.CrossRefGoogle Scholar
  9. 9.
    Linden PA, Bueno R, Colson YL, et al. Lung resection in patients with FEV1 < 35% predicted. Chest. 2005;127:1984–90.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Bach PB, Cramer LD, Schrag D. The influence of hospital volume on survival after resection for lung Cancer. N Eng J Med. 2001;345:181–8.CrossRefGoogle Scholar
  11. 11.
    Brunelli A, Rocco G. Spirometry: predicting outcome and risk. Thorac Surg Clin. 2008;18:1–8.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Slinger PD, Kruger M, McRae K, Winton T. The relation of the static compliance curve and positive end-expiratory pressure to oxygenation during one-lung ventilation. Anesthesiology. 2001;95:1096–102.CrossRefGoogle Scholar
  13. 13.
    Ferguson MK, Vigneswaran WT. Diffusing capacity predicts morbidity after lung resection in patients without obstructive lung disease. Ann Thorac Surg. 2008;85:1158–65.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    National Emphysema Treatment Trial Research Group. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003;348:2059.CrossRefGoogle Scholar
  15. 15.
    Lim E, Baldwin D, Beckles M, et al. Guidelines on the radical management of patients with lung cancer. Thorax. 2010;65:iii1–iii27.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Weisman IM. Cardiopulmonary exercise testing in the preoperative assessment for lung resection surgery. Semin Thorac Cardiovasc Surg. 2001;13:116–22.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Coyle EF. Improved muscular efficiency as Tour de France champion matures. J Appl Physiol. 2005;98:2191–6.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Walsh GL, Morice RC, Putnam JB, et al. Resection of lung cancer is justified in high risk patients selected by oxygen consumption. Ann Thorac Surg. 1994;58:704–10.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Nagamatsu Y, Shima I, Hayashi A, et al. Preoperative spirometry versus expired gas analysis during exercise testing as predictors of cardiopulmonary complications after lung resections. Surg Today. 2004;34:107–10.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Forshaw MJ, Strauss DC, Davies AR, et al. Is cardiopulmonary exercise testing a useful test before esophagectomy? Ann Thorac Surg. 2008;85:294–9.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Brunelli A, Pompili C, Salati M, et al. Preoperative maximum oxygen consumption is associated with prognosis after pulmonary resection in stage I non-small cell lung cancer. Ann Thorac Surg. 2014;98:238–42.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Carter R, Holiday DB, Stocks J, et al. Predicting oxygen uptake for men and women with moderate to severe chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2003;84:1158–64.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Lee L, Schwartzman K, Carli F, et al. The association of the distance walked in 6 min with preoperative peak oxygen consumption and complications 1 month after colorectal resection. Anaesthesia. 2013;68:811–6.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Marjanski T, Wnuk D, Bosakowski D. Patients who do not reach a distance 6of 500 m during the 6-min walk test have an increased risk of postoperative complications and prolonged hospital stay after lobectomy. Eur J Cardiothorac Surg. 2015;47:e213–9.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Ninan M, Sommers KE, Landranau RJ, et al. Standardized exercise oximetry predicts post-pneumonectomy outcome. Ann Thorac Surg. 1997;64:328–33.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Bolliger CT, Wyser C, Roser H, et al. Lung scanning and exercise testing for the prediction of postoperative performance in lung resection candidates at increased risk for complications. Chest. 1995;108:341–8.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Olsen GN, Bolton JWR, Weiman DS, Horning CA. Stair climbing as an exercise test to predict postoperative complications of lung resection. Chest. 1991;99:587–90.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Kinasewitz GT, Welsh MH. A simple method to assess postoperative risk. Chest. 2001;120:1057–8.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Heerdt PM. Post-thoracotomy cardiovascular adaptations and complications. In: Kaplan J, Slinger P, editors. Thoracic anesthesia. 3rd ed. Philadelphia: Churchill Livingston; 2003. p. 423–35.Google Scholar
  30. 30.
    Koegelenberg CFN, Bollinger CT. Assessing regional lung function. Thorac Surg Clin. 2008;18:19–29.PubMedCrossRefGoogle Scholar
  31. 31.
