The role of anaesthesia and enhanced recovery in the future of thoracic surgery

The development of enhanced recovery after surgery (ERAS) for thoracic surgery has created new challenges for the anaesthetist. The preoperative phase is critical not only to identify high-risk patients, but to optimise organ function. An anaesthetic is required which adequately suppresses the surgical stress response, the mainstay of ERAS, but also promotes rapid recovery with minimal side effects. Locoregional anaesthesia is the key. The use of a non-intubated, spontaneous breathing technique may confer some benefits. Effective analgesia is essential to allow early postoperative mobilisation and to reduce complications.