Anesthesiology pp 131-139 | Cite as

Anesthesia for Pleural and Chest Wall Surgery

  • Jonathan Rost
  • Jeffery Gerritsen
  • Talia K. Ben-JacobEmail author


Chest wall surgery includes cases such as resection for chest wall tumors, repair of pectus excavatum or carinatum, thoracoplasty and chest wall reconstruction. Procedures involving the pleural cavity include drainage of empyema, drainage of pleural effusions, decortication, thoracentesis, pleurodesis, and chest tube thoracostomy. These cases often present anesthetic challenges and require interdisciplinary cooperation. This chapter will discuss the physiologic considerations and alterations during chest wall and pleural cavity surgery and suggest the complete preoperative work-up. It will also delve into intraoperative considerations and monitoring as well as regional anesthetic techniques for postoperative pain control. A brief discussion of postoperative complications and special considerations for certain surgeries will be reviewed.


Anesthesia Chest wall Pleural cavity Nuss procedure Clagett’s procedure Rib resections Eloesser flaps Empyema Hemothorax Bronchopleural fistula Decortication Pleurodesis 


  1. 1.
    Neustein SM, Eisenkraft JB, Cohen E. Anesthesia for thoracic surgery. In: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, editors. Clinical anesthesia. Philadelphia: Lippincott Williams and Wilkins; 2009. p. 1032–72.Google Scholar
  2. 2.
    Vallieres E. Management of empyema after lung resections (pneumonectomy/lobectomy). Chest Surg Clin N Am. 2002;12:571–85.CrossRefPubMedGoogle Scholar
  3. 3.
    Zanotti G, Mitchell JD. Bronchopleural fistula and empyema after anatomic lung resection. Thorac Surg Clin. 2015;25(4):421–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Maagaard M, Tang M, Ringgaard S, Nielsen HH, Frokiaer J, Haubuf M, et al. Normalized cardiopulmonary exercise function in patients with pectus excavatum three years after operation. Ann Thorac Surg. 2013;96:272–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Chatterjee K, Zhang J, Honbo N, Karlinerb JS. Doxorubicin cardiomyopathy. Cardiology. 2010;115(2):155–62.CrossRefPubMedGoogle Scholar
  6. 6.
    Patil N, Paulose RM, Udupa KS, Ramakrishna N, Ahmed T. Pulmonary toxicity of Bleomycin—a case series from a Tertiary Care Center in Southern India. J Clin Diagn Res. 2016;10(4):FR01–3.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Slinger PD. Perioperative respiratory assessment and management. Can J Anaesth. 1992;39:115–31.CrossRefGoogle Scholar
  8. 8.
    McHugh MA, Poston PM, Rossi NO, Turek JW. Assessment of potential confounders when imaging pectus excavatum with chest radiography alone. J Pediatr Surg. 2016;51(9):1485–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Gerson MC, Hurst JM, Herrtzberg VS, et al. Prediction of cardiac and pulmonary complication related to elective abdominal and non-cardiac surgery in thoracic surgery in geriatric patients. Am J Med. 1990;88:101–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Ivanov A, Yossef J, Tailon J, Worku BM, et al. Do pulmonary function tests improve risk stratification before cardiothoracic surgery? J Thorac Cardiovasc Surg. 2016;151(4):1183–1189.e3.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Kurlansky P. Preoperative PFTs: the answer is blowing in the wind. J Thorac Cardiovasc Surg. 2016;151(4):918–9.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Mavi J, Moore DL. Anesthesia and analgesia for pectus excavatum surgery. Anesthesiol Clin. 2014;32(1):175–84.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Katlic MR. Video-assisted thoracic surgery utilizing local anesthesia and sedation. Eur J Cardiothorac Surg. 2006;30(3):529–32.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lumb AB, Slinger P. Hypoxic pulmonary vasoconstriction: physiology and anesthetic implications. Anesthesiology. 2015;122(4):932–46.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Pruszkowski O, Dalibon N, Moutafis M, Jugan E, Law-Koune JD, Laloë PA, Fischler M. Effects of propofol vs sevoflurane on arterial oxygenation during one-lung ventilation. Br J Anaesth. 2007;98:539–44.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Fox ME, Bensard DD, Roaten JB, Hendrickson RJ. Positioning for the Nuss procedure: avoiding brachial plexus injury. Paediatr Anaesth. 2005;15(12):1067–71.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Mansour KA, Thourani VH, Losken A, et al. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg. 2002;73(6):1720–6.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Hebra A, Swoveland B, Egbert M, Tagge EP, Georgeson K, Othersen HB Jr, Nuss D. Outcome analysis of minimally invasive repair of pectus excavatum: review of 251 cases. J Pediatr Surg. 2000;35(2):252–7; discussion 257–258.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Luh S-P, Chou M-C, Wang L-S, Chen J-Y, Tsai T-P. Video-assisted thoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas. Chest. 2005;127(4):1427–32. Scholar