    Win T, Larouche CM, Groves AM, et al. Use of quantitative lung scintigraphy to predict pulmonary function in lung cancer patients undergoing lobectomy. Ann Thorac Surg. 2004;78:1215–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Wu MT, Pan HB, Chiang AA, et al. Predicting postoperative lung function in patients with lung cancer. Am J Radiol. 2002;178:667–72.Google Scholar
  33. 33.
    Ohno Y, Koyama H, Nogami M, et al. Post-operative lung function in lung cancer patients: comparative analysis of predictive capacity of MRI, CT, SPECT. Am J Radiol. 2007;189:400–8.Google Scholar
  34. 34.
    Tisi GM. Preoperative evaluation of pulmonary function. Am Rev Resp Dis. 1979;119:293–301.PubMedGoogle Scholar
  35. 35.
    Lewis JW Jr, Bastanfar M, Gabriel F, Mascha E. Right heart function and prediction of respiratory morbidity in patients undergoing pneumonectomy with moderately severe cardiopulmonary dysfunction. J Thorac Cardiovasc Surg. 1994;108:169–75.PubMedGoogle Scholar
  36. 36.
    Amar D, Burt M, Roistacher N, Reinsel RA, Ginsberg RJ, Wilson R. Value of perioperative echocardiography in patients undergoing major lung resection. Ann Thorac Surg. 1996;61:516–22.CrossRefGoogle Scholar
  37. 37.
    Jordan S, Evans TW. Predicting the need for intensive care following lung resection. Thorac Surg Clin. 2008;18:61–9.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Ford MK, Beattie WS. Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index. Ann Int Med. 2010;152:26–35.PubMedCrossRefGoogle Scholar
  39. 39.
    Ferguson MK, Saha-Chaudhuri P, Mitchell JD, et al. Prediction of major cardiovascular events after lung resection using a modified scoring system. Ann Thorac Surg. 2014;97:1135–41.PubMedCrossRefGoogle Scholar
  40. 40.
    Wotton R, Marshall A, Kerr A, et al. Does the revised cardiac risk index predict cardiac complications following elective lung resection? J Cardiothorac Surg. 2013;8:220–7.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Roshanov P, Rochwerg B, Patel A, et al. Withholding versus continuing angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers before noncardiac surgery. Anesthesiology. 2017;126:16–27.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. JACC. 2007;50:1707–32.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    von Knorring J, Lepäntalo M, Lindgren L, Lindfors O. Cardiac arrhythmias and myocardial ischemia after thoracotomy for lung cancer. Ann Thorac Surg. 1992;53:642–7.CrossRefGoogle Scholar
  44. 44.
    Fleisher LA, Fleishmann KE, Auerbach AD, et al. ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing non-cardiac surgery. Circulation. 2014;130:2215–45.PubMedCrossRefGoogle Scholar
  45. 45.
    Etchells E, Meade M, Tomlinson G, et al. Semiquantitative dipyridamole myocardial stress perfusion imaging before noncardiac vascular surgery: a metaanalysis. J Vasc Surg. 2002;36:534–40.PubMedCrossRefGoogle Scholar
  46. 46.
    Brett AS. Are the current perioperative risk management strategies flawed? Circulation. 2008;117:3145–51.PubMedCrossRefGoogle Scholar
  47. 47.
    Yang H, Beattie WS. POISE results and perioperative β-blockade. Can J Anesth. 2008;55:727–34.PubMedCrossRefGoogle Scholar
  48. 48.
    2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease. J Thorac Cardiovasc Surg. 2016;152:1243–75.Google Scholar
  49. 49.
    Ritchie AJ, Bowe P, Gibbons JRP. Prophylactic digitalisation for thoracotomy: a reassessment. Ann Thorac Surg. 1990;50:86–8.PubMedCrossRefGoogle Scholar
  50. 50.
    de Perrot M, McRae K, Anraku M, et al. Risk factors for major complications after extra-pleural pneumonectomy for malignant pleural mesothelioma. Ann Thorac Surg. 2008;85:1206–10.CrossRefGoogle Scholar
  51. 51.
    Sekine Y, Kesler KA, Behnia M, et al. COPD may increase the incidence of refractory supraventricular arrhythmias following pulmonary resection for non-small cell lung cancer. Chest. 2001;120:1783–90.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Frendyl G, Sodickson AC, Chung MK, et al. 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. J Thorac Cardiovasc Surg. 2014;148:772–91.CrossRefGoogle Scholar
  53. 53.
