Feasibility of non-intubated anesthesia and regional block for thoracoscopic surgery under spontaneous respiration: a prospective cohort study

Abstract

Data about the feasibility and safety of thoracoscopic surgery under non-intubated anesthesia and regional block are limited. In this prospective study, 57 consecutive patients scheduled for thoracoscopic surgery were enrolled. Patients were sedated with dexmedetomidine and anesthetized with propofol and remifentanil. Ropivacaine was used for intercostal nerve and paravertebral block. Lidocaine was used for vagal block. The primary outcomes were mean arterial pressure (MAP), heart rate (HR), oxygen saturation, and end-tidal carbon dioxide partial pressure (ETCO2) at T0 (pre-anesthesia), T1 (immediately after laryngeal mask/nasopharyngeal airway placement), T2 (immediately after skin incision), T3 (10 min after opening the chest), T4 (end of surgery), and T5 (immediately after laryngeal mask/nasopharyngeal airway removal). One patient required conversion to intubation, 15 developed intraoperative hypotension, and two had hypoxemia. MAP at T0 and T5 was higher than at T1–T4; MAP at T3 was lower (P<0.05 vs other time points). HR at T0 and T5 was higher (P<0.05 vs other time points). ETCO2 at T2 and T3 was higher (P<0.05 vs other time points). Arterial pH, PCO2, and lactic acid at T1 differed from values at T0 and T2 (P<0.05). The Quality of Recovery-15 (QoR-15) score at 24 h was lower (P<0.05). One patient experienced dysphoria during recovery. Thoracoscopic surgery with regional block under direct thoracoscopic vision is a feasible and safe alternative to conventional surgery under general anesthesia, intubation, and one-lung ventilation.

Ultrasound-guided thoracal paravertebral block for awake thoracoscopic lobectomy in a high-risk patient: The first reported case

“…In previous studies at the literature, it was reported that TEA performed surgical procedures with VATS for various thoracic pathologies in awake patients that will increase the post-operative morbidity and prolong the hospital stay. [ 2 7 ]…”

“…[ 1 ] This method, which is usually performed under general anaesthesia by providing single-lung ventilation with a double-lumen endotracheal tube or bronchial blocker, can be used to prevent some complications related to general anaesthesia (vocal cord, tracheal injury, barotrauma). [ 2 ] Thoracic epidural anaesthesia (TEA) and thoracic paravertebral block (PVB) are the two most common regional anaesthesia techniques used in non-intubated thoracoscopic surgical procedures while preserving spontaneous ventilation. However, TEA has rare but serious complications such as dural puncture, epidural abscess, epidural haematoma and nerve damage.…”

“…In the literature, VATS procedure with thoracic PVB without intubation appears to be applied to patients under deep sedation. [ 2 ] In our case, due to the existing comorbidities, right lobectomy was performed awakely under thoracic PVB under US-guided thoracic PVB without applying any anaesthetic agent to the patient.…”

Non-intubated video-assisted thoracoscopic tracheal resection and reconstruction for benign distal tracheal stenosis—a case report and review of literature

“…Mechanical ventilation is often associated with airway pressure induced injury due to overdistension and will eventually lead to pneumonia (3,4,(6)(7)(8). Some centres advocate the use of high flow jet ventilation (HFV) during NiVATS.…”

“…Morbidity following thoracotomy for distal tracheal resection has been reported as high as 12.7% (1,2). Nonintubated video-assisted thoracoscopic surgery (NiVATS) tracheal resection and reconstruction is recently gaining popularity among thoracic surgeons and has shown to have better outcome in terms of shorter surgery time, shorter hospital stay and has no adverse events that are usually associated with general anaesthesia and intubation (2)(3)(4)(5)(6)(7)(8). We present a case of a 23-year-old female with post-intubation distal tracheal stenosis, who underwent NiVATS tracheal resection and reconstruction.…”