Airway Management in Thoracic Anesthesia

Abstract

This article is the third in a series of articles prepared as part of a comprehensive, international and professional society-approved consensus project to advise on thoracic anesthesia. It represents the views and structured opinions of experts delegated to the Airway Management Task Force of the Thoracic Subcommittee of the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC). This review highlights the main concepts and expert opinion of international leaders on the task of lung isolation and separation, as well as the current recommendations on the benefits and disadvantages of different devices in both routine and difficult airway scenarios. The consensus statement addresses the following main clinical topics and questions: (1) What are the overall goals and means of lung isolation and separation? (2) What are the best practices for using double-lumen tubes? (3) What is the role of alternative devices, specifically bronchial blockers? (4) What are the best practices for managing a difficult airway? (5) What are the recommendations for special cases? (6) What are the research priorities for thoracic anesthesia regarding airway management? The authors conclude with a brief reference to how these recommendations relate to the concepts of good clinical practice and enhanced recovery. The document was developed and formally evaluated by senior clinicians representing the core membership of the EACTAIC Thoracic Subcommittee from Europe, the United States, Africa, and the Middle East. Although the high-level evidence base is generally limited and significant controversies remain, all recommendations of the Task Force achieved an agreed (>60%), strong (>80%), or sometimes full (>95%) consensus. This consensus should serve as a consolidation of diverse practices of thoracic anesthesia and a starting point toward obtaining stronger evidence to further enhance our clinical practice in the future.

Keywords: bronchial blocker; difficult airway; double-lumen tube; flexible fiberoptic/video bronchoscopy; minimally invasive thoracic surgery; one-lung ventilation.