Thesis (Ph.D.) - Cairo University - National Cancer Institute - Department of Anesthesia and Pain relief

Thoracic procedures are routinely performed under general anesthesia (GA), with one lung ventilation (OLV)and are usually combined with thoracic epidural analgesia. However, GA with OLV may have adverse effects including peri- intubational hypoxia, trauma to the upper airway, mechanical ventilation- induced injuries, impaired cardiac performance, neuromuscular problems, increased risk of pneumonia, and release of proinflammatory mediators. Recently, awake thoracic epidural anesthesia (ATEA) has been used alone in thoracic procedures.The results achieved in early studies have been encouraging. ATEA may eventually provide an alternative method to GA for thoracic proceduresthat would not only eliminate the need for OLV but also facilitate both surgical reconstruction and eventually patient recovery.Recent studies suggested better clinical outcomes with ATEA, including less intraoperative bleeding, a better control of postoperative pain, early mobilization, oral intake tolerance, reduction of surgical stress response, reduction of intraoperative cardiac events, improvement of myocardial flow determinants and left ventricular function, and a reduction of complications including pulmonary, thrombotic and infectious events. Multiple studies evaluated the safety of intravenous ketamine/propofol combination for sedation and analgesia and there is evidence that this

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