Clinical application of preserving spontaneous breathing non-intubation anesthesia in thoracoscopic surgery for lung cancer under ERAS concept.

Abstract

To explore the safety and feasibility of thoracoscopic surgery in patients with lung cancer under non-intubation anesthesia, and to evaluate the advantages of the non-intubation anesthesia compared with intubation anesthesia on enhanced recovery after surgery (ERAS). A retrospective cohort study was conducted in which 100 patients who underwent thoracoscopic lung cancer surgery from January 2020 to February 2021 in the Department of Thoracic Surgery of the First Affiliated Hospital of Soochow University were included and divided into non-intubation group (n=50) and intubation group (n=50). The primary outcome was the comparison of intra- and postoperative parameters. Secondary outcomes included inflammatory response indicators and intra- and postoperative complications. There was no significant difference between the two groups in anesthesia effect score, blood loss, lowest pulse oxygen saturation, operation time, postoperative chest tube indwelling time (P>0.05). Non-intubation group had less intraoperative remifentanil dosage, less change of blood pressure and heart rate, lower postoperative pain numerical score(NRS), less medical costs, smaller incidence rate of throat discomfort (P<0.05). The non-intubation group was also associated with less extubation time, postanesthesia care unit recovery time, ambulation time, food intake time, postoperative antibiotic use time, and hospital stay (P<0.05). The increase of C-reactive protein in the non-intubation group was lower than that in the intubation group (P<0.05). Non-intubation anesthesia for thoracoscopic lung cancer surgery is safe and feasible. Compared with the intubation anesthesia, it has advantages in ERAS and reducing medical costs.