Awake thoracic surgery--is it worth the trouble?

Awake thoracic surgery is performed by regional anesthesia techniques in spontaneously breathing, fully conscious patients to avoid side-effects of general anesthesia, fasten recovery, and reduce morbidity, particularly in high-risk patients. Results of ongoing experience are promising, and this novel surgical approach has been successfully applied to several thoracoscopic procedures, including management of pleural effusion, wedge resections, lung volume reduction surgery, bullectomy, and thymectomy. In this article, the historical background, main pathophysiology features of the surgical pneumothorax, and the various regional anesthesia techniques as well as reported results are reviewed and critically discussed.