Recommendations from the Italian intersociety consensus on Perioperative Anesthesia Care in Thoracic surgery (PACTS) part 1: preadmission and preoperative care

Abstract

Introduction Anesthetic care in patients undergoing thoracic surgery presents specific challenges that necessitate standardized, multidisciplionary, and continuously updated guidelines for perioperative care. Methods A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, comprising 24 members from 19 Italian centers, was established to develop recommendations for anesthesia practice in patients undergoing thoracic surgery (specifically lung resection for cancer). The project focused on preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and PubMed and Embase literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventative Services Task Force criteria. Results Recommendations for preoperative care focus on risk assessment, patient preparation (prehabilitation), and the choice of procedure (open thoracotomy vs. video-assisted thoracic surgery). Conclusions These recommendations should help pulmonologists to improve preoperative management in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.

Thoracic Anesthesia during the COVID-19 Pandemic: 2021 Updated Recommendations by the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) Thoracic Subspecialty Committee

“…We electronically searched specialist thoracic anesthesia societies’ and groups’ previous recommendations on the perioperative management principles for patients with potential SARS-CoV-2 infection focusing on unique aspects of thoracic anesthesia. 5 , 6 , 7 , 8 , 9 …”

“…We electronically searched specialist thoracic anesthesia societies' and groups' previous recommendations on the perioperative management principles for patients with potential SARS-CoV-2 infection focusing on unique aspects of thoracic anesthesia. [5][6][7][8][9] C. The thoracic subcommittee of EACTIC has performed a survey exploring changes in clinical practice occurring during the COVID-19 era to better understand how practice has evolved and to aid development of further general recommendations on the perioperative management of patients with ‗suspected' or ‗diagnosed' COVID-19 undergoing thoracic surgery (unpublished). This survey included a 36-item questionnaire to explore the changes in daily practice during the COVID-19 pandemic, emphasizing the general aspects of anesthesia, airway management and lung isolation, ventilation, and postoperative analgesia.…”

Special Anesthesiologic Considerations in Robot-Assisted Thoracic Surgery

“…In most RATS interventions, multimodal analgesics combined with local anesthesia of the surgical incisions are considered sufficient for pain control [32,22]. Intercostal nerve blockade and submuscular analgesic depositories may be applied additionally [33,34]. Especially patients with an increased surgical likelihood for conversion to thoracotomy should be counselled very differentiated.…”

“…Preexisting comorbidities should be controlled, and modifiable risk factors and medications should be optimized before surgery [24,33]. To minimize postoperative pulmonary complications and impaired wound healing, smoking cessation should be encouraged as far in advance as possible [5••, 33].…”

Intraoperative Strategien für die Ein-Lungen-Ventilation

“…Die klinischen Auswirkungen der Wahl des Anästhetikums bei thoraxchirurgischen Patienten sind unklar, da sich bisher veröffentlichte Studien im Design deutlich unterscheiden und zu widersprüchlichen Ergebnissen führten [81]. Es wurde vorgeschlagen, dass nur Patienten mit einem erheblichen chirurgischen Trauma (z.…”