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Anesthesia for thoracic ambulatory surgery

Raft, Juliena,b; Richebé, Philippec

Current Opinion in Anesthesiology: December 2019 - Volume 32 - Issue 6 - p 735–742
doi: 10.1097/ACO.0000000000000795
AMBULATORY ANESTHESIA: Edited by Claude Meistelman
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Purpose of review Ambulatory surgery plays a major role in cost-effective patient care without compromising patient safety and satisfaction. This concept improves the patient support and decreases the length of stay sometimes until ambulatory surgery. The aim of this review is to examine the current state of the art of anesthesia for thoracic ambulatory surgery.

Recent findings Guidelines for enhanced recovery after thoracic surgery (ERATS) have recently been published. They can be safely implemented without increasing hospital readmission or mortality. Video-assisted thoracoscopy may be the best approach within a fast-track program. Anesthetic management should focus on combination of regional analgesia and general anesthesia techniques. General anesthesia should be performed with short acting agent and prevention of residual paralysis. Thoracic epidural analgesia is the gold standard technique for pain control after major thoracic surgery but not compatible with a quick hospital discharge. Thoracic paravertebral block, Serratus plane block, intercostal nerve block, and more recently erector spinae plane block have all been used with success for analgesia in thoracic surgery.

Conclusion ERATS program may lead to improved outcomes including decreased length of stay, but it is currently too early to show the impact on thoracic ambulatory surgery that concerned selected patients for lung resection.

aDepartment of Anesthesiology, Institut de Cancerologie de Lorraine, 6 avenue de Bourgogne, 54500 Vandoeuvre-lès-Nancy, France

bINSERM UMR-S 1116 Equipe 2 Université de Lorraine, 9 avenue de la Forêt de Haye, 54500 Vandoeuvre-lès-Nancy, France

cDepartment of Anesthesiology and Pain Medicine, University of Montreal, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l’Assomption Montréal, Quebec H1T 2M4, Canada

Correspondence to Julien Raft, Department of Anesthesiology, Institut de Cancerologie de Lorraine, 6 avenue de Bourgogne, 54500 Vandoeuvre-lès-Nancy, France. Tel: +33 383598453; fax: +33 383598609; e-mail: julien.raft@free.fr

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