Abstract

BackgroundVideo-assisted thoracoscopic surgery (VATS) is usually performed under general anesthesia with a double-lumen tube. Recently, VATS without tracheal intubation in a patient with severe respiratory dysfunction has been reported. A case of nonintubated (also known as awake or tubeless) VATS using adaptive servo ventilation (ASV), a form of noninvasive positive pressure ventilation providing varying amounts of ventilator support, is presented. This is the first report of nonintubated VATS using ASV.Case presentationA 60-year-old woman was scheduled for VATS bullectomy for the treatment of pneumothorax. She had severe respiratory dysfunction and had been receiving ASV therapy because of type 2 respiratory failure. Thus, nonintubated VATS using ASV, epidural anesthesia, and dexmedetomidine were selected. When surgical pneumothorax was created by incision of the pleura, her respiratory status remained stable. In addition, lung collapse was easily induced at operation. The leaking bulla was easy to identify, and bullectomy was performed. During surgery, she continued spontaneous breathing and did not complain of pain or discomfort. She was transferred to the intensive care unit with ASV and discharged on postoperative day 12 with no respiratory complications.ConclusionIt is necessary to maintain a stable respiratory status, as well as adequate analgesia and sedation, during nonintubated VATS in patients with severe respiratory dysfunction. When total lung collapse is not necessary for the surgical procedure, use of ASV would be an effective strategy.

Highlights

  • Video-assisted thoracoscopic surgery (VATS) is usually performed under general anesthesia with a double-lumen tube

  • A case of nonintubated VATS bullectomy for the treatment of pneumothorax using adaptive servo ventilation (ASV), epidural anesthesia, and dexmedetomidine in a patient with severe respiratory dysfunction is presented. This is the first report of nonintubated VATS using ASV

  • Our experience indicates that ASV can be successfully used to maintain a stable respiratory status during nonintubated VATS with severe respiratory dysfunction, in combination with epidural anesthesia and dexmedetomidine

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Summary

Conclusion

It is necessary to maintain a stable respiratory status, as well as adequate analgesia and sedation, during nonintubated VATS in patients with severe respiratory dysfunction.

Background
Discussion
Funding Not applicable
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