    Lindgren L, Lepantalo M, Von Knorring J, et al. Effect of verapamil on right ventricular pressure and atrial tachyarrhythmia after thoracotomy. Br J Anaesth. 1991;66:205–11.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Oka T, Ozawa Y, Ohkubo Y. Thoracic epidural bupivacaine attenuates supraventricular tachyarrhythmias after pulmonary resection. Anesth Analg. 2001;93:253–9.Google Scholar
  55. 55.
    Osaki T, Shirakusa T, Kodate M, et al. Surgical treatment of lung cancer in the octogenarian. Ann Thorac Surg. 1994;57:188–92.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Brunelli A, Salati M, Refai M, et al. Development of a patient-centered aggregate score to predict survival after lung resection for non-small cell lung cancer. J Thorac Cardiovasc Surg. 2013;146:385–90.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Brunelli A, Monteverde M, Al Refai M. Stair climbing as a predictor of cardiopulmonary complications after pulmonary lobectomy in the elderly. Ann Thorac Surg. 2004;77:266–70.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Pricopi C, Mordant O, Rivera C, et al. Postoperative morbidity and mortality after pneumonectomy. Interact Cardiovasc Thorac Surg. 2015;20:316–21.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Lai Y, Huang J, Yang M, et al. Seven-day preoperative rehabilitation for elderly patients with lung cancer. J Surg Res. 2017;209:30–6.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Golledge J, Goldstraw P. Renal impairment after thoracotomy: incidence, risk factors and significance. Ann Thorac Surg. 1994;58:524–8.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Ishikawa S, Greisdale D, Lohser J. Acute kidney injury after lung resection surgery. Anesth Analg. 2012;114:1256–62.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Ahn HJ, Kim JA, Lee AR, et al. The risk of acute kidney injury from fluid restriction and hydroxyethyl starch in thoracic surgery. Anesth Analg. 2016;122:186–93.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Slinger PD. Postpneumonectony pulmonary edema: good news, bad news. Anesthesiology. 2006;105:2–5.PubMedCrossRefPubMedCentralGoogle Scholar
  64. 64.
    American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Resp Critic Care Med. 1995;152:s77–s121.Google Scholar
  65. 65.
    Parot S, Saunier C, Gauthier H, Milic-Emile J, Sadoul P. Breathing pattern and hypercapnia in patients with obstructive pulmonary disease. Am Rev Resp Dis. 1980;121:985–91.PubMedPubMedCentralGoogle Scholar
  66. 66.
    Aubier M, Murciano D. Milic-Emili al.. Effects of the administration of O2 on ventilation and blood gases in patients with chronic obstructive pulmonary disease during acute respiratory failure. American Rev Resp Dis. 1980;122:747–54.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Simpson SQ. Oxygen-induced acute hypercapnia in chronic obstructive pulmonary disease: what’s the problem? Critic Care Med. 2002;30:258–9.CrossRefGoogle Scholar
  68. 68.
    Hanson CW III, Marshall BE, Frasch HF, Marshall C. Causes of hypercarbia in patients with chronic obstructive pulmonary disease. Critic Care Med. 1996;24:23–8.CrossRefGoogle Scholar
  69. 69.
    Nguyen DM, Mulder DS, Shennib H. Altered cellular immune function in atelectatic lung. Ann Thorac Surg. 1991;51:76–80.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Hublitz UF, Shapiro JH. Atypical pulmonary patterns of congestive failure in chronic lung disease. Radiology. 1969;93:995–1006.PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Sasaki F, Ishizaki T, Mifune J, et al. Bronchial hyperresponsiveness in patients with chronic congestive heart failure. Chest. 1990;97:534–8.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Nisar M, Earis JE, Pearson MG, Calverly PMA. Acute bronchodilator trials in chronic obstructive pulmonary disease. Am Rev Resp Dis. 1992;146:555–9.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Warner DO. Preventing postoperative pulmonary complications. Anesthesiology. 2000;92:1467–72.PubMedCrossRefGoogle Scholar
  74. 74.
