Thoracic Anesthesiology

The Division of Thoracic Anesthesiology at UCLA provides specialized care for nearly 1,000 thoracic surgery cases each year at the UCLA-affiliated hospitals, including Ronald Reagan Medical Center, Santa Monica Medical Center, the West Los Angeles VA Medical Center, and Olive View-UCLA Medical Center.

In this section, you will find information about:

Our Clinical Practice

Thoracic surgery is distinct from cardiac surgery at UCLA, and focuses on surgical treatment of the lungs, pleura, diaphragm, and esophagus. UCLA’s thoracic surgeons perform a high percentage of lung resections either by video-assisted thoracoscopy (VATS) or with the assistance of a da Vinci surgical robot. Our service routinely provides anesthesia care for:

  • Cervical mediastinoscopy
  • Endobronchial ultrasound-guided (EBUS) biopsy of mediastinal lymph nodes
  • Rigid bronchoscopy
  • Thoracoscopic lung biopsy
  • Segmental lung resection
  • Lobectomy
  • Pneumonectomy
  • Pulmonary decortication
  • Mediastinal mass biopsy and resection
  • Thymectomy
  • Thoracic sympathectomy for treatment of refractory cardiac arrhythmias
  • Esophageal surgery including total esophagectomy
  • Total pleurectomy and decortication for treatment of mesothelioma

As a center of excellence for the treatment of mesothelioma, the UCLA Comprehensive Mesothelioma Program draws patients from a wide geographic area. UCLA is one of the few centers nationally to offer patients the option of surgical pleurectomy and decortication, which spares the lung and offers a significant mortality advantage over extrapleural pneumonectomy. These are challenging and unusual cases in terms of intraoperative and postoperative anesthetic management, and they present a rare opportunity for clinical research. UCLA anesthesiology residents have presented outcomes data about total pleurectomy cases at our annual Scientific Evening and at the 2017 Western Anesthesia Residents’ Conference.

Our busy thoracic service gives faculty members, fellows, and residents the ready opportunity to insert right-sided as well as left-sided double-lumen endotracheal tubes, or bronchial blockers when indicated, and confirm placement with immediate bronchoscopy. Large video monitors overhead and on OR side walls facilitate teaching, and provide a full view of the tracheobronchial tree. Our resident rotation is one of the few to emphasize learning full bronchial anatomy down to the segment level. When UCLA thoracic surgeons perform segmental lung resection, our real-time bronchoscopy guides their final placement of staples across the correct segmental bronchus.

Faculty members in the thoracic division are recognized experts in the field of thoracic anesthesiology. They lecture at national and international meetings, have published peer-reviewed articles and book chapters, and are involved in research and product development to advance the specialty.

Research in Thoracic Anesthesiology

In the basic science arena, our team, in close collaboration with leading research scientists, is studying the mechanism of ventilator-acquired lung injury in the setting of severe lung pathology. Using innovative small-animal models, we are studying the mechanisms by which mechanical ventilation injures animals with pulmonary fibrosis and pulmonary hypertension. The goal is to translate these findings into potential lung-protective interventions that can be evaluated for effectiveness to help patients with these devastating diseases.

In the clinical arena, our team of clinician scientists has pushed the boundaries of understanding the relationship between lung mechanics, disease pathology, and patient anatomy. The quest to implement precision medicine in mechanical ventilation has led us to new discoveries. Utilizing novel technologies, we can define the true relationship between a patient’s predicted body weight and actual lung volumes. Our findings have challenged age-old dogmatic formulas for selecting tidal volumes on purely weight-based variables. We have presented new hypotheses for determining lung-protective precision ventilator settings, and our work has been accepted for publication in Anesthesia & Analgesia. In the future, we hope to expand on these new discoveries with larger, multi-center clinical trials that will evaluate novel lung-protective ventilation strategies for patients with significant lung disease.

In the research and development arena, our division is at the forefront of medical innovation. One new device is a unique dual-lumen endobronchial tube (DLT). Different from all previous DLTs and other lung-isolation devices on the market, this product will help solve the deficiencies of the current gold-standard devices. With patented designs to improve the ease of precise placement, the device is currently undergoing final prototype-phase testing prior to submission for FDA approval. We anticipate that within a few years this device will be in clinical use, helping patients undergoing thoracic surgery and one-lung ventilation, and useful in the setting of critical care as well as in the operating room.

Fellowship Training in Thoracic Anesthesiology

The University of California Los Angeles Invites applications for anesthesiology fellowship positions in Thoracic Anesthesiology. The primary goal of the one-year, non-ACGME fellowship is to prepare participants for the perioperative care of high-acuity patients undergoing thoracic surgery.

The UCLA Thoracic Surgery Program cares for adults and children undergoing complex oncological and non-oncological chest surgery for a full range of diagnostic and treatment objectives. Our program specializes in minimally invasive and robotic-assisted surgery. Important secondary goals of the fellowship include training in perioperative transesophageal echocardiography leading to basic certification, and research opportunities in thoracic anesthesiology. The fellowship also includes advanced training in intensive care medicine, and anesthesia for cardiac surgery and lung transplantation in conjunction with the Division of Cardiothoracic Anesthesiology.

Please send all inquiries to the Fellowship Director:

Nir Hoftman, MD
Clinical Professor
Director, Thoracic Surgery Anesthesiology
Department of Anesthesiology & Perioperative Medicine
nhoftman@mednet.ucla.edu

Please note that a valid California medical license is required by the first day of the fellowship year. For more information, please see: Application Process.

Information for Patients and Families

More information for patients and families may be found in the Patient Information section of our website — please click here.

To learn more about preparing for thoracic surgery, please see these videos:

For information about lung transplantation, please visit the UCLA Lung Transplant web page. The UCLA Cardiothoracic Anesthesiology Division provides anesthesiology care for heart and lung transplant patients.

Our Faculty Team