An update on anesthesia for thoracoscopic surgery

Fischer, Gregory W.; Cohen, Edmond

doi:10.1097/aco.0b013e3283346c6d

Cited by 54 publications

(28 citation statements)

References 27 publications

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“…Intravenous patient-controlled analgesia (PCA) with opioids is an effective, safe method of postoperative analgesia. Video-assisted thoracoscopic surgery is associated with less postoperative pain than thoracotomy [3], and PCA with fentanyl is an alternative to invasive regional analgesia such as epidural or paravertebral block [4]. However, to be safe and acceptable, PCA in patients undergoing video-assisted thoracoscopic surgery should be accompanied by effective prophylaxis of nausea and vomiting.…”

Section: Discussionmentioning

confidence: 99%

The effect of combining dexamethasone with ondansetron for nausea and vomiting associated with fentanyl‐based intravenous patient‐controlled analgesia*

et al. 2011

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SummaryWe investigated whether combined dexamethasone and ondansetron is more effective than ondansetron alone in preventing postoperative nausea and vomiting in patients with fentanyl-based intravenous patient-controlled analgesia. One hundred and thirty patients undergoing videoassisted thoracoscopic surgery were assigned to either an ondansetron group or a dexamethasone and ondansetron group. In all patients, ondansetron 4 mg was administered at the end of surgery and 12 mg was added to the patient-controlled analgesia solution. The dexamethasone and ondansetron group received dexamethasone 8 mg at the induction of anaesthesia. The overall incidence of nausea and vomiting during the first 48 h postoperatively did not differ between groups (34/61 (56%) vs 28/62 (45%) in the ondansetron group and dexamethasone and ondansetron groups, respectively). The incidence of severe nausea and vomiting ( ‡ 7 nausea on an 11-point verbal numerical rating scale, retching or vomiting) was higher in the ondansetron group than in the dexamethasone and ondansetron group (15/61 (25%) vs 6/62 (10%, respectively, p = 0.028). Combined dexamethasone and ondansetron is more effective in reducing severe nausea and vomiting than ondansetron alone in patients receiving fentanyl-based intravenous patient-controlled analgesia. Postoperative nausea and vomiting (PONV) is one of the most common and distressing complications after surgery. The incidence of PONV varies from 10% to 78% according to surgical, anaesthetic and patient factors [1,2]. Intravenous patient-controlled analgesia (PCA) with opioids is an effective, safe method of postoperative analgesia. Video-assisted thoracoscopic surgery is associated with less postoperative pain than thoracotomy [3], and PCA with fentanyl is an alternative to invasive regional analgesia such as epidural or paravertebral block [4]. However, to be safe and acceptable, PCA in patients undergoing video-assisted thoracoscopic surgery should be accompanied by effective prophylaxis of nausea and vomiting.While several investigators have reported that prophylactic administration of ondansetron reduces PONV in patients using morphine-based PCA [5,6], the incidence of PONV incidence in patients using

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Section: Discussionmentioning

confidence: 99%

The effect of combining dexamethasone with ondansetron for nausea and vomiting associated with fentanyl‐based intravenous patient‐controlled analgesia*

et al. 2011

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“…Effective collapse of the non‐ventilated lung facilitates video‐assisted thoracoscopic surgery (VATS) . The lung collapse consists of two phases, with distinct mechanisms and contribution to the process of lung collapse .…”

Section: Introductionmentioning

confidence: 99%

Preemptive one lung ventilation enhances lung collapse during thoracoscopic surgery: A randomized controlled trial

et al. 2019

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In routine practice, one lung ventilation (OLV) is initiated upon pleural opening. We conducted a randomized controlled trial to compare lung collapse after preemptive OLV versus conventional OLV in thoracoscopic surgery. A total of 67 patients were enrolled (34 with conventional OLV; 33 with preemptive OLV). Preemptive OLV was conducted by closing the DLT lumen to the non‐ventilated lung immediately upon assuming the lateral position with the distal port closed to the atmosphere until pleural opening (>6 minutes in all cases). Lung collapse was assessed at 1, 5, 10, 20, 30 and 40 minutes after pleural opening using a 10‐point rating scale (10: complete collapse). The primary end point was the duration from pleural opening to satisfactory lung collapse (score of 8). Secondary end points included PaO 2 and hypoxemia. The duration from pleural opening to satisfactory lung collapse was shorter in the preemptive OLV group (9.1 ± 1.2 vs. 14.1 ± 4.7 minutes, P < 0.01). PaO 2 was comparable between the two groups prior to anesthetic induction (T0), and 20 (T2), 40 minutes (T3) after pleural incision, but was lower in the preemptive OLV group at zero minutes after pleural incision (T1) (457.5 ± 19.0 vs. 483.1 ± 18.1 mmHg, P < 0.01). No patients in either group developed hypoxemia. In summary, preemptive OLV expedites lung collapse during thoracoscopic surgery with minimal safety concern.

