During the early twentieth century, thoracic surgery procedures were frequently attempted
through local anesthesia, although the pneumothorax created after opening of the chest wall was
deemed invariably fatal. During the ensuing decades, some surgeons started performing awake thoracic
surgery procedures taking into account the experience matured during the World War I, which
suggested that soldiers with severe open thoracic traumas could eventually survive.
In the 1940s, a multi-step analgesia protocol entailing multiple local blocks with Novocaine was
developed in Russia. Using this technique, hundreds of major thoracic surgery procedures including
major lung resections and esophagectomies, were carried out. Subsequently, Buckingham first reported
on major surgery procedures using sole thoracic epidural anesthesia in awake patients.
The introduction of double-lumen tube ventilation in the 1950s led to the birth of modern thoracic
surgery and general anesthesia with one-lung ventilation is still considered mandatory to allow
accomplishment of more complex surgical procedures including lung resections.
Awake thoracic surgery fell into disuse until recent years when, thanks to the better knowledge of
potential adverse effects of general anesthesia, some surgeons again started to investigate the possibility
of performing thoracic surgery operation in awake patients
Awake thoracic surgery could not have been developed without the previous experience of pioneering
thoracic surgeons. Moreover, continuing technological advances and the increased knowledge in
cardiopulmonary physiology, are leading to a potentially revolutionary strategy capable of minimizing
both surgical and anesthesiological trauma to eventually offer patients comprehensive non-invasive
surgical management.
Keywords: Awake thoracic surgery, history, VATS, local anesthesia, epidural anesthesia.
