Awake video-assisted thoracic surgery resection of lung nodules

Thoracic surgery in awake patients incorporates newer technologies that require the thoracic surgeons to update their skills and evolve their methodologies. For the thoracic surgeon, awake surgery implies effective communication skills in order for the patients to be, at the same time, collaborative and fully aware of potential risks. In addition, a proper selection of the right procedure for the right patient and a close collaboration with the anesthesiologists to ensure adequate analgesia are necessary well as patient satisfaction with regard to the anesthetic conduct throughout the procedure. The challenge of providing adequate anesthetic care to an awake patient candidate to lung resection requires more than careful evaluation of the entire anesthetic management. This coordinated teamwork should implement a protocol for awake procedures that includes description of indications and contraindications, exclusion criteria, patient consent-form, psychological support for patients, the most appropriate anesthetic technique for the surgical procedure, and criteria for conversion to general anesthesia.