PURPOSE OF REVIEW: The surgical management of patients partly determines the anesthetic management. A shift has taken place in thoracic surgery, with a large portion of procedures now being performed through a video-assisted thoracoscopic surgery (VATS) approach. This review is intended to provide the anesthesiologist with an update on the management of thoracic surgical patients presenting for VATS. RECENT FINDINGS: Although there are cosmetic and economical advantages to the VATS approach, large randomized controlled trials are still lacking documenting the benefit of VATS versus conventional 'thoracotomy'. The classic division in absolute and relative indications for one-lung ventilation (OLV) should be viewed as antiquated. All VATS procedures represent an indication for OLV. A better classification is to divide the purpose of OLV: separation versus isolation. Treatment for hypoxemia during OLV also needs to be modified. Patient expectations are also different as a minimal invasive approach is often falsely associated with minimal risk. This leads to an additional stress factor imposed upon the anesthesiologist. SUMMARY: Minimal invasive VATS is gaining widespread popularity among our surgical colleagues. The anesthesiologist must recognize the impact that this change in surgical philosophy will have upon the anesthetic management of these complex patients.
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