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Thanks to the experience gained through the improvement of video-assisted thoracoscopic surgery (VATS) technique, and the enhancement of surgical instruments and high-definition cameras, most pulmonary resections can now be performed by minimally invasive surgery. The future of the thoracic surgery should be associated with a combination of surgical and anaesthetic evolution and improvements to reduce the trauma to the patient. Traditionally, intubated general anaesthesia with one-lung ventilation was considered necessary for thoracoscopic major pulmonary resections. However, thanks to the advances in minimally invasive techniques, the non-intubated thoracoscopic approach has been adapted even for use with major lung resections. An adequate analgesia obtained from regional anaesthesia techniques allows VATS to be performed in sedated patients and the potential adverse effects related to general anaesthesia and selective ventilation can be avoided. The non-intubated procedures try to minimize the adverse effects of tracheal intubation and general anaesthesia, such as intubation-related airway trauma, ventilation-induced lung injury, residual neuromuscular blockade, and postoperative nausea and vomiting. Anaesthesiologists should be acquainted with the procedure to be performed. Furthermore, patients may also benefit from the efficient contraction of the dependent hemidiaphragm and preserved hypoxic pulmonary vasoconstriction during surgically induced pneumothorax in spontaneous ventilation. However, the surgical team must be aware of the potential problems and have the judgement to convert regional anaesthesia to intubated general anaesthesia in enforced circumstances. The non-intubated anaesthesia combined with the uniportal approach represents another step forward in the minimally invasive strategies of treatment, and can be reliably offered in the near future to an increasing number of patients. Therefore, educating and training programmes in VATS with non-intubated patients may be needed. Surgical techniques and various regional anaesthesia techniques as well as indications, contraindications, criteria to conversion of sedation to general anaesthesia in non-intubated patients are reviewed and discussed.

AbstractsResults Of the 1123 infants (Invasive Bacterial Infection -IBI-, 48; 4.2%), 488 (43.4%) were classified as low risk criteria for IBI according to the "step by step" approach (vs 693-61.7%-with the Labscore and 458-40.7%-with the Rochester criteria). The prevalence of IBI in the low-risk criteria patients was 0.2% (95% CI 0-0.6%) using the "step by step" approach (vs 0.7%-95% CI 0.1-1.3% with the Labscore and 1.1%-95% CI 0.1-2%-with Rochester). Using the "step by step" approach, 1 patient with IBI was not correctly classified (2.0%, CI95% 0-6.12) vs 5 using the Labscore or Rochester (10.4%, CI95% 1.76-19.04%). Conclusions A sequential approach to young febrile infants including procalcitonin identifies better patients more suitable for outpatient management. Inhaled foreign bodies are very serious problem in the pediatric pulmonology since they increase the rate of morbidity and mortality. Aim of this study was analysis of endoscopic changes caused by vegetable foreign bodies (VFB) in correlation with their long -standing in the bronchial tree. ENDOSCOPIC ASPECTS OF INHALED VEGETABLE FOREIGN BODIES IN CHILDREN Material and MethodsIn ten years period (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) inhaled foreign bodies were removed in 219 children (age 6 mths-14 yrs), 60.27%-male and 39.73%-female. Most of the children (57.50%) belong to the youngest group of age (1-2 yrs). The inhaled foreign bodies were from organic origin in 208 (94.97%). Of these, 203 (92.69%) were with vegetable origin. The most commonly found grains were peanuts (57.14%). Inhaled foreign bodies were single object in 123 (56.16%) while in 96 (43.80%) they were multiple. Results Endoscopically we found:Insignificant inflammation (some hours presence of VFB) in 48 (23.64%)Significant inflammation -vulnerable mucous membrane (VFB with presence more than 3 days) in 78 (38.42%) Severe inflammation -manifest inflammation (VFB more than 7 days presence) in 77 (37.93%). In this group of children we detected:-granulomatous formations 57 (82.60%)-decubital changes 28 (40.57%)-mucopurulent secretion 41 (59.42%). Conclusion Severity of the endoscopic changes was closely correlated with the quality of the foreign body (vegetable ones), the period of lodgement and the age of the patients. Timely broncoscopic extirpation of VFB decreases the percentage of complications and represents the most successful and only logically carried out therapeutically procedure.

Among well-appearing young infants with FWS, PCT performs better than CRP in identifying patients with IBIs and seems to be the best marker for ruling out IBIs. Among patients with normal urine dipstick results and fever of recent onset, PCT remains the most accurate blood test.

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Video-assisted thoracic surgery (VATS) anatomic lobectomy for lung cancer was initially described in 1993. Since then, many thoracic surgery departments have progressively adopted this technique, although the approach description may vary greatly among them. Most of surgeons use three incisions but the lobectomy can be performed by only one port, especially when it is performed by surgeons experienced in double-port technique. Lower lobes are the easiest cases to perform. To the best of our knowledge this is the first report of a single-port upper lobectomy with no rib spreading.

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