Intraoperative aspects and complications for the anesthesiologist in the management of patients undergoing thoracic surgery for lung cancer.

Surgery, when feasible, rappresents the treatment of choice for lung cancer. Several problems can come to the attention of the anesthesiologist in relation to the respiratory function with implications in airway control (double-lumen tube for lung collapse required for better surgical exposure of the pulmonary tissue), mechanical and gas-exchange aspects (increase in airway pressure of the dependent lung, increased blood shunt). The effect of these disorders, with no compensatory mechanism (pulmonary hypoxic vasoconstriction) and in the absence of an anesthesiologist (higher FiO2, low tidal volumes, allowing "permissive hypercapnia", CPAP to the non-dependent lung), normal arterial oxygenation (hypoxemia) is impaired. Right heart failure is the major risk particularly in preexisting pulmonary hypertension Supraventricular arrytmias can often occur in case of history of cardiovascular disease, metabolic and mechanical intraoperative alterations (type and duration of surgery, pericardial and autonomic nervous system manipulations). Unusual complications are cardiac herniation and pulmonary re-expansion-edema.