Awake Thoracic Surgery

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Awake thoracic surgery is a new surgical field that is set to expand in the near future. Employing sole epidural or local anaesthesia in fully awake patients renders many thoracic surgical procedures ...
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Anesthesia Techniques in Awake Thoracic Surgery

Pp. 44-73 (30)

Mario Dauri, Sarit Nahmias, Ludovica Celidonio, Elisabetta Sabato, Maria Beatrice Silvi and Eleonora Fabbi


In order to avoid the adverse effects of general anesthesia in patients undergoing thoracic surgery procedures and to allow surgical treatment for those patients considered at high-risk for general anesthesia because of their compromised medical conditions, some anesthesiological techniques can be employed to perform awake thoracic surgery.

In this chapter we describe three different anesthesiological techniques which can be performed successfully in this setting.

Our favourite technique is Thoracic Epidural Anesthesia (TEA), which can be chosen for most awake thoracic procedures. This technique offers a sympathetic block that decreases stress response to surgery, positively affecting the cardiovascular system, gastrointestinal function and postoperative pulmonary function. Furthermore, it provides excellent postoperative analgesia.

Thoracic paravertebral block is another technique that can offer effective intraoperative and postoperative management of surgical pain. It has a better side-effects profile and lower complication rate compared with TEA, but so far, it has not often been used as a sole anesthetic method for thoracic surgery.

Local anesthesia as a sole technique can also represent a valid method for minor thoracic surgery procedures.


Thoracic epidural anesthesia, local anesthesia, paravertebral anesthesia, thoracic surgery.


Department of Anesthesiology and Intensive Care, Policlinico Tor Vergata University, Rome, Italy.