Adaptation Allowing for Bronchial Blocker Proximal Port Filtration during Lung Isolation for Patients with Airborne Precautions

Anesthetic Management for Thoracic Surgery During the COVID-19 Pandemic

PURPOSE OF REVIEW

This review explores recent international guidance on the anesthetic management of patients undergoing thoracic surgery during the COVID-19 pandemic: those with suspected or confirmed COVID-19 requiring urgent thoracic surgery and those presenting for elective procedures.

RECENT FINDINGS

A significant mortality risk is associated with patients with COVID-19 undergoing thoracic surgery; therefore, where possible, it should be avoided. Thoracic surgery also carries a significant risk of viral transmission to healthcare workers due to the necessarily high frequency of intraoperative aerosol-generating procedures involved, such as lung isolation, one-lung ventilation, and flexible bronchoscopy.

SUMMARY

Guidelines recommend appropriate personal protective equipment and numerous procedural modifications to prevent viral transmission to staff and other patients. With appropriate disease mitigation strategies in place, elective thoracic surgery, in particular for lung cancer, has been able to continue safely in many centres.

The Year in Thoracic Anesthesia: Selected Highlights From 2020

Selected highlights in thoracic anesthesia in 2020 include updates in the preoperative assessment and prehabilitation of patients undergoing thoracic surgery; updates in one-lung ventilation (OLV) pertaining to the devices used for OLV; the use of dexmedetomidine for lung protection during OLV and protective ventilation, recommendations for the care of thoracic surgical patients with coronavirus disease 2019; a review of recent meta-analyses comparing truncal blocks with paravertebral and thoracic epidural blocks; and a review of outcomes after initiating the enhanced recovery after surgery guidelines for lung and esophageal surgery.