Abstract

BackgroundOne-lung ventilation under general anesthesia is necessary for thoracic surgery, but this procedure is often difficult in surgery for patients with cardiopulmonary failure. Non-intubated video-assisted thoracic surgery (VATS) is performed under local anesthesia for patients with respiratory failure, but has not been performed for patients with circulatory failure. Here, we report management of two patients with cardiopulmonary failure who underwent non-intubated VATS with paravertebral block and infiltration anesthesia.Case presentationCase 1 was a 79-year-old male with dyspnea at rest due to left large pleural effusion and cardiac dysfunction who underwent thoracoscopic pleural biopsy with paravertebral block under spontaneous breathing. The patient was also receiving dialysis. Case 2 was a 53-year-old male who developed empyema due to large pleural effusion, resulting in a poor general condition and cardiac dysfunction, and underwent video-assisted empyema curettage only with infiltration anesthesia under spontaneous breathing. In both patients, intraoperative respiration and circulation remained stable with values similar to those present preoperatively, and there were no problems after surgery.ConclusionsWe safely anesthetized two patients with difficulty to general anesthesia by ensuring sufficient regional anesthesia during VATS under spontaneous breathing. These cases suggest that regional anesthesia for non-intubated VATS can contribute to maintain intra- and postoperative respiration and circulation in patients with cardiopulmonary failure.

Highlights

  • One-lung ventilation under general anesthesia is necessary for thoracic surgery, but this procedure is often difficult in surgery for patients with cardiopulmonary failure

  • We safely anesthetized two patients with difficulty to general anesthesia by ensuring sufficient regional anesthesia during video-assisted thoracic surgery (VATS) under spontaneous breathing. These cases suggest that regional anesthesia for non-intubated VATS can contribute to maintain intra- and postoperative respiration and circulation in patients with cardiopulmonary failure

  • Non-intubated VATS performed under local anesthesia has fewer risks for pulmonary disorder caused by general anesthesia, such as barotrauma and

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Summary

Conclusions

We safely performed non-intubated VATS in combination with PVB and infiltration anesthesia in two patients with respiratory and hemodynamic failure. Regional anesthesia techniques in non-intubated VATS are likely to be useful for patients with respiratory failure and circulatory failure, but accumulation of more case reports is necessary for establishment of evidence for the efficacy of this approach

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