scholarly journals Converting to Intubation During Non-intubated Thoracic Surgery: Incidence, Indication, Technique, and Prevention

2021 ◽  
Vol 8 ◽  
Author(s):  
Xu-Heng Chiang ◽  
Mong-Wei Lin
Keyword(s):  
Thoracic Surgery ◽  
General Anesthesia ◽  
Conversion Rate ◽  
Thoracoscopic Surgery ◽  
Postoperative Nausea And Vomiting ◽  
Lung Ventilation ◽  
Surgical Team ◽  
One Lung Ventilation ◽  
Large Tumor ◽  
Airway Injury

Traditionally, intubated general anesthesia with one-lung ventilation is standard in thoracoscopic surgery. However, in recent decades, non-intubated thoracoscopic surgery (NITS) has become an alternative method to minimize the adverse effects of intubated general anesthesia. Non-intubated procedures result in fewer adverse events than tracheal intubation and general anesthesia, such as intubation-related airway injury, ventilation-induced lung injury, prolonged hospital stay, and postoperative nausea and vomiting. Despite these benefits, surgeons must consider the possibility of converting to intubation during NITS as the conversion rate is between 2 and 11%, varying between regions and learning time. The conversion rate is also affected by race, body size, the learning curve, and the surgical team's preferred methods. There are surgical (e.g., significant respiratory movements, uncontrolled bleeding, hindered surgical fields, large tumor sizes, adhesions) and anesthetic (e.g., hypoxemia, hypercapnia, airway spasms) reasons for converting to intubation. When a conversion is deemed necessary by the surgical team, the members should be well-prepared and act rapidly. Anesthesiologists should also feel comfortable intubating patients in the lateral decubitus position with or without bronchoscopic guidance. Patient selection is the key factor for avoiding conversion into an intubated surgery. Patients with an American Society of Anesthesiologists grade 2 or less, a body mass index <25, and less surgical complexity may be good candidates for NITS. Careful monitoring, adequate anesthesia depth, an experienced surgical team, and sufficient preparation can also prevent conversion. Conversion from a non-intubated into intubated thoracic surgery is unwanted but not inevitable. Therefore, NITS can be successful when performed on select patients by a well-prepared and experienced surgical team and is worthy of recommendation owing to its non-invasiveness.

scholarly journals May awake video-assisted thoracoscopic surgery with thoracic epidural anesthesia use routinely for minimaly invasive thoracic surgery procedures in the future?

2018 ◽  
Vol 5 (5) ◽  
pp. 1602
Author(s):  
Gonul Sagiroglu ◽  
Fazli Yanik ◽  
Yekta A. Karamusfaoglu ◽  
Elif Copuroglu
Keyword(s):  
Thoracic Surgery ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Thoracoscopic Surgery ◽  
Lung Ventilation ◽  
Thoracic Epidural Anesthesia ◽  
One Lung Ventilation ◽  
Thoracic Epidural ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Background: In the last years thoracic surgery developed in greater extent with equipments and techniques in one lung ventilation. Still general anesthesia in one lung ventilation approved as gold standard. In thoracic surgery most performed surgeries are plerural decortication and lung biopsy. Avoidance of intubation in Video Assisted Thoracoscopic Surgery (VATS) procedures gains us some advantages in postoperative period; a better respiratory parameters, survival and morbidity mortality rates, reduced hospitalization time and costs, reduced early stress hormone and immune response.  Methods: In this study, we reported our experience of 24 consecutive patients undergoing VATS with Thoracic Epidural Anesthesia (TEA) between December 2015 through July 2016 to evaluate the feasibility, safety and indication of this innovative technique whether it will be a gold standart in thoracic surgeries or not in the future.Results: Operation procedures included wedge resection in 11 (46%) patients (eight of them for pneumothorax, three of them for diagnosis), in 10 (42%) patients pleural biopsy (eight of them used talc pleurodesis), in two (8%) patients air leak control with fibrin glue and in one (4%) patient bilateral thoracal sympathectomy for hyperhidrosis.  We used T4-5 TEA space for 17 (72%) of patients, while we used T4-6 TEA space for 7 (28%) of patients. TEA block reached the desired level after the mean 26.4±4.3 minutes (range 21-34 min). There was no occurrence of hypotension and bradycardia during and after TEA. One (4%) patient required conversion to general anesthesia and tracheal intubation because of significant diaphragmatic contractions and hyperpne. Conversion to thoracotomy was not needed in any patient.Conclusions: We conclude that nVATS procedure with aid of TEA is feasibile and safety with minimal adverse events. The procedure can have such advantages as early mobilization, opening of early oral intake, early discharge, patient satisfaction, low pain level. Nevertheless, there is a need for randomized controlled trials involving wider case series on the subject.

