還在學: 胸腔麻醉進展
 

近十年來肺部疾病從診斷、治療與治療目標都發生巨大的改變，麻醉醫師加入的團隊從傳統胸腔外科手術團隊、ERAS團隊，到肺科醫師團隊，在不同團隊中須與外科、影醫部、肺科醫師密切合作，麻醉的目標與所需之精準度日新月異。麻醉團隊的加入能大幅提升相關醫療品質，但也因麻醉目標、工作環境與實際操作的挑戰，進入新的紀元。
胸腔外科手術麻醉的變化:低侵襲性與精準麻醉已成常規。手術上的進展，segmectectomy也日漸增多，但肺部segment的解剖變異很多，麻醉醫師須了解相關的進展。近年來為了精準定位，各類定位也常需麻醉醫師的協助，如CT定位與pheno定位等等。Pheno手術的環境與麻醉目標是不同的，團隊必須充分學習。
肺科麻醉的變化:如在門診、支氣管鏡室也有巨大的進步，可執行各類診斷與治療。因應不同需求，麻醉醫師須增加相關知識、了解麻醉與術式的需求，建立更嚴格的術後照顧常規。
本次將呈現新發展的一些胸腔麻醉方式，都是進行中的發展；在未來十年內，胸腔麻醉仍是最具挑戰性的專科麻醉。

New Challeges of Thoracic Anesthesia

A massive progress has taken place on the diagnosis and treatment on thoracic diseases in recent decade. From thoracotomy to VATS and ERAS, now anesthesiologists are working in many teams including thoracic surgeons, radiologists, and pulmonologists. More challenges for anesthetic team are on group communication, individually precise anesthesia, and team education.
Minimal invasiveness has become gold standard in thoracic operation. Presurgical localization of lung nodules plays the crucial part of precise operation. Therefore, anesthetic planning is affected by different localization and operation such as in Pheno room or CT room.
Multimodal treatment for lung nodules changes the practice of pulmonologists. Bronchoscopy, bronchoscopic EBUS, electromagnetic navigation bronchoscopy, Cone-beam CT, augmented fluoroscopy, transthoracic needle aspiration and even endobronchial cryotherapy brings necessity of brand new anesthetic planning and operation models.
It will be a big jump for management on lung nodules in the coming decade. The challenge on thoracic anesthesia will be far beyond how to provide a perfect operation field.