Abstract
Data about the feasibility and safety of thoracoscopic surgery under non-intubated anesthesia and regional block are limited. In this prospective study, 57 consecutive patients scheduled for thoracoscopic surgery were enrolled. Patients were sedated with dexmedetomidine and anesthetized with propofol and remifentanil. Ropivacaine was used for intercostal nerve and paravertebral block. Lidocaine was used for vagal block. The primary outcomes were mean arterial pressure (MAP), heart rate (HR), oxygen saturation, and end-tidal carbon dioxide partial pressure (ETCO2) at T0 (pre-anesthesia), T1 (immediately after laryngeal mask/nasopharyngeal airway placement), T2 (immediately after skin incision), T3 (10 min after opening the chest), T4 (end of surgery), and T5 (immediately after laryngeal mask/nasopharyngeal airway removal). One patient required conversion to intubation, 15 developed intraoperative hypotension, and two had hypoxemia. MAP at T0 and T5 was higher than at T1–T4; MAP at T3 was lower (P<0.05 vs other time points). HR at T0 and T5 was higher (P<0.05 vs other time points). ETCO2 at T2 and T3 was higher (P<0.05 vs other time points). Arterial pH, PCO2, and lactic acid at T1 differed from values at T0 and T2 (P<0.05). The Quality of Recovery-15 (QoR-15) score at 24 h was lower (P<0.05). One patient experienced dysphoria during recovery. Thoracoscopic surgery with regional block under direct thoracoscopic vision is a feasible and safe alternative to conventional surgery under general anesthesia, intubation, and one-lung ventilation.
Highlights
Thoracic surgery has evolved rapidly in recent decades due to the development and refinement of one-lung isolation procedures
These results suggest that non-intubated anesthesia for thoracoscopic surgery was feasible and safe
A small number of previous studies explored the use of non-intubated anesthesia for thoracic surgery, with most of these focusing on epidural anesthesia
Summary
Thoracic surgery has evolved rapidly in recent decades due to the development and refinement of one-lung isolation procedures. Intubated surgery under general anesthesia with one-lung ventilation is recognized as a routine methodology [1]. Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique and is conventionally used in intubated patients under general anesthesia. During VATS, one-lung ventilation can be achieved using a bronchial blocker or a doublelumen tube. Because intubation and general anesthesia are not without risks, there has been increasing interest in the use of thoracic surgery without tracheal intubation to achieve a stable perioperative status and complete the treatment in patients at high risk of complications during intubated general anesthesia. Non-intubated thoracoscopic procedures are feasible and safe for multiple thoracic diseases such as resection of lung parenchyma for pulmonary tumors [2], biopsy of interstitial lung disease [3], bullectomy for pneumothorax [4], decortication for thoracic empyema [5], and excision of mediastinal tumors [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
