Intraoperative Hypoxia During Thoracic Surgery: What should we do?

One lung ventilation is a common anesthetic technique that is indicated for thoracic surgery either due to pulmonary (Lopectomy, pneumonectomy) or extrapulmonary (oesophygectomy, repair of thoracic aortic aneurysm) indications. Hypoxia is a common problem that is usually encountered during thoracic surgery due to many causes. The understanding of the physiology of lateral decubitus position, shunting and the factors that influence them is of extreme importance to the anesthetist to avoid hypoxia. This review aim at focusing the most common causes of hypoxia during thoracic surgery, highlighting the physiological aspects of lateral decubitus, and to recommend guidelines to avoid and to manage hypoxia if it happens.