scholarly journals Non-intubated Thoracoscopic Surgery—Pros and Cons

2021 ◽  
Vol 8 ◽  
Author(s):  
Miroslav Janík ◽  
Peter Juhos ◽  
Martin Lučenič ◽  
Katarína Tarabová
Keyword(s):  
Endotracheal Intubation ◽  
Pulmonary Resection ◽  
Surgical Stress ◽  
Thoracoscopic Surgery ◽  
Lung Ventilation ◽  
Minimal Risk ◽  
Intravenous Anesthesia ◽  
Residual Neuromuscular Blockade ◽  
Airway Injury ◽  
Airway Trauma

Pulmonary resection by video-assisted thoracoscopic surgery with single-lung ventilation has become a standardized modality over the last decades. With the aim to reduce surgical stress during operation procedures, some have adopted a uniportal approach in pulmonary resection as an alternative to multiportal VATS. The ERAS program has been widely spread to achieve even better outcomes. In 2004, Pompeo reported the resection of pulmonary modules by conventional VATS under intravenous anesthesia without endotracheal intubation. Within less than a decade thereafter, complete VATS pulmonary resections under anesthesia without endotracheal intubation had been reported for a range of thoracoscopic procedures. Avoiding tracheal intubation under general anesthesia can reduce the incidence of complications such as intubation-related airway trauma, residual neuromuscular blockade, ventilation-induced lung injury, impaired cardiac performance, and postoperative nausea. Numerous studies can be found especially from Asian countries, focusing on comparison of intubated and non-intubated procedures showing that non-intubated VATS could reduce the rate of postoperative complications, shorten hospital stay and decrease the perioperative mortality rate, indicating that non-intubated VATS is a safe, effective and feasible technique for thoracic disease. However, if we look closely at all studies, it is obvious that there are no significant differences between intubated and non-intubated surgery in terms of the standard procedures and maneuvers. In non-intubated procedures it can be less comfortable for the surgeon to manipulate in the thoracic cavity, but the procedural steps remain the same. All the differences between the intubated and non-intubated operation procedure are found in perioperative management of the patient. The patient is still in deep anesthesia during the procedure and hypecapnia can occur. It is easier to manage this if the patient is intubated. In addition, if a complication occurs during the operation and intubation is required, this can cause an emergent situation, which means that not all patients are suitable for such a procedure, especially those with severe emphysema, obese patients and those with a problematic oropharyngeal configuration-Mallampati score. Moreover, studies on non-intubated thoracic surgery point to shortened hospitalization, faster recovery etc. But there are also studies on intubated uniportal VATS procedures in combination with ERAS protocol showing shortened hospitalization and better outcome for patients. Currently, especially with the use of optical intubation canylas, totally intravenous anesthesia (TIVA), BIS and relaxometer, anesthesia is safe for avoiding airway injury, hypercapnia, and there is minimal risk of residual curarization as well as one of the postoperative lung complications such as microaspiration and atelectasis. In addition, the patient recovers rapidly from anesthesia and can be verticalised and mobilized a couple of hours after the operation. It is desirable to take into consideration what type of patient and what lung disease is suitable for non-intubated technique and what is more convenient for intubation.

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 Non-intubated video-assisted thoracoscopic surgery for pulmonary resection in children

2021 ◽  
pp. 102015
Author(s):  
Sira Laohathai ◽  
Chompunoot Pathonsamit ◽  
Daranee Isaranimitkul ◽  
Pornsiri Wannadilok ◽  
Sujaree Poopipatpab ◽  
...  
Keyword(s):  
Pulmonary Resection ◽  
Thoracoscopic Surgery ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

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.

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.

Problems with CPAP during one-lung ventilation in thoracoscopic surgery

1998 ◽  
Vol 12 (2) ◽  
pp. 239 ◽  
Author(s):  
John Bailey ◽  
Maged Mikhail ◽  
Steven Haddy ◽  
Duraiyah Thangathurai
Keyword(s):  
Thoracoscopic Surgery ◽  
Lung Ventilation ◽  
One Lung Ventilation

scholarly journals Effects of Dexmedetomidine Infusion on Inflammatory Responses and Injury of Lung Tidal Volume Changes during One-Lung Ventilation in Thoracoscopic Surgery: A Randomized Controlled Trial

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Chun-Yu Wu ◽  
Yi-Fan Lu ◽  
Man-Ling Wang ◽  
Jin-Shing Chen ◽  
Yen-Chun Hsu ◽  
...  
Keyword(s):  
Tidal Volume ◽  
Inflammatory Responses ◽  
Thoracoscopic Surgery ◽  
Controlled Trial ◽  
Lung Ventilation ◽  
Saline Group ◽  
Medical Complication ◽  
Volume Changes ◽  
One Lung Ventilation ◽  
Monocyte Chemoattractant Protein 1

One-lung ventilation in thoracic surgery provokes profound systemic inflammatory responses and injury related to lung tidal volume changes. We hypothesized that the highly selective a2-adrenergic agonist dexmedetomidine attenuates these injurious responses. Sixty patients were randomly assigned to receive dexmedetomidine or saline during thoracoscopic surgery. There is a trend of less postoperative medical complication including that no patients in the dexmedetomidine group developed postoperative medical complications, whereas four patients in the saline group did (0% versus 13.3%,p=0.1124). Plasma inflammatory and injurious biomarkers between the baseline and after resumption of two-lung ventilation were particularly notable. The plasma high-mobility group box 1 level decreased significantly from 51.7 (58.1) to 33.9 (45.0) ng.ml−1(p<0.05) in the dexmedetomidine group, which was not observed in the saline group. Plasma monocyte chemoattractant protein 1 [151.8 (115.1) to 235.2 (186.9) pg.ml−1,p<0.05] and neutrophil elastase [350.8 (154.5) to 421.9 (106.1) ng.ml−1,p<0.05] increased significantly only in the saline group. In addition, plasma interleukin-6 was higher in the saline group than in the dexmedetomidine group at postoperative day 1 [118.8 (68.8) versus 78.5 (58.8) pg.ml−1,p=0.0271]. We conclude that dexmedetomidine attenuates one-lung ventilation-associated inflammatory and injurious responses by inhibiting alveolar neutrophil recruitment in thoracoscopic surgery.

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