    Cesario A, Ferri L, Cardaci V, et al. Pre-operative pulmonary rehabilitation and surgery for lung cancer. Lung Cancer. 2007;57:118–9.PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Nici L. Preoperative and postoperative pulmonary rehabilitation in lung cancer patients. Thorac Surg Clin. 2008;18:39–43.PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Morano M, Araujo A, Nascimento F, et al. Preoperative pulmonary rehabilitation vs. chest physical therapy in patients undergoing lung cancer resection. Arch Phys Med Rehab. 2013;94:53–8.CrossRefGoogle Scholar
  77. 77.
    American Thoracic Society/European Respiratory Society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Am J Resp Crit Care Med. 2002;165:277–304.Google Scholar
  78. 78.
    Kumar P, Goldstraw P, Yamada K. Pulmonary fibrosis and lung cancer: risk and benefit analysis of pulmonary resection. J Thorac Cardiovasc Surg. 2003;125:1321–7.PubMedCrossRefPubMedCentralGoogle Scholar
  79. 79.
    Vaporciyan AA, Merriman KW, Ece F, et al. Incidence of major pulmonary complications after pneumonectomy; association with timing of smoking cessation. Ann Thorac Surg. 2002;73:420–5.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Akrawi W, Benumof JL. A pathophysiological basis for informed preoperative smoking cessation counseling. J Cardiothorac Vasc Anesth. 1997;11:629–40.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Moller A, Tonnesen H. Risk reduction: perioperative smoking intervention. Best Pract Res Clin Anaesthesiol. 2006;20:237–48.PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Barrera R, Shi W, Amar D, et al. Smoking and timing of cessation. Impact on pulmonary complications after thoracotomy. Chest. 2005;127:1977–83.PubMedPubMedCentralCrossRefGoogle Scholar
  83. 83.
    Warner DO. Feasibility of tobacco interventions in anesthesiology practices: a pilot study. Anesthesiology. 2009;110:1223–8.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Thomsen T, Tonnesen H, Moller AM. Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation. Br J Surg. 2009;96:451–61.PubMedCrossRefPubMedCentralGoogle Scholar
  85. 85.
    Rodriguez M, Gomez Hernandez M, Novoa N, et al. Morbidity and mortality in octogenarians with lung cancer undergoing pneumonectomy. Arch Bronchoneumol. 2015;51:211–2.Google Scholar
  86. 86.
    Puente-Maestu L, Villar F, Gonzalez-Causurran G, et al. Early and long term validation of an algorithm assessing fitness for surgery in patients with postoperative FEV1 and diffusing capacity for carbon monoxide <40%. Chest. 2011;139:1430–8.PubMedCrossRefPubMedCentralGoogle Scholar
  87. 87.
    Schulte T, Schniewind B, Dohrmann P, et al. The extent of lung parenchymal resection significantly affects long-term quality of life in patients with non-small cell lung cancer. Chest. 2009;135:322–9.PubMedCrossRefPubMedCentralGoogle Scholar
  88. 88.
    Tang S, Redmond K, Griffiths M, et al. The mortality from acute respiratory distress syndrome after pulmonary resection is decreasing: a 10-year single institutional experience. Eur J Cardiothorac Surg. 2009;34:898–902.CrossRefGoogle Scholar
  89. 89.
    Thomas P, Falcoz P, Bernard A, et al. Bilobectomy for lung cancer: contemporary national early morbidity and mortality outcomes. Eur J Cardiothorac Surg. 2016;49:e38–43.PubMedCrossRefPubMedCentralGoogle Scholar
  90. 90.
    Linden P, D’Amico T, Perry Y, et al. Quantifying the safety benefits of wedge resection: a society of thoracic surgery database propensity-matched analysis. Ann Thorac Surg. 2014;98:1705–11.PubMedCrossRefPubMedCentralGoogle Scholar
  91. 91.
    Larsen L, Petersen R, Hansen H, et al. Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy. Eur J Cardiothorac Surg. 2016;49:870–5.CrossRefGoogle Scholar
  92. 92.
    Burt B, Kosinski A, Shrager J, et al. Thoracoscopic lobectomy is associated with acceptable morbidity and mortality in patients with predicted postoperative forced expiratory volume in 1 second or diffusing capacity for carbon monoxide less than 40% of normal. J Thorac Cardiovasc Surg. 2014;148:19–28.PubMedCrossRefPubMedCentralGoogle Scholar
  93. 93.
