Spontaneous ventilation in thoracoscopic surgeries(VATS), early experience

Abstract

Introduction Thoracoscopic surgery (VATS) has been an important minimally invasive tool in the hands of experienced surgeons. On a natural progress, anaesthetic support has evolved and become equally less invasive1. Thoracoscopic surgery without tracheal intubation is an emerging treatment modality for a wide variety of thoracic procedures.2 The Key advantage is to avoid the use of muscle relaxants and its related complications in a wide range of patients as well as it can reduce the need for endotracheal intubation and hence airway instrumentation. Methods This audit was a retrospective review of 26 patients underwent VATS with spontaneous breathing general anaesthesia (between March and November 2018). Inclusion criteria:BMI Anaesthetic perspective: All patients received General anaesthesia with induction with Propofol 10 patients, PropofolM 2 single-port techniques). Pain management modalities: 23/ 26 received pre-incision paravertebral block, using anatomical landmark with 2 level single shot of total of 40 ml 0,25% Levobubivacaine provided by anaesthetic team. Additionally, pre-incision wound block and surgical ports with 20 ml Lidocaine 1% Provided by Surgeon. Adjuvant analgesics were used in the form of Morphine i.v, Paracetamol & if not contraindicated Ketorolac i.v. Patients received Morphine IV PCA in the recovery. Results 18 males and 8 females were studied with a mean age of 41 years. Average operative time was 101.3 minutes. Average values of oxygen saturation peak end-tidal carbon dioxide & respiratory rate were 97% and 6.1 KPa and 15 cycles/min respectively. Average recovery Period was 79.9 minutes. Average pain score in the recovery was 3.9, with an average use of 5.2 mg of morphine PCA.Average reocvery PaCo2 of 6.4 KPa. Mean postoperative stay was 4.8 days. Discussion Our initial experience in Glenfield Hospital showed that Spontaneously Breathing Thoracic Surgical procedure is feasible and safe with Careful patient selection and Multi-disciplinary collaboration between anaesthetists, surgeons and theatre team.