Intravenous anesthesia for thoracic procedures

PURPOSE OF REVIEW: The article reviews the rationale for using intravenous anesthesia for thoracic operations, the drugs and equipment required, and the methodology involved. RECENT FINDINGS: Recent studies examining whether total intravenous anesthesia offers a physiological advantage over inhalational anesthesia for thoracic surgery remain inconclusive. Nevertheless, total intravenous anesthesia is preferable for certain thoracic procedures incompatible with effective delivery of inhalational anesthetics. Additionally, total intravenous anesthesia offers advantages in procedures conducted in nonideal environments, such as offsite or austere scenarios. SUMMARY: Total intravenous anesthesia is indicated for procedures in which inhalational anesthetics may not be safely or effectively delivered, including endobronchial procedures using flexible or rigid bronchoscopy and proximal airway-disrupting surgeries. Total intravenous anesthesia may be beneficial in lung volume reduction surgery, lung transplantation and thymectomy. Total intravenous anesthesia is safer and more practical for thoracic procedures performed outside of the operating room, such as offsite locations, military field or impoverished areas of the world. Propofol, dexmedetomidine, ketamine and remifentanil may be used in combination with anesthetic depth monitoring to execute an effective total intravenous anesthesia regimen. Target-controlled infusion may improve the delivery of total intravenous anesthesia and is a focus for future research. This article reviews the balanced total intravenous anesthesia technique currently used at the University of Texas M.D. Anderson Cancer Center.