**Author details**

January Tsai, Teresa Moon, Shital Vachhani, Javier Lasala, Peter H Norman and Ronaldo Purugganan\*

\*Address all correspondence to: rpurugga@mdanderson.org

Department of Anesthesia and Perioperative Medicine, Division of Anesthesia and Critical Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

### **References**


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**•** Neuraxial techniques are best avoided

34 Principles and Practice of Cardiothoracic Surgery

**•** Unknown risk of spinal hematoma

patient safety and surgical outcomes.

The challenges of thoracic anesthesia are unique among all anesthetic subspecialties. Its practitioners must be well-versed in a wide range of anesthetic management principles, from advanced airway techniques to ventilations strategies and pain management. The two subspecialties of thoracic surgery and thoracic anesthesia continue to co-evolve to improve

Department of Anesthesia and Perioperative Medicine, Division of Anesthesia and Critical

[1] BTS guidelines: guidelines on the selection of patients with lung cancer for surgery‐

[2] Slinger, P. Update on anesthetic management for pneumonectomy. Curr Opin An‐

[3] Brunelli, A, & Rocco, G. Spirometry: predicting risk and outcome. Thorac Surg Clin.

[4] Nakahara, K, Ohno, K, Hashimoto, J, Miyoshi, S, Maeda, H, Matsumura, A, et al. Pre‐ diction of postoperative respiratory failure in patients undergoing lung resection for

January Tsai, Teresa Moon, Shital Vachhani, Javier Lasala, Peter H Norman and

Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Thorax. [Guideline Practice Guideline]. (2001). Feb;, 56(2), 89-108.

lung cancer. Ann Thorac Surg. (1988). Nov;, 46(5), 549-52.

\*Address all correspondence to: rpurugga@mdanderson.org

aesthesiol. [Review]. (2009). Feb;, 22(1), 31-7.

[Review]. (2008). Feb;, 18(1), 1-8.

**8.** Fondaparinux

**5. Conclusion**

**Author details**

Ronaldo Purugganan\*

**References**

**•** Factor Xa inhibitor


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**Chapter 2**

**Evolution of Surgical Approaches for Lung Resection**

Early surgical interventions were highly morbid, painful and deadly. Understanding of antisepsis, after Lister's first report in 1867 and development of anesthetic techniques, in particular chloroform and ether made way for early successful surgical intervention. Thoracic surgery and lung resection, however, proved more difficult to advance than other surgical specialties due to the problem of pneumothorax. The principles of intra-thoracic and intrapleural surgery developed during the early 20th century with significant progress in a short

Lung surgery prior to the late 1800's was largely rare reports of draining deep abscesses, resecting prolapsing gangrenous tissue after trauma and resecting portions of the chest wall with small segments of accompanying lung. Tuffier performed the first partial lung resection that consisted of placing a ligature on the lung, excising and suturing the lung to the perios‐ teum.[1], [2] Initial works demonstrating the feasibility of lung resection came from extensive animal experimentation. Block of Danzig described many lung resections in rabbits and dogs. The animals survived surgery and returned to health. The problem of pneumothorax however plagued the operative and the post-operative period. Positive pressure ventilation was not immediately seen as a solution to advance intra-thoracic surgery and those who did use it were divided between the use of face-masks, intra-pharyngeal and endotracheal insufflation. Sauerbruch, in Germany, with the support of the internationally acclaimed Von Mikulicz, persisted for many years operating in expensive negative pressure chambers. He pioneered the first tank ventilator in 1907, allowing surgeons to operate on an open thorax with the patient's head and anesthesiologist literally in another room. Surgery in the US, less hindered by the negative pressure camp, was quicker to adopt endotracheal intubation, the use of bellows and ultimately endobronchial lung isolation ventilation. Negative pressure was used extensively however and persisted through the polio epidemic until the late 1930's.[2], [3]

> © 2013 Williams and Vigneswaran; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

> © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

and reproduction in any medium, provided the original work is properly cited.

Trevor Williams and Wickii T. Vigneswaran

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/56641

**1. Introduction**

time.

