Purpose of review
Pneumonectomy has the highest perioperative risk among common pulmonary
resections. The purpose of this review is to update clinicians on the importance of
anesthetic management for these patients.
Two complications associated with increased perioperative mortality are relevant to
anesthetic management: postoperative arrhythmias and acute lung injury. The geriatric
population is particularly at risk for arrhythmias. Adequate preoperative cardiac
assessment and drug prophylaxis may decrease this risk. Patients with decreased
respiratory function are at increased risk for acute lung injury. The use of large tidalvolume
ventilation during anesthesia may increase this risk. There is a trend to better
outcomes in centers with larger surgical volumes.
Patients should have a preoperative assessment of their respiratory function in three
areas: lung mechanical function, pulmonary parenchymal function and cardiopulmonary
reserve. Interventions that have been shown to decrease the incidence of respiratory
complications include cessation of smoking, physiotherapy and thoracic epidural
analgesia. Extrapleural pneumonectomy and sleeve pneumonectomy are surgical
variations that place specific increased demands on the anesthesiologist. The rare but
treatable complication of cardiac herniation must always be remembered as a potential
cause of life-threatening hemodynamic instability in the early postoperative period.
pneumonectomy, pulmonary resection, thoracic anesthesia
Curr Opin Anaesthesiol 22:31–37
2009 Wolters Kluwer Health | Lippincott Williams & Wilkins