TY - JOUR AU - Umari, Marzia AU - Falini, Stefano AU - Segat, Matteo AU - Zuliani, Michele AU - Crisman, Marco AU - Comuzzi, Lucia AU - Pagos, Francesco AU - Lovadina, Stefano AU - Lucangelo, Umberto PY - 2018 TI - Anesthesia and fast-track in video-assisted thoracic surgery (VATS): from evidence to practice JF - Journal of Thoracic Disease; Vol 10, Supplement 4 (March 09, 2018): Journal of Thoracic Disease (Enhanced Recovery Pathways in Thoracic Surgery from Italian VATS Group) Y2 - 2018 KW - N2 - In thoracic surgery, the introduction of video-assisted thoracoscopic techniques has allowed the development of fast-track protocols, with shorter hospital lengths of stay and improved outcomes. The perioperative management needs to be optimized accordingly, with the goal of reducing postoperative complications and speeding recovery times. Premedication performed in the operative room should be wisely administered because often linked to late discharge from the post-anesthesia care unit (PACU). Inhalatory anesthesia, when possible, should be preferred based on protective effects on postoperative lung inflammation. Deep neuromuscular blockade should be pursued and carefully monitored, and an appropriate reversal administered before extubation. Management of one-lung ventilation (OLV) needs to be optimized to prevent not only intraoperative hypoxemia but also postoperative acute lung injury (ALI): protective ventilation strategies are therefore to be implemented. Locoregional techniques should be favored over intravenous analgesia: the thoracic epidural, the paravertebral block (PVB), the intercostal nerve block (ICNB), and the serratus anterior plane block (SAPB) are thoroughly reviewed and the most common dosages are reported. Fluid therapy needs to be administered critically, to avoid both overload and cardiovascular compromisation. All these practices are analyzed singularly with the aid of the most recent evidences aimed at the best patient care. Finally, a few notes on some of the latest trends in research are presented, such as non-intubated video-assisted thoracoscopic surgery (VATS) and intravenous lidocaine. UR - https://jtd.amegroups.org/article/view/18635