1)     RECOMMENDATIONS

a)      General Approach

i)        Control ventilation

(1)   Tidal volume = 10 to 15 ml/kg (5 to 7.5 ml/lb)

(a)    Some quote as high as 20 ml/kg (10 ml/lb)

(2)   Airway pressures

(a)    15 to 20 cm H₂O if closed chest

(b)   20 to 30 cm H₂O if open chest

(3)   Ventilate at 6 to10 breaths per minute to control ventilation

(a)    Reduce to 4 to 6 breaths per minute at end of procedure to increase CO₂ and subsequent respiratory drive

ii)       Epidural analgesics are considered helpful in thoracotomies

iii)     Intercostal nerve blocks with bupivacaine are of substantial benefit to these patients

b)      Pre-anesthetic Medications

i)        Hydromorphone, morphine, or oxymorphone

(1)   Can combine with diazepam IV, midazolam IM, or very low acepromazine or medetomadine doses

c)      Induction

i)         Based upon specific health status of patient

d)      Maintenance

i)        Isoflurane or sevoflurane

e)      Support

i)         Patient should have ECG, Pulse Oximeter, Blood Pressure, and ETCO₂ monitors in place at all times during the procedure

2)     PRECAUTIONS

a)      Pre-anesthetic Medications

i)         Avoid non-reversible agents

b)      Induction

i)        Based upon specific health status of patient

c)      Maintenance

i)         Based upon specific health status of patient

d)      Support

i)        Inadequate postoperative analgesic management may interfere with postoperative patient ventilation, increasing postoperative morbidity