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“…All of these surgical procedures require excellent lung collapse for optimal surgical exposure without having to compress the lung parenchyma facilitate the surgeon’s dissection and reduce both the operating time and incidence of postoperative complications [16]. The definition of lung collapse time changes from one study to another, from the opening of the pleura [8] or from the start of one-lung ventilation [17].…”

Section: Discussionmentioning

confidence: 99%

Two-minute disconnection technique with a double-lumen tube to speed the collapse of the non-ventilated lung for one-lung ventilation in thoracoscopic surgery

Zhang

et al. 2017

BMC Anesthesiol

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BackgroundThoracic surgery requires the effective collapse of the non-ventilated lung. In the majority of cases, we accomplished, accelerated lung collapse using a double-lumen tube (DLT). We hypothesized that using the two-minute disconnection technique with a DLT would improve lung collapse during subsequent one-lung ventilation.MethodsFifty patients undergoing thoracoscopic surgery with physical classification I or II according to the American Society of Anesthesiologists were randomly divided into two groups for respiratory management of one-lung ventilation (OLV). In group N, OLV was initiated after the DLT was disconnected for 2 min; the initiation time began when the surgeon made the skin incision. In group C, OLV was initiated when the surgeon commenced the skin incision and scored the quality of lung collapse (using a four-point ordinal scale). The surgeon’s satisfaction or comfort with the surgical conditions was assessed using a visual analogue scale. rSO2 level, mean arterial pressure, pulse oxygen saturation, arterial blood gas analysis, intraoperative hypoxaemia, intraoperative use of CPAP during OLV, and awakening time were determined in patients at the following time points: while inhaling air (T0), after anaesthesia induction andinhaling 100% oxygen in the supine position under double lung ventilation for five mins (T1), at two mins after skin incision (T2), at ten mins after skin incision (T3), and after the lung recruitment manoeuvres and inhaling 50% oxygen for five mins (T4).ResultsThe two-minute disconnection technique was associated with a significantly shorter time to total lung collapse compared to that of the conventional OLV ventilation method (15 mins vs 22 mins, respectively; P < 0.001), and the overall surgeon’s satisfaction was higher (9 vs 7, respectively; P < 0.001). At T2, the PaCO2, left rSO2 and right rSO2 were higher in group N than in group C. There were no statistically significant differences between the incidence of intraoperative hypoxaemia and intraoperative use of CPAP during OLV (10% vs 5%, respectively; P = 1.000), duration of awakening (18 mins vs 19 mins, respectively; P = 0.616).ConclusionsA two-minute disconnection technique using a double-lumen tube was used to speed the collapse of the non-ventilated lung during one-lung ventilation for thoracoscopic surgery. The surgeon was satisfied with the surgical conditions.Trial registrationChinese Clinical Trial Registry number, ChiCTR-IPR-17010352. Registered on Jan, 7, 2017.

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An update on anesthesia for thoracoscopic surgery

Abstract: Minimal invasive VATS is gaining widespread popularity among our surgical colleagues. The anesthesiologist must recognize the impact that this change in surgical philosophy will have upon the anesthetic management of these complex patients.

Cited by 54 publications

References 27 publications

The effect of combining dexamethasone with ondansetron for nausea and vomiting associated with fentanyl‐based intravenous patient‐controlled analgesia*

The effect of combining dexamethasone with ondansetron for nausea and vomiting associated with fentanyl‐based intravenous patient‐controlled analgesia*

Preemptive one lung ventilation enhances lung collapse during thoracoscopic surgery: A randomized controlled trial

Two-minute disconnection technique with a double-lumen tube to speed the collapse of the non-ventilated lung for one-lung ventilation in thoracoscopic surgery

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