Anesthesia for Pleural Space Procedures

A variety of conditions can involve the pleural space that may require surgical intervention. Diseases that involve the pleura include pleurisy, pneumothorax, pleural effusion, hemothorax, chylothorax, empyema, and pleural tumors, as well as alveolopleural or bronchopleural fistula. Surgical interventions for treatment of pleural diseases include catheter drainage, debridement, decortication, pleurodesis, and thoracic duct ligation or repair of bronchopleural or alveolopleural fistula. Aside from overall patient assessment and workup, the preanesthetic evaluation should focus on cardiopulmonary risks to determine patients’ tolerance to one-lung ventilation. Anesthetic plan typically includes general anesthesia with or without one-lung isolation techniques. There are specific cases that may benefit from awake anesthetic techniques in order to allow maintenance of spontaneous ventilation. Most patients undergoing surgery for pleural disease can be extubated at the end of the procedure unless their cardiopulmonary status is rather tenuous. Postoperative analgesia is best addressed through a multimodal approach with certain cases benefiting from epidural or paravertebral analgesia.