  20. 20.
    Ambrosino N, Gabbrielli L. Physiotherapy in the perioperative period. Best Pract Res Clin Anaesthesiol. 2010;24(2):283–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Christine P-A, Gupta S. Choices in pain management follow thoracotomy. Chest. 1999;115(5):122S–4S.CrossRefGoogle Scholar
  22. 22.
    Li N-L, Yu B-L, Hung C-F. Paravertebral block plus thoracic wall block versus paravertebral block alone for analgesia of modified radical mastectomy: a retrospective cohort study. PLoS ONE. 2016;11(11):e0166227.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Hetta R. Pectoralis-serratus interfascial plane block versus thoracic paravertebral block for unilateral radical mastectomy with axillary evacuation. J Clin Anesth. 2016;34:91–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Choudry B, Sacks R. Continuous chest wall ropivacaine infusion for analgesia in children undergoing Nuss procedure: a comparison with thoracic epidural. Paediatr Anaesth. 2016;26(6):582–9.CrossRefGoogle Scholar
  25. 25.
    Frawley G, Frawley J, Crameri J. A review of anesthetic techniques and outcomes following minimally invasive repair of pectus excavatum (Nuss procedure). Paediatr Anaesth. 2016;26(11):1082–90.; Epub 2016 Aug 11.CrossRefPubMedGoogle Scholar
  26. 26.
    Waurick VA. Update in thoracic epidural anaesthesia. Best Pract Res Clin Anaesthesiol. 2005;19(2):201–13.CrossRefPubMedGoogle Scholar
  27. 27.
    Kosinski S, et al. Comparison of continuous epidural block and continuous paravertebral block in postoperative analgaesia after video-assisted thoracoscopic surgery lobectomy: a randomised, non-inferiority trial. Anaesthesiol Intensive Ther. 2016;48(5):280–7. Scholar
  28. 28.
    Tamura T, et al. A randomized controlled trial comparing paravertebral block via the surgical field with thoracic epidural block using ropivacaine for post-thoracotomy pain relief. J Anesth. 2017;31(2):263–70.; Epub 2017 Jan 23.CrossRefPubMedGoogle Scholar
  29. 29.
    Soniya B, et al. Comparison between thoracic epidural block and thoracic paravertebral block for post thoracotomy pain relief. J Clin Diagn Res. 2016;10(9):UC08–12.Google Scholar
  30. 30.
    Ahmed Z, Samad K, Ullah H. Role of intercostal nerve block in reducing postoperative pain following video-assisted thoracoscopy: a randomized controlled trial. Saudi J Anaesth. 2017;11(1):54–7. Scholar
  31. 31.
    Hord AH, Wang JM, Pai UT, Raj PP. Anatomic spread of India ink in the human intercostal space with radiologic correlation. Reg. Anesth. 1991;16(1):13–6.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Jaroszewski DE, Temkit M, Ewais MM, et al. Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults. J Thorac Dis. 2016;8(8):2102–10. Scholar
  33. 33.
    Dale O, Somogyi AA, Li Y, Sullivan T, Shavit Y. Does intraoperative ketamine attenuate inflammatory reactivity following surgery? A systematic review and meta-analysis. Anesth Analg. 2012;115(4):934–43.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Shah M, Frye R, Marzinsky A, et al. Complications associated with bar fixation following Nuss repair for pectus excavatum. Am Surg. 2016;82(9):781–2.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Kawai H, Tayasu Y, Saitoh A, et al. Nocturnal hypoxemia after lobectomy for lung cancer. Ann Thorac Surg. 2005;79(4):1162–6. Scholar
  36. 36.
    Wildgaard K, Ravn J, Kehlet H. Chronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention. Eur J Cardiothorac Surg. 2009;36(1):170–80. Scholar
  37. 37.
    Kinney MA, Jacob AK, Passe MA, Mantilla CB. Increased risk of postthoracotomy pain syndrome in patients with Prolonged Hospitalization and increased postoperative Opioid use. Pain Res Treat. 2016;2016:7945145.; Epub 2016 Jun 2.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jonathan Rost
    • 1
  • Jeffery Gerritsen
    • 1
  • Talia K. Ben-Jacob
    • 2
    Email author
  1. 1.Department of AnesthesiologyCooper University HospitalCamdenUSA
  2. 2.Division of Critical Care, Department of AnesthesiologyCooper Medical School of Rowan University, Cooper University HospitalCamdenUSA

Personalised recommendations