Clinical evaluation of the rapid recovery of patients who underwent video-assisted thoracoscopic lung surgery under non-intubated anesthesia

Cai, Linsheng; Hou, Bo; Jin, Hua; Bo, Yu; Chen, Xin-Long; Dai, Jun; Yang, Tao; Lan, Bao-Shi; Jia, Yali; Peng, Hao; Peng, Jun

doi:10.21037/atm-21-6434

Cited by 12 publications

(9 citation statements)

References 18 publications

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“…Most traditional surgical methods involve anterolateral incisions, which are long incisions that lead to a higher blood loss volume, take a longer time to open and to close the chest, and occasionally require the surgeon to cut through the ribs ( 10 ). Therefore, the application of thoracoscopic surgery has greatly reduced postoperative complications and accelerated recovery for patients who experience obvious postoperative pain, have large incision scars, exhibit slow postoperative healing, and have a high incidence of complications ( 11 ). In recent years, with the advancement of endoscopic technology and instruments, minimally invasive surgery has evolved from traditional three-port and two-port to uniportal VATS ( 12 – 14 ).…”

Section: Discussionmentioning

confidence: 99%

Would the width of a metal rib spreader affect postoperative pain in patients who undergo video-assisted mini-thoracotomy (VAMT)?

Wang

Ge²,

Fu³

et al. 2022

Front. Oncol.

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BackgroundHitherto, no study has evaluated postoperative pain in patients with non-small cell lung cancer (NSCLC) treated with video-assisted mini-thoracotomy (VAMT). In this study, we aimed to assess postoperative pain related to the width of the metal rib spreader in patients who underwent lobectomy using VAMT.MethodsWe retrospectively analysed the data of 94 consecutive patients with NSCLC who underwent lobectomy using VAMT at our institution between March 2019 and May 2022. We divided the patients into groups according to the width ratio of the rib spreader to that of a single intercostal space. Patients with width ratios ≤ 2.5 times were assigned to group A, and those with width ratios > 2.5 times were assigned to group B. Pre-, intra-, and postoperative data were collected and reviewed.ResultsWe successfully performed VAMT in 94 patients with NSCLC. Forty-five patients were in group A, and 49 were in group B. There were no intraoperative mortalities, although one patient, due to respiratory failure, experienced 30-day mortality. There were no significant differences between the two groups in terms of the blood loss volume, operative time, drainage time, postoperative complications, length of hospital stay, or number of lymph node stations explored and retrieved. The drainage volumes (Day 1–Day 3) were higher in group B than in group A (P < 0.05). The postoperative visual analogue scale (VAS) pain scores were significantly lower in Group A than in Group B at 12, 24, and 48 h (P < 0.05), although there was no significant difference in the VAS scores between the two groups at 72 h and 1 week postoperatively (P > 0.05).ConclusionThe smaller the width of the metal rib spreader used in surgery, the less pain experienced by the patient and the faster the recovery. Multicentre, randomised, controlled trials should be conducted in the future.

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Section: Discussionmentioning

confidence: 99%

Would the width of a metal rib spreader affect postoperative pain in patients who undergo video-assisted mini-thoracotomy (VAMT)?

Wang

Ge²,

Fu³

et al. 2022

Front. Oncol.

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“…Previous studies have shown that nonintubation anesthesia promotes early feeding and ambulation. Simultaneously, because it avoids the use of muscle relaxants, it can reduce the incidence of postoperative vomiting, and the ventilation method of a laryngeal mask or face mask can reduce the possibility of throat injury, reduce the incidence of postoperative throat discomfort, and improve patient satisfaction ( 28 , 29 ). In our study, no significant differences were observed between the two groups.…”

Section: Discussionmentioning

confidence: 99%

The short-term outcomes of nonintubated anesthesia compared with intubated anesthesia in single-port video-assisted lung surgery in enhanced recovery after thoracic surgery: results from a single-center retrospective study

Yang¹,

Zhang²,

Wang³

et al. 2022

J Thorac Dis

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Background: Nonintubated anesthesia avoids invasive tracheal intubation operations and reduces trauma. in addition, it has advantages in lung surgery in some patients with poor lung function, in line with the concept of rapid recovery. However, few studies have discussed the clinical significance of Enhanced recovery after surgery (ERAS) combined with nonintubated anesthesia in single-port video-assisted thoracoscopic surgery (VATS). We conducted a retrospective study to examine the safety and availability of nonintubated anesthesia single-port video-assisted lung surgery (NI-SP-VALS) combined with ERAS programs in patients.Methods: This was a single-center retrospective study. All patients were preoperatively diagnosed with lung nodules and underwent NI-SP-VALS or intubated anesthesia SP-VALS (I-SP-VALS) combined with ERAS programs between July 2021 and March 2022. Short-term postoperative outcomes were compared in 2 cohorts.Results: In total, 272 patients were included. Among them, 91 patients received NI-SP-VALS combined with ERAS programs (observation group), and 181 underwent intubation anesthesia (control group). Baseline data were statistically different between the two groups, and 1:1 propensity score matching (PSM) matching was used. A total of 73 patients remained in each group after PSM, and baseline characteristics were not significantly different between the 2 cohorts. The time of hospital stay [4.00 (4.00-5.00) vs. 44.50 (0.00-5.75) d; P=0.029] and catheter stay [0.50 (0.20-2.00) vs. 2.00 (2.00-2.00) d; P<0.001] were significantly shorter, the white blood cell count (WBC) [9.45 (8.08-11.30) vs. 11 (8.50-12.80)/L; P=0.009] and the lowest SpO 2 in operation [96.00 (94.00-97.50) vs. 97.00 (95.00-98.50); P=0.035] were also lower in the nonintubated group than those of the intubated group. No differences were observed in variables of intraoperation, other routine blood indexes, postoperative drainage, postoperative medicine use, postoperative symptoms, complications, hospitalization expenses, postoperative follow-up index, or self-assessment of anxiety. Conclusions:The data after PSM shows that compared with intubated anesthesia, NI-SP-VALS combined with ERAS programs is safe and effective. Nonintubated anesthesia promotes rapid recovery of patients and reduces postoperative inflammatory reactions. Hence, nonintubated anesthesia may conform to the idea of ERAS and has application value in thoracic surgery.

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“…Furthermore, optimizations of anesthetic agent selection and airway management are crucial to guarantee the life safety of asthmatic patients. Non-intubated video-assisted thoracoscopic surgery (NIVATS) has been widely used worldