Thoracic Procedures

  • Steven M. Neustein
  • James B. Eisenkraft


From 1900 to 1990, the fraction of the population aged 65 years and older tripled to 13%.1 Persons aged 80 years and older now constitute the fastest-growing elderly group in the United States.2 Between 2000 and 2020, this segment of the United States population is expected to increase by approximately 35%.


Lung Resection Pulmonary Resection Intrathecal Morphine Rigid Bronchoscopy Thoracic Procedure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Jaklitsch MJ, Mery CM, Audisio RA. The use of surgery to treat lung cancer in elderly patients. Lancet 2003;4: 463–471.CrossRefGoogle Scholar
  2. 2.
    Etzioni DA, Liu JH, O’Connell JB, Maggard MA, Ko CY. Elderly patients in surgical workloads: a population-based analysis. Am Surg 2003;69:901–905.Google Scholar
  3. 3.
    Hurria A, Kris MG. Management of lung cancer in older adults. CA Cancer J Clin 2003;53:325–341.PubMedCrossRefGoogle Scholar
  4. 4.
    Cangemi V, Volpino P, D’Andrea N, et al. Lung cancer surgery in elderly patients. Tumori 1996;82:237–241.PubMedGoogle Scholar
  5. 5.
    Levi F, LaVecchia C, Lucchini F, Negri E. Worldwide trends in cancer mortality in the elderly, 1955–1992. Eur J Cancer 1996;32:652–672.CrossRefGoogle Scholar
  6. 6.
    Smetana GW. Preoperative pulmonary assessment of the older adult. Clin Geriatr Med 2003;19:35–55.PubMedCrossRefGoogle Scholar
  7. 7.
    Mery CM, Pappas AN, Lukanich JM, et al. Long-term survival of patients with early stage non-small cell lung cancer as a function of age and treatment modality. Chest 2001;120:176.Google Scholar
  8. 8.
    Damhuis RA, Schutte PR. Resection rates and perioperative mortality in 7899 patients with lung cancer. Eur Respir J 1996;9:7–10.PubMedCrossRefGoogle Scholar
  9. 9.
    National Cancer Institute. SEER Cancer Statistics Review 1973–1997. Bethesda, MD: National Cancer Institute; 2000.Google Scholar
  10. 10.
    Hall SW. Cancer: special considerations in older patients. Geriatrics 1984;39:74–78.PubMedGoogle Scholar
  11. 11.
    Kohman, LJ, Meyer JA, Ilkins PM, Oates RP. Random versus predictable risks of mortality after thoracotomy for lung cancer. Thorac Cardiovasc Surg 1986;91:551–554.Google Scholar
  12. 12.
    Mizushima Y, Noto H, Sugiyama S, et al. Survival and prognosis after pneumonectomy in the elderly. Ann Thorac Surg 1997;64:193–198.PubMedCrossRefGoogle Scholar
  13. 13.
    Osaki T, Shirakura T, Kodte M, et al. Surgical treatment of lung cancer in the octogenarian. Ann Thorac Surg 1994; 57:188–193.PubMedGoogle Scholar
  14. 14.
    Jaklitsch MT, DeCamp MM Jr, Liptay MJ, et al. Video assisted thoracic surgery in the elderly: a review of 307 cases. Chest 1996;110:751–758.PubMedCrossRefGoogle Scholar
  15. 15.
    Gerson MC, Hurst JM, Hertzberg VS, Baughman R, Rouan GS, Ellis K. Prediction of cardiac and pulmonary complications related to elective abdominal and non-cardiac thoracic surgery in geriatric patients. Am J Med 1990;88:101–107.PubMedCrossRefGoogle Scholar
  16. 16.
    Liu LL, Leung JM. Predicting adverse postoperative outcomes in patients aged 80 years or older. J Am Geriatr Soc 2000;48:405–412.PubMedGoogle Scholar
  17. 17.
    Castillo R, Haas A. Chest physical therapy: comparative efficacy of preoperative and postoperative in the elderly. Arch Phys Med Rehabil 1985;66:376–379.PubMedGoogle Scholar
  18. 18.
    Warner DO. Preventing postoperative pulmonary complications. Anesthesiology 2000;92:1467–1471.PubMedCrossRefGoogle Scholar
  19. 19.
    Gerson MC, Hurst JM, Hertzber VS, et al. Cardiac prognosis in non-cardiac geriatric surgery. Ann Intern Med 1985; 103:832–837.PubMedGoogle Scholar
  20. 20.
    Shore ET, Millman RD, Silage DA, et al. Ventilatory and arousal patterns during sleep in normal young and elderly subjects. J Appl Physiol 1985;59:1607.PubMedGoogle Scholar
  21. 21.
    Rossi A, Ganassini A, Tantucci C, Grassi V. Aging and the respiratory system. Aging (Milano) 1996;8:143–161.Google Scholar
  22. 22.
    Ganguly R, Craig CP, Waldman RH. Respiratory tract immunity in the aged. Z Erkr Atmungsorgane 1984;163: 112–120.PubMedGoogle Scholar
  23. 23.
    VanDewater JM. Preoperative and postoperative techniques in the prevention of pulmonary complications. Surg Clin North Am 1980;60:1339–1348.Google Scholar
  24. 24.
    Naunheim KS, Kesler KA, D’Orazio SA, et al. Lung cancer surgery in the octogenarian. Eur J Cardiothorac Surg 1994; 8:453–456.PubMedCrossRefGoogle Scholar
  25. 25.
    Slinger P, Johnston MR. Preoperative assessment for pulmonary function. J Cardiothorac Vasc Anesth 2000;14: 202–211.PubMedCrossRefGoogle Scholar
  26. 26.
    Ploeg AJ, Kappefeim P, van Tangeren, et al. Factors associated with perioperative complications and long-term results after pulmonary resection for primary carcinoma of the lung. Eur J Cardiothorac Surg 2003;23:26–29.PubMedCrossRefGoogle Scholar
  27. 27.
    Bernard L, Ferrand O, Benoit L. Identification of prognostic factors determining risk groups for lung resection. Ann Thorac Surg 2000;70:1161–1167.PubMedCrossRefGoogle Scholar
  28. 28.
    Nakahara K, Ohno K, Hashimoto J, et al. Prediction of postoperative respiratory failure in patients undergoing lung resection for cancer. Ann Thorac Surg 1988;46:549–552.PubMedGoogle Scholar
  29. 29.
    Ferguson MK, Reeder LB, Mick R. Optimizing selection of patients for major lung resection. J Thorac Cardiovasc Surg 1995;109:275–283.PubMedCrossRefGoogle Scholar
  30. 30.
    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.PubMedGoogle Scholar
  31. 31.
    Bollinger 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;108:341–348.CrossRefGoogle Scholar
  32. 32.
    Eisenkraft JB, Neustein SM. Anesthesia for special problems in thoracic surgery. Probl Anesth 1990;4:326–354.Google Scholar
  33. 33.
    Frumin MJ, Epstein R, Cohen G. Apneic oxygenation in man. Anesthesiology 1959;20:789.PubMedGoogle Scholar
  34. 34.
    Sanders RD. Two ventilating attachments for bronchoscopes. Del Med J 1967;39:1270.Google Scholar
  35. 35.
    Vourc’h G, Fishler M, Michon F, et al. Manual jet ventilation vs. high frequency jet ventilation during laser resection of tracheobronchial stenosis. Br J Anaesth 1983;55:973.CrossRefGoogle Scholar
  36. 36.
    Carlens E. Mediastinoscopy: a method for inspection and tissue biopsy stenosis. Br J Anaesth 1983;55:973.CrossRefGoogle Scholar
  37. 37.
    Morton JR, Guinn GA. Mediastinoscopy using local anesthesia. Am J Surg 1971;122:696.PubMedCrossRefGoogle Scholar
  38. 38.
    Roberts JT, Gissen AJ. Management of complications encountered during anesthesia for mediastinoscopy. Anesthesiol Rev 1979;6:31.Google Scholar
  39. 39.
    Lee J, Salvatore AJ. Innominate artery compression simulating cardiac arrest during mediastinoscopy. Anesth Analg 1976;55:748.PubMedGoogle Scholar
  40. 40.
    Ashbaugh DG. Mediastinoscopy. Arch Surg 1970;100:568.PubMedGoogle Scholar
  41. 41.
    Morandi U, Stefani A, Golinelli M, et al. Results of surgical resection in patients over the age of 70 years with non smallcell lung cancer. Eur J Cardiothorac Surg 1997;11:432–439.PubMedCrossRefGoogle Scholar
  42. 42.
    Krowke MJ, Pairolero PC, Trustek F, Payne WS, Bernatz PE. Cardiac dysrhythmia following pneumonectomy: clinical correlates and prognostic significance. Chest 1987;91:490–495.CrossRefGoogle Scholar
  43. 43.
    Burman SO. The prophylactic use of digitalis before thoracotomy. Ann Thorac Surg 1972;14:359–368.PubMedGoogle Scholar
  44. 44.
    Shields TW, Unik GT. Digitalization for prevention of arrhythmias following pulmonary surgery. Surg Gynecol Obstet 1968;126:743–746.PubMedGoogle Scholar
  45. 45.
    Ritchie AJ, Bowe P, Gibbons JRP. Prophylactic digitalization for thoracotomy: a reassessment. Ann Thorac Surg 1990;50:86–88.PubMedGoogle Scholar
  46. 46.
    Jakobsen CJ, Billie S, Ahlburg P. Perioperative metoprolol reduces the frequency of atrial fibrillation after thoracotomy for lung resection. J Cardiothorac Vasc Anesth 1997;11: 746–751.PubMedCrossRefGoogle Scholar
  47. 47.
    Neustein SM, Cohen E, Reich D, et al. Transesophageal echocardiography and the intraoperative diagnosis of left atrial invasion by carcinoid tumor. Can J Anaesth 1993;40: 664–666.PubMedGoogle Scholar
  48. 48.
    Licker M, dePerrot M, Spiliopoulos A. Risk factor for acute lung injury after thoracic surgery for lung cancer. Anesth Analg 2003;97:1558–1565.PubMedCrossRefGoogle Scholar
  49. 49.
    Eisenkraft JB. Effects of anaesthetics on the pulmonary circulation. Br J Anaesth 1990;65:63–78.PubMedCrossRefGoogle Scholar
  50. 50.
    Gallagher C, Sladen RN, Lubarsky D. Thoracotomy. Postoperative complications. Probl Anesth 1990;4:393–415.Google Scholar
  51. 51.
    Breyer RH, Sippe C, Pharr WF, et al. Thoracotomy in patients over age seventy years: ten year experience. J Thorac Cardiovasc Surg 1981;81:187.PubMedGoogle Scholar
  52. 52.
    Hankins JR, Miller JE, Atlar S, et al. Bronchopleural fistula: thirteen-year experience with 77 cases. J Thorac Cardiovasc Surg 1978;76:755–762.PubMedGoogle Scholar
  53. 53.
    Craig DB. Postoperative recovery of pulmonary function. Anesth Analg 1981;60:46–52.PubMedGoogle Scholar
  54. 54.
    Bennett RL, Battenhorst RL, Graves D, et al. Patientcontrolled analgesia—a new concept of postoperative relief. Ann Surg 1982;195:700–705.PubMedCrossRefGoogle Scholar
  55. 55.
