title: Surgical pneumothorax under spontaneous ventilation-effect on oxygenation and ventilation.
abstract: Surgical pneumothorax allows obtaining comfortable surgical space for minimally invasive thoracic surgery, under spontaneous ventilation and thoracic epidural anesthesia, without need to provide general anesthesia and neuromuscular blockade. One lung ventilation (OLV) by iatrogenic lung collapse, associated with spontaneous breathing and lateral position required for the surgery, involves pathophysiological consequences for the patient, giving rise to hypoxia, hypercapnia, and hypoxic pulmonary vasoconstriction (HPV). Knowledge of these changes is critical to safely conduct this type of surgery. Surgical pneumothorax can be now considered a safe technique that allows the realization of minimally invasive thoracic surgery in awake patients with spontaneous breathing, avoiding the risks of general anesthesia and ensuring a more physiological surgical course.
authors.affiliation: 1 Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata-Chair of Anesthesia and Intensive care, Rome, Italy ; 2 Department of Biomedicine and Prevention, University of Rome Tor Vergata-Chair of Thoracic Surgery, Rome, Italy ; 3 Department of Anesthesia and Intensive Care Medicine, Policlinico Tor Vergata University, Rome, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: David
authors.affiliation: 1 Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata-Chair of Anesthesia and Intensive care, Rome, Italy ; 2 Department of Biomedicine and Prevention, University of Rome Tor Vergata-Chair of Thoracic Surgery, Rome, Italy ; 3 Department of Anesthesia and Intensive Care Medicine, Policlinico Tor Vergata University, Rome, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Pompeo
authors.affiliation: 1 Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata-Chair of Anesthesia and Intensive care, Rome, Italy ; 2 Department of Biomedicine and Prevention, University of Rome Tor Vergata-Chair of Thoracic Surgery, Rome, Italy ; 3 Department of Anesthesia and Intensive Care Medicine, Policlinico Tor Vergata University, Rome, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Fabbi
authors.affiliation: 1 Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata-Chair of Anesthesia and Intensive care, Rome, Italy ; 2 Department of Biomedicine and Prevention, University of Rome Tor Vergata-Chair of Thoracic Surgery, Rome, Italy ; 3 Department of Anesthesia and Intensive Care Medicine, Policlinico Tor Vergata University, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Dauri
keywords: Pneumothorax; awake thoracic surgery; lateral position; minimally invasive surgery; nonintubated thoracic surgery; one lung ventilation (OLV); spontaneous ventilation