Background and Purpose-There is considerable heterogeneity in practice patterns between sedation in the intubated state vs nonintubated state during endovascular acute stroke therapy. We sought to compare clinical and radiographic outcomes between these 2 sedation modalities. Methods-Consecutive patients with acute stroke due to middle cerebral artery-M1 segment occlusion treated with endovascular therapy between January 2006 and July 2009 were identified in our interventional acute stroke database.

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Purpose of Review This review focuses on describing the procedural and anesthetic management of patients undergoing nonintubated video-assisted thoracoscopy surgery. Recent Findings Most thoracic surgery is performed under general endotracheal anesthesia with either a double lumen endotracheal tube or a bronchial blocker. In an attempt to lessen the incidence and severity of postoperative complications, the nonintubated videoassisted thoracoscopic technique was developed, where the surgical procedure is performed under regional anesthesia with sedation. Currently, this technique is recommended for the elderly and in patients with severe cardiopulmonary disease who are at increased risk of complications after general anesthesia. It is the role of the anesthesia team to assist in the decisions whether the patient is a candidate and which block should be performed and to carefully monitor these patients in the operating room. Summary Nonintubated video-assisted thoracic surgery is an emerging technique with the goal of reducing postoperative complications. The anesthetic technique is highly variable and ranges from general anesthesia with a laryngeal mask airway with a truncal block to thoracic epidural anesthesia with minimal to no block. It is important to have excellent communication with the surgical team and the patient to ensure a safe, successful procedure.Keywords Video-assisted thoracic surgery . Uniportal technique . Thoracic epidural analgesia . Paravertebral block . Intercostal block . Serratus anterior block . Erector spinae plane block . Pendular respiration . Artificial pneumothorax Upon completion of this lesson, the reader should be able to: 1. Define the concept of nonintubated video-assisted thoracic surgery. 2. Discuss the potential advantages of NIVATS. 3. Consider the patient population that would benefit from the NIVATS technique. 4. Review the patient, anesthetic, and surgical contraindications for NIVATS. 5. Discuss the procedures that can be performed using the NIVATS technique. 6. Discuss the preoperative assessment for NIVATS. 7. Review the anesthetic technique for NIVATS. 8. Review the regional blocks used for NIVATS. 9. Demonstrate the goals of the intraoperative management for patients undergoing the NIVATS procedure. 10. Recognize and treat complications that can occur during NIVATS. This article is part of the Topical Collection on Thoracic Anesthesia

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As the population ages, the incidence of patients presenting for surgical procedures with diastolic dysfunction and heart failure with preserved ejection fraction will rise. This review will discuss the most current and relevant information on the pathophysiology, treatment, and perioperative management of these patients.

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