    Bennett RL, Baumann TJ, Graves DA, Griffen WD Jr. Patient controlled analgesia and analgesic outcome, nocturnal sleep, and spontaneous activity. Surg Forum 1987;35: 57–59.Google Scholar
  56. 56.
    Lange MP, Dahn MS, Jacobs LA. Patient-controlled analgesia versus intermittent analgesia dosing. Heart Lung 1988;17: 495–498.PubMedGoogle Scholar
  57. 57.
    Maiwand O, Makey AR, Rees A. Cryoanalgesia after thoracotomy. Improvement of technique and review of 600 cases. J Thorac Cardiovasc Surg 1986;92:291–295.PubMedGoogle Scholar
  58. 58.
    Nordberg G, Hedner T, Mellstrand T, et al. Pharmacokinetic aspect of epidural morphine analgesia. Anesthesiology 1983;58:545–551.PubMedCrossRefGoogle Scholar
  59. 59.
    Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology 1984;61:276–310.PubMedCrossRefGoogle Scholar
  60. 60.
    Gray JR, Fromme GA, Nauss LA, Wang JK, Istrup DM. Intrathecal morphine for post-thoracotomy pain. Anesth Analg 1986;65:873–876.PubMedCrossRefGoogle Scholar
  61. 61.
    Kotob HIM, Hand CV, Moore RA, et al. Intrathecal morphine and heroin in humans: six-hour drug levels in spinal fluid and plasma. Anesth Analg 1986;65:718–722.PubMedCrossRefGoogle Scholar
  62. 62.
    Shulman M, Sandler AN, Bradley JW, Young PS, Brobrer J. Post-thoracotomy pain and pulmonary function following epidural and systemic morphine. Anesthesiology 1984;61: 509–575.CrossRefGoogle Scholar
  63. 63.
    Samii J, Chavim M, Viars P. Postoperative spinal analgesia with morphine. Br J Anaesth 1981;53:817–820.PubMedCrossRefGoogle Scholar
  64. 64.
    Neustein SM, Cohen E. Intrathecal morphine during thoracotomy. Part II. Effect on postoperative meperidine requirements and pulmonary function tests. J Cardiothorac Vasc Anesth 1993;7:157–159.PubMedCrossRefGoogle Scholar
  65. 65.
    Whiting WG, Sandler AN, Lau LC, Chovaz PM. Analgesic and respiratory effects of epidural sufentanil in postthoracotomy patients. Anesthesiology 1988;609:36–42.Google Scholar
  66. 66.
    Melendez J, Cirella VN, Delphin ES. Lumbar epidural fentanyl analgesia after thoracic surgery. J Cardiothorac Anesth 1989;3:150–153.PubMedCrossRefGoogle Scholar
  67. 67.
    Mann C, Pouzeratte J, Eledjam JJ. Postoperative patient controlled analgesia in the elderly: risks and benefits of epidural versus intravenous administration. Drugs Aging 2003;20:337–345.PubMedCrossRefGoogle Scholar
  68. 68.
    Alon E, Jaquenod M, Schaepp B. Post-operative epidural versus intravenous patient-controlled analgesia. Minerva Anestesiol 2003;69:473–476.Google Scholar
  69. 69.
    Flisberg P, Rudin A, Linne R, et al. Pain relief and safety after major surgery. A prospective study of epidural and intravenous analgesia in 2696 patients. Acta Anaesthesiol Scand 2003;47:457–465.PubMedCrossRefGoogle Scholar
  70. 70.
    Cashman JN, Dolin SJ. Respiratory and hemodynamic effects of acute postoperative pain management: evidence from published data. Br J Anaesth 2004;93:212–223.PubMedCrossRefGoogle Scholar
  71. 71.
    Reiestad F, Stromskag KE. Interpleural catheter in the management of postoperative pain: a preliminary report. Reg Anaesth 1986;11:89–91.Google Scholar
  72. 72.
    el-Baz N, Faber LP, Ivankovic AD, et al. Intrapleural infusion of local anesthetic: a word of caution. Anesthesiology 1988;68:809–810.PubMedCrossRefGoogle Scholar
  73. 73.
