Anesthesia

Given the increasing numbers of complex and high risk patients requiring thoracic surgery, awake thoracic surgery (ATS) could be an option in frail patients especially those with high risks for ventilator dependency to reduce morbidity and mortality. Several papers conclude that ATS was superior to surgery under general anaesthesia in terms of reduced operating room time, better perioperative outcomes, reduced incidence of postoperative respiratory infections and acute respiratory distress syndrome, lower mortality rate, generally less complications, less need for nursing care, lower costs and shorter hospital stays. ATS may allow a fast-track protocol avoiding the intensive care unit. In spite of its benefits, ATS is ethically still widely debated and therefore there remains an urgent need to provide more evidence base medical facts to the current discussion. ATS is technically extremely challenging for the anesthesiologist and requires careful patient selection, thorough anesthetic preparation, high vigilance during the perioperative period, knowledge about potential perioperative difficulties and management of its complications.