    Berry M, Villamizar-Ortiz N, Tong B, et al. Pulmonary function tests do not predict pulmonary complications after thoracoscopic lobectomy. Ann Thorac Surg. 2010;89:1044–52.PubMedPubMedCentralCrossRefGoogle Scholar
  94. 94.
    Bilimoria K, liu Y, Paruch J, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator. J Am Coll Surg. 2013;217:833–42.PubMedPubMedCentralCrossRefGoogle Scholar
  95. 95.
    Licker M, Triponez F, Diaper J, et al. Preoperative evaluation of lung cancer patients. Curr Anesthesiol Rep. 2014;4:124–34.CrossRefGoogle Scholar
  96. 96.
    Farjah F, Wood DE, Yanez D III, et al. Temporal trends in the management of potentially resectable lung cancer. Ann Thorac Surg. 2008;85:1850–6.PubMedCrossRefPubMedCentralGoogle Scholar
  97. 97.
    National Health Statistics of the United States 2007.
  98. 98.
    Feinstein MB, Bach PB. Epidemiology of lung cancer in lung cancer: past, present and future. Ginsberg RJ, Ruckdeschel JC eds. Chest Surg Clin. 2000;10:653–61.Google Scholar
  99. 99.
    Darling GE, Dickie AJ, et al. Invasive mediastinal staging of non-small-cell lung cancer: a clinical practice guideline. Curr Oncol. 2011;18(6):e304–10.PubMedPubMedCentralCrossRefGoogle Scholar
  100. 100.
    de Perrot M, Cherenko S, Waddell T, et al. Role of lung transplantation in the treatment of bronchogenic carcinomas for patients with end-stage pulmonary disease. J Clin Oncol. 2004;22:4351–6.PubMedCrossRefPubMedCentralGoogle Scholar
  101. 101.
    Johnson BE. Management of small cell lung cancer. Clin in Chest Med. 1993;14:173–87.Google Scholar
  102. 102.
    Levin KH. Paraneoplastic neuromuscular syndromes. Neurol Clin. 1997;15:597–614.PubMedCrossRefPubMedCentralGoogle Scholar
  103. 103.
    Petty R. Lambert-Eaton Myasthenic syndrome. Pract Neurol. 2007;7:265–7.PubMedCrossRefPubMedCentralGoogle Scholar
  104. 104.
    Telford RJ, Holloway TE. The myasthenic syndrome: anesthesia in a patient treated with 3-4 diaminopyridine. Br J Anaest. 1990;64:363–6.CrossRefGoogle Scholar
  105. 105.
    Mehta AC, Rafanan AL, Bulkley R, et al. Coronary spasm and cardiac arrest from carcinoid syndrome during laser bronchoscopy. Chest. 1999;115:598–600.PubMedCrossRefPubMedCentralGoogle Scholar
  106. 106.
    Vaughan DJ, Brunner MD. Anesthesia for patients with the carcinoid syndrome. Int Anesthesiol Clin. 1997;35:129–42.PubMedCrossRefPubMedCentralGoogle Scholar
  107. 107.
    Hartigan PM, Ng JM. Anesthetic strategies for patients undergoing extrapleural pneumonectomy. Thorac Surg Clin. 2004;14:575–83.CrossRefGoogle Scholar
  108. 108.
    Sleijfer S. Bleomycin-induced pneumonitis. Chest. 2001;120:617–24.PubMedCrossRefPubMedCentralGoogle Scholar
  109. 109.
    Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery: a review of current techniques. Anesthesiology. 1994;81:737–59.PubMedCrossRefPubMedCentralGoogle Scholar
  110. 110.
    Licker M, de Perrot M, Hohn L, et al. Perioperative mortality and major cardio-pulmonary complications after lung surgery for non-small call carcinoma. Eur J Cardiothorac Surg. 1999;15:314–9.PubMedCrossRefPubMedCentralGoogle Scholar
  111. 111.
    Rigg JRA, Jamrozik K, Myles PS. Epidural anaesthesia and analgesia and outcome of major surgery: a randomized trial. Lancet. 2005;359:1276–82.CrossRefGoogle Scholar
  112. 112.
