Anesthetic considerations in minimally invasive cardiothoracic surgery

Thoracoscopy is not a new surgical technique, its use in the treatment of tuberculosis being reported by Jacobeus in 1921. However, advances in both surgical and anesthetic management have led to the application of this technique for minimally invasive cardiothoracic surgery (MICTS) in progressively sick patients. Although less invasive than the traditional techniques, MICTS is not without potential complications. The anesthesiologist must be alert to problems related to one-lung ventilation (placement of the endobronchial tube, malposition of the endobronchial tube, bronchial rupture, hypoxia), lateral positioning (impaired venous return, respiratory impairment, structural injury resulting in nerve injury), pleural cavity insufflation (carbon dioxide embolism, pneumothorax), and hemorrhage. The anesthesiologist can now manage the most difficult patient and solve most problems during MICTS with greater confidence. This presentation focused on these problems and the authors' personal observations and practice based on over 2000 cases are reported.