Thoracic surgery

2018 ◽  
Author(s):  
Claire Todd ◽  
Bruce McCormick
Keyword(s):  
Thoracic Surgery ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Bronchopleural Fistula ◽  
Lung Ventilation ◽  
Anaesthetic Management ◽  
Rigid Bronchoscopy ◽  
Stent Insertion ◽  
One Lung Ventilation ◽  
Chest Injuries

This chapter discusses the anaesthetic management of thoracic surgery. It begins with general principles of thoracic surgery, including isolation of the lungs, one-lung ventilation, and providing analgesia for thoracic surgery. Surgical procedures covered include rigid bronchoscopy and bronchial stent insertion, mediastinoscopy, wedge resection, lobectomy, pneumonectomy, thoracoscopy and video-assisted thoracoscopic surgery, drainage of empyema and decortications, lung volume reduction surgery and bullectomy, repair of bronchopleural fistula, pleurectomy and pleurodesis, oesophagectomy, and surgical management of chest injuries.

Thoracic surgery

2021 ◽  
pp. 529-556
Author(s):  
Charlotte Earnshaw ◽  
Kajan Kamalanathan
Keyword(s):  
Thoracic Surgery ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Bronchopleural Fistula ◽  
Lung Ventilation ◽  
Rigid Bronchoscopy ◽  
Stent Insertion ◽  
One Lung Ventilation ◽  
Chest Injuries ◽  
Bronchial Stent

This chapter discusses the anaesthetic management of thoracic surgery. It begins with general principles of thoracic surgery, including isolation of the lungs, one-lung ventilation, and providing analgesia for thoracic surgery. Surgical procedures covered include rigid bronchoscopy and bronchial stent insertion; mediastinoscopy; wedge resection; lobectomy; pneumonectomy; thoracoscopy and video-assisted thoracoscopic surgery (VATS); drainage of empyema and decortications; lung volume reduction surgery and bullectomy; repair of bronchopleural fistula; pleurectomy and pleurodesis; oesophagectomy and surgical management of chest injuries.

Robotic Thoracic Surgery

2019 ◽  
pp. 289-295
Author(s):  
D. Keegan Stombaugh ◽  
Allison Dalton
Keyword(s):  
Thoracic Surgery ◽  
Thoracoscopic Surgery ◽  
Lung Ventilation ◽  
Wound Complications ◽  
One Lung Ventilation ◽  
Double Lumen Endotracheal Tube ◽  
Improved Outcomes ◽  
Surgical Field ◽  
Minimally Invasive Thoracic Surgery ◽  
Video Assisted Thoracoscopic Surgery

Minimally invasive thoracic surgery has improved outcomes, including reduced length of postoperative admission, reduced postoperative pain, shorter postoperative stay, reduced wound complications, reduced blood loss, improved cosmesis, and improved equivalent oncological outcomes compared to traditional thoracotomy. Robotic thoracic surgery (RTS) is an improvement on video-assisted thoracoscopic surgery in that it allows the surgeon a greater degree of freedom with instrument movement and better surgical field visualization. Thoracic insufflation and one-lung ventilation both significantly alter and compromise the patient’s baseline cardiopulmonary physiology. Due to this, adequate preoperative workup, deftness at double-lumen endotracheal tube management, and advanced understanding of how RTS affects cardiopulmonary physiology are essential.

scholarly journals The fraction of Nitrous Oxide in oxygen for facilitating Lung collapse During One-Lung Ventilation with double lumen tube

2020 ◽  
Author(s):  
chao liang ◽  
Yuechang Lv ◽  
Yu Shi ◽  
Jing Cang ◽  
Zhanggang Xue
Keyword(s):  
Nitrous Oxide ◽  
Confidence Interval ◽  
Thoracoscopic Surgery ◽  
Prospective Trial ◽  
Lung Ventilation ◽  
Effective Concentration ◽  
Double Lumen Tube ◽  
Test Results ◽  
Lung Collapse ◽  
One Lung Ventilation

Abstract Backgroud To the best of our knowledge, it is still unclear what is the proper fraction of nitrous oxide(N 2 O) in oxygen(O 2 ) for fast lung collapse. Therefore, we designed this prospective trial to determine the 50% effective concentration (EC 50 ) and 95% effective concentration (EC 95 ) of N 2 O in O 2 for fast lung collapse. Methods We studied 38 consecutive patients undergoing video-assisted thoracoscopic surgery(VATS). The lung collapse score(LCS) of each patient during one lung ventilation was evaluated by the same surgeon. The first patient received 30% N 2 O in O 2 , and subsequent N 2 O fraction in O 2 was determined by the LCS of previous patient using Dixon up-and-down method. The testing interval was set at 10%, and the lowest concentration was 10% (10%, 20%, 30%, 40%, or 50%). The EC 50 and EC 95 of N 2 O in O 2 for fast lung collapse were analyzed using probit test. Results The N 2 O fraction in O 2 at which all patients showed success lung collapse was 50%, according to the up-and-down method. The EC 50 and EC 95 of N 2 O in O 2 for fast lung collapse were 27.7% (95% confidence interval, 19.9%–35.7%) and 48.7% (95% confidence interval, 39.0%–96.3%), respectively. Conclusions In patients undergoing VATS, the EC 50 and EC 95 of N 2 O in O 2 for fast lung collapse were 27.7% and 48.7%, respectively.

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