Anesthetic technique

General anesthesia, in combination with epidural or regional anesthesia, is the preferred technique. If an epidural is used, it should be placed at the thoracic level (see Chapter 20).

1. General anesthesia can be maintained with volatile anesthetic or total intravenous anesthesia (TIVA).
2. Muscle relaxants are useful adjuncts to general anesthesia. Although surgical exposure does not require muscle relaxation, movement and coughing carry some risk.
3. One-lung ventilation is typically necessary to isolate and collapse the operative lung to provide optimal surgical exposure. This can be achieved with DLT or bronchial blocker as described in the section that follows.
4. Epidural analgesia is an effective method for postoperative pain relief after thoracotomy. The epidural may be used intraoperatively to augment the general anesthetic.