Thoracic Anesthesia Rotation
The University of Virginia Health System is fortunate in having a very active thoracic surgical group performing over 500 procedures a year. About 20 of these are lung transplants, including non-related donor lobe transplants, and 325 are pneumonectomies and lobectomies. We also are involved in the development of bilateral lung volume reduction surgery for the severe emphysematous patient using both open and thoracoscopic approaches. Our surgeons also perform thymectomies, esophagectomies, numerous diagnostic procedures for mediastinal and pulmonary masses, as well as palliative procedures such as pleurodesis, decortications, thoracic chain sympathectomies, intra-bronchial stent placements, and thoracoplasties. Our residents have performed anesthetics for laser surgery and reconstructive surgery of the trachea and bronchi. This translates into an exceptional exposure to a wide variety of patients and an opportunity to hone skills in the management of cancer and end-stage chronic pulmonary lung disease patients both under anesthesia and during the post-operative period.
Our residents become quite experienced with the pre-anesthetic assessment of the patient for thoracic and tracheal surgery, the selection and use of double-lumen endobronchial tubes, bronchial blockers, Univent endotracheal tubes, and the wide variety of thoracic surgical procedures via didactic lectures, case conferences, and case management. We stress understanding the basic pulmonary physiology of mechanical ventilation and its application to one-lung ventilation in the patient with pulmonary disease. Other modes of ventilation such as jet ventilation may be employed in tracheal surgery. Because we are frequently asked by the surgeons to provide an intraoperative evaluation of their lung resection, knowledge of the tracheal and bronchial anatomy and facility with the fiberoptic bronchoscope become essential.
Finally, an extremely important aspect of anesthesia for thoracic procedures is the management of post-operative pain. The pain from a thoracotomy is intense and impacts on the patient’s ability to be extubated, participate in respiratory physiotherapy, and avoid post-operative complications. We are very aggressive in managing pain in this setting with thoracic epidurals, adjunctive medications, and nerve blocks. As a result, our residents become confident and comfortable with all aspects of the perioperative management of the thoracic surgical patient.
Thoracic Rotation Faculty
Randal Blank heads the Thoracic Anesthesia division. Most of the thoracic team is active on both the cardiac anesthesia and thoracic anesthesia rotations.