    Hansdottir V, Woestenborghs R, Nordberg G. The pharmacokinetics of continuous epidural sufentanil and bupivacaine infusion after thoracotomy. Anesth Analg. 1996;83:401–6.PubMedCrossRefPubMedCentralGoogle Scholar
  113. 113.
    Tejwani GA, Rattan AK, McDonald JS. Role of spinal opioid receptors in the antinociceptive interactions between intrathecal morphine and bupivacaine. Anesth Analg. 1992;74:726–34.PubMedCrossRefPubMedCentralGoogle Scholar
  114. 114.
    Hansdottir V, Bake B, Nordberg G. The analgesic efficiency and adverse effects of continuous epidural sufentanil and bupivacaine infusion after thoracotomy. Anesth Analg. 1996;83:394–400.PubMedCrossRefPubMedCentralGoogle Scholar
  115. 115.
    Bauer C, Hentz J-G, Ducrocq X, et al. Lung function after lobectomy: a randomized trial comparing thoracic epidural ropivacaine/sufentanil and intra-venous morphine for patient-controlled analgesia. Anesth Analg. 2007;105:238–44.PubMedCrossRefPubMedCentralGoogle Scholar
  116. 116.
    Saada M, Catoire P, Bonnet F, et al. Effect of thoracic epidural anesthesia combined with general anesthesia on segmental wall motion assessed by transesophageal echocardiography. Anesth Analg. 1992;75:329–35.PubMedCrossRefPubMedCentralGoogle Scholar
  117. 117.
    Karmakar MK. Thoracic paravertebral block. Anesthesiology. 2001;95:771–80.PubMedCrossRefPubMedCentralGoogle Scholar
  118. 118.
    Liu SS, Mulroy MF. Neuraxial anesthesia and analgesia in the presence of standard heparin. Reg Anesth Pain Med. 1998;23(6 Suppl 2):157–63.PubMedCrossRefPubMedCentralGoogle Scholar
  119. 119.
    Kempainen RR, Benditt JO. Evaluation and management of patients with pulmonary disease before thoracic and cardiovascular surgery. Semin Thorac Cardiovasc Surg. 2001;13:105–15.PubMedCrossRefPubMedCentralGoogle Scholar
  120. 120.
    Bayes J, Slater EM, Hadberg PS, Lawson D. Obstruction of a double-lumen tube by a saber-sheath trachea. Anesth Analg. 1994;79:186–8.PubMedCrossRefPubMedCentralGoogle Scholar
  121. 121.
    Slinger P, Suissa S, Triolet W. Predicting arterial oxygenation during one-lung anaesthesia. Can J Anaesth. 1992;39:1030–5.PubMedCrossRefPubMedCentralGoogle Scholar
  122. 122.
    Hurford WE, Kolker AC, Strauss HW. The use of ventilation/perfusion lung scans to predict oxygenation during one-lung anesthesia. Anesthesiology. 1987;67:841–4.CrossRefGoogle Scholar
  123. 123.
    Lewis JW, Serwin JP, Gabriel FS, Bastaufar M, Jacobsen G. The utility of a double-lumen tube for one-lung ventilation in a variety of non-cardiac thoracic surgical procedures. J Cardiothorac Vasc Anesth. 1992;6:705–10.PubMedPubMedCentralCrossRefGoogle Scholar
  124. 124.
    Katz JA, Lavern RG, Fairley HB, et al. Pulmonary oxygen exchange during endobronchial anesthesia, effect of tidal volume and PEEP. Anesthesiology. 1982;56:164–71.PubMedPubMedCentralCrossRefGoogle Scholar
  125. 125.
    Naunheim KS, Virgo KS. Postoperative surveillance following lung cancer resection. Chest Surg Clin. 2001;11:213–25.Google Scholar
  126. 126.
    Slinger PD, Johnston M. Preoperative assessment: an anesthesiologist’s perspective. Thorac Surg Clin. 2005;15:11–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of AnesthesiaToronto General HospitalTorontoCanada
  2. 2.Department of Surgery, Division of Thoracic SurgeryToronto General Hospital, University Health NetworkTorontoCanada

Personalised recommendations