Hensley's Practical Approach to Cardiothoracic Anesthesia

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IV. Thoracic Anesthesia

2. Anesthesia: Airway topicalization with or without sedation, or general anesthesia (vola tile or total intravenous anesthesia, TIVA) with an endotracheal tube (ETT) or a supra glottic airway (SGA), with or without paralysis, depending on additional procedures or interventions 3. Complications: Bronchospasm, laryngospasm, hypercarbia, hypoxemia, pneumothorax, vocal cord trauma or edema, and airway trauma 9

4 5

ESP/MTP

EPI

PVB

Rhomboid m. Erector spinae m.

ICNB

Transverse process

Spinal cord

Latissimus dorsi m.

Vertebral body

External intercostal m. Internal intercostal m. Innermost intercostal m.

Thoracodorsal artery

Serratus anterior m.

SPB

Intercostal nerve

Lateral cutaneous branch of the intercostal nerve

Transverse thoracis m.

Internal thoracic artery

PEC II

Pectoralis minor m.

Sternum

Thoracoacromial artery

Pectoralis major m.

Anterior cutaneous branch of the intercostal nerve

PEC I

TTMP

Copyright © 2024 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. FIGURE 26.2 Chest wall nerve blocks. Coverage of the chest wall can be achieved via various blocks, either in isola tion or in combination, depending on the location of injury, surgery, or pain. Epidural block (EPI), midtransverse process to pleura block (MTP), erector spinae block (ESP), paravertebral block (PVB), serratus plane block (SPB), intercostal nerve block (ICNB), pectoralis nerve block (PEC I and PEC II), and transversus thoracis muscle plane (TTMP) block can all be performed and block progressively more distal nerves. (Courtesy of Julia Scarpa.)