Anesthesia for thoracic surgery: a survey of UK practice

Abstract

Objective: The authors sought to provide a snapshot of contemporary thoracic anesthetic practice in the United Kingdom and Ireland.

Design: An online survey.

Setting: United Kingdom.

Participants: An invitation to participate was e-mailed to all members of the Association of Cardiothoracic Anaesthetists.

Intervention: None.

Measurements and main results: A total of 132 responses were received; 2 were excluded because they did not originate from the United Kingdom. Values are number (percent). ANESTHETIC TECHNIQUE: The majority of respondents (109, 85%) maintain anesthesia with a volatile anesthetic agent, with a lesser proportion (20, 15%) reporting use of a total intravenous anesthetic technique. The majority of respondents (78, 61%) favor pressure control ventilation over volume control (50, 39%); just under half (57, 45%) report the routine use of positive end-expiratory pressure (median = 5 cmH(2)O [interquartile range (IQR), 4-5]). Fifty-two (40%) respondents report ventilating to a target tidal volume (median = 6 mL/kg [IQR, 5-7]). Most (114, 89%) respondents routinely ventilate with an F(I)O(2) less than 1.0. Thoracic epidural blockade (TEB) is favored by nearly two thirds of respondents (80, 62%) compared with paravertebral block (39, 30%) and other analgesic techniques (10, 8%). Anesthesiologists favoring TEB are significantly less likely to prescribe systemic opioids (17, 21% v 39, 100% [p < 0.001]). Proponents of TEB are significantly more likely to "routinely" use vasopressor infusions both intra- and postoperatively (16, 20% v 0, 0% [p = 0.003] and 28, 35% v 4, 11% [p =0.013], respectively). Most respondents (127, 98%) report a double-lumen tube as their first choice. Many (82, 64%) report "rarely" using bronchial blockers.

Conclusions: The authors hope this survey both provides interest and serves as a useful resource reflecting the current practice of thoracic anesthesia.