Anaesthetic agents for thoracic surgery: what's best?

Purpose Of Review: Pneumonectomy is still associated with a 5% 30-day mortality in a large series involving a variety of anaesthetic agents and techniques.

Recent Findings: As well as the immediate 'anaesthetic' complications of pain, nausea and vomiting and respiratory dysfunction, differences between anaesthetic agents have emerged in systemic inflammation, postoperative cognitive dysfunction, immune suppression and cell signalling after surgery.

Summary: No one anaesthetic agent has emerged as best.

Coronary artery bypass grafting and concomitant excision of chest wall chondrosarcoma.

Coexistence of coronary artery disease and cancer with both requiring surgical treatment at the same time is rare. A 52 year male undergoing elective coronary artery bypass grafting was incidentally discovered to have a large soft tissue mass of variable consistency with cartilaginous elements arising from the right costal margin and adjoining ribs by a broad attachment and protruding into right pleural cavity. Frozen section suggested it to be either a chondrosarcoma or a teratoma.

Efficacy and safety of remifentanil in coronary artery bypass graft surgery: a randomized, double-blind dose comparison study.

Objectives: To compare the efficacy and safety of 3 doses of remifentanil as part of a total intravenous anesthesia technique with low-dose propofol in patients undergoing coronary artery bypass graft (CABG) surgery.

Design: Multicenter, multinational, double-blind, randomized, dose comparison study.

Setting: Nine hospitals in 5 countries.