Airway management in thoracic anesthesia in the light of the guidelines of EACTAIC-thoracic group: what is next?

Purpose of review This article reviews the latest literature and discusses future guidance on airway management in thoracic surgery. Recent findings It has been recommended for the preoperative assessment to use validated scales such as the Airway Risk Index combined with tools for predicting difficult lung isolation, especially in patients with chronic obstructive pulmonary disease, endobronchial tumors, or tracheal pathology. Preoperative imaging plays a crucial role in predicting and planning lung isolation in thoracic anesthesia, with computed tomography (e.g. three-dimensional reconstructions and virtual bronchoscopy) being very useful for identifying airway abnormalities and guiding the selection of appropriate lung isolation devices. One of the most reliable methods to achieve lung collapse with a bronchial blocker is the apnea-disconnection for improvate nonventilated lung collapse. Recent studies suggest that the adoption of videolaryngoscopes in thoracic surgery procedures involving double-lumen endotracheal intubation may enhance patient safety and outcomes by reducing the incidence of malpositioned tubes. In addition, the development of double-lumen tubes with integrated cameras enables real-time visualization of tube positioning, a growing trend that may partially replace conventional bronchoscopy. Summary The field of airway management is constantly evolving, with new technologies and techniques emerging regularly, improving patient safety, reducing the risk of complications, and enhancing surgical conditions.