Survey of Thoracic Anesthetic Practice in Italy

https://doi.org/10.1053/j.jvca.2013.03.026Get rights and content

Objective

The object of this study was to conduct and analyze the output of a survey involving a cohort of all Italian hospitals performing thoracic surgery to gather data on anesthetic management, one-lung ventilation (OLV) management, and post-thoracotomy pain relief in thoracic anesthesia.

Design

Survey.

Setting

Italy.

Participants

An invitation to participate in the survey was e-mailed to all the members of the Italian Society of Anesthesia and Intensive Care Medicine.

Intervention

None.

Measurements and Main Results

A total of 62 responses were received from 47 centers. The key findings were: Double-lumen tube is still the first choice lung separation technique in current use; pressure-controlled ventilation and volume-controlled ventilation modes are homogenously distributed across the sample and, a tidal volumes (VT) of 4-6 mL/kg during OLV was preferred to all others; moderate or restrictive fluid management were the most used strategies of fluid administration in thoracic anesthesia; thoracic epidural analgesia represented the “gold standard” for post-thoracotomy pain relief in combination with intravenous analgesia.

Conclusion

The results of this survey showed that Italian anesthesiologist follow the recommended standard of care for anesthetic management during OLV.

Section snippets

Methods

The survey was endorsed by the Italian Society of Anesthesia and Intensive Care Medicine (SIAARTI). To obtain an overview of thoracic anesthesia clinical practices in Italy, an invitation to participate in the survey was e-mailed to all SIAARTI members. All participating anesthesiologists were informed about the study aims and methodology to ensure they understood the study context. Respondents were asked to indicate 1 or more (when necessary) reply options in response to each question and to

Results

Thoracic surgery in Italy currently is performed in a total of 92 centers. Sixty-two responses were received from a total of 47 hospitals, located across 16 geographic regions of Italy (21 hospitals across the 5 northern regions, 10 hospitals across the 4 central regions and 16 hospitals across the 7 southern regions). The proportion of centers represented 51% of the overall potential respondents. Eighteen centers (38.5%) were university hospitals and 29 (61.5%) non-university hospitals (Fig. 1

Airway Management

Most centers (96%) used a DLT as the lung separation technique of choice for “routine” thoracotomy. Two centers (4%) reported the sole use of BB. Forty-one centers (91%) indicated the use of both left and right DLTs in surgical thoracic procedures. Four (9%) indicated the sole use of left-sided double-lumen tubes.

Thirty-six centers (76.5%) also reported the use of bronchial blockers in their thoracic anesthetic practice. Nine of these centers (25%) did not indicate their choice of device, while

Discussion

The main findings of the present survey of Italian anesthetic management in thoracic anesthesia were: DLT was still the first-choice lung separation technique, PCV and VCV ventilator modes were homogenously distributed across the sample and a VT of 4-6 mL/kg during OLV was preferred to all others, moderate or restrictive fluid management were the most used strategies of fluid administration in thoracic anesthesia, and TEA represented the “gold-standard” technique for post-thoracotomy pain

Conclusions

This survey described the current situation concerning Italian anesthetic management, OLV management and pain relief during and after thoracic surgery. According to the results, Italian anesthesiologists consider a left-side double-lumen tube the best device for performing OLV during thoracic surgery. New devices, especially bronchial blockers, still are not popular and probably are applied only when their advantages are clear. “Low”-tidal-volume ventilation managed with pressure-controlled

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