Abstract
Background
Thoracoscopic esophagectomy for esophageal cancer performed with single-lumen tracheal tube ventilation in the semi-prone position provides the advantages of easier anesthesia induction; easiness of left-sided recurrent laryngeal nerve lymph node dissection; and shortening of the transit time to laparotomy. The aim of this study was to clarify the surgical safety and anesthetic procedure associated with thoracoscopic esophagectomy with single-lumen tracheal tube ventilation by intraoperative monitoring of respiratory status and hemodynamic changes.
Methods
A total of 30 patients with esophageal cancer who underwent thoracoscopic subtotal esophagectomy at our institute from January 2014 to December 2017 were retrospectively reviewed. Cardiac index (CI), systemic vascular resistance index (SVRI), mean arterial pressure (MAP), partial pressure of oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in arterial blood (PaCO2), end-tidal carbon dioxide pressure (EtCO2), and tidal volume (TV) using FloTrac system were measured.
Results
There were no significant changes in CI, SVRI, and MAP during artificial pneumothorax. Conversely, PaCO2 and EtCO2 gradually increased during artificial pneumothorax (P < 0.05) and decreased to almost their original levels thereafter. Furthermore, progressive reduction in tidal volume was observed in four cases after anti- side pneumothorax due to the injury of the left pleura with lymph node dissection. The mean TV and mean PaO2 were 0.42 L and 229.0 mmHg during artificial pneumothorax, respectively.
Conclusion
There was no exaggerated circulatory or ventilatory depression during artificial pneumothorax in the semi-prone position. Artificial pneumothorax with single-lumen tracheal tube ventilation in thoracoscopic subtotal esophagectomy may be a reliable anesthetic procedure. However, further examinations in the future will be necessary to determine its safety.
Disclosure
All authors have declared no conflicts of interest.
Videolaryngoscope‐assisted flexible intubation tracheal tube exchange in a patient with a difficult airway