    Rosenberg PH, Scheinin BWA, Lepantalo MJ, et al. Continuous intrapleural infusion of bupivacaine for analgesia after thoracotomy. Anesthesiology 1987;67:811–813.PubMedCrossRefGoogle Scholar
  74. 74.
    Reddy Kanbam J, Hammon J, Parris WC, et al. Intrapleural analgesia for postthoracotomy pain and blood levels of bupivacaine following intrapleural injection. Can J Anaesth 1989;36:106–109.Google Scholar
  75. 75.
    Symreng T, Gomez MN, Rossi N. Intrapleural bupivacaine and saline after thoracotomy: effects on pain and lung function—a double blind study. J Cardiothorac Anaesth 1989; 3:144–149.CrossRefGoogle Scholar
  76. 76.
    Tetik O, Islamoglu F, Ayan E, et al. Intermittent infusion of 0.25% bupivacaine through an intrapleural catheter for post-thoracotomy pain relief. Ann Thorac Surg 2004;77: 284–288.PubMedCrossRefGoogle Scholar
  77. 77.
    Hasnin JU, Krasna MJ, Barker SJ, Weiman DS, Whitman GJR. Anesthetic consideration for thoracoscopic procedures. J Cardiothorac Vasc Anesth 1992;6:624–627.CrossRefGoogle Scholar
  78. 78.
    Wakabayashi A. Thoracoscopic ablation of blebs in the treatment of recurrent or persistent spontaneous pneumothorax. Ann Thorac Surg 1989;48:651–653.PubMedGoogle Scholar
  79. 79.
    Torre M, Belloni P. Nd:YAG laser pleurodesis through thoracoscopy: new curative therapy in spontaneous pneumothorax. Ann Thorac Surg 1989;47:887–889.PubMedGoogle Scholar
  80. 80.
    Barker SJ, Clarke C, Hyatt J, Le N, Bhakta C. Thoracoscopic laser ablation of bullous emphysema: an anesthetic case study. Anesth Analg 1991;72:S11.Google Scholar
  81. 81.
    Neustein SM, Kahn P, Krellenstein D, et al. Incidence of arrhythmias after thoracic surgery: thoracotomy vs video-assist thoracoscopy. J Cardiothorac Vasc Anesth 1998;12:659–661.PubMedCrossRefGoogle Scholar
  82. 82.
    Oka T, Ozawa Y, Ohkubo Y. Thoracic epidural bupivacaine attenuates supraventricular tachyarrhythmias after pulmonary resection. Anesth Analg 2001;93:253–259.PubMedCrossRefGoogle Scholar
  83. 83.
    Faulkner SI. Is lobectomy the gold standard for stage I lung cancer in year 2000? Chest 2000;118:119S.Google Scholar
  84. 84.
    Swanson SJ, Bueno R, Jaklitsch MT, et al. Subcentimeter non-small cell lung cancer: a program for detection and resection is warranted. Proceedings of the 80th Annual Meeting of the American Association of Thoracic Surgery, Toronto, Canada; 2000:70.Google Scholar
  85. 85.
    Roberts JR, DeCamp MM, Mentzer SJ, Sugarbaker DJ. Prospective comparison of open and video assisted lobectomy. Chest 1996;110:45S.CrossRefGoogle Scholar
  86. 86.
    Jaklitsch MT, Pappas-Estocin A, Bueno R. Thoracoscopic surgery in elderly lung patients. Crit Rev Oncol Hematol 2004;49:165–171.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Steven M. Neustein
    • 1
  • James B. Eisenkraft
    • 1
  1. 1.Department of AnesthesiologyMount Sinai School of MedicineNew YorkUSA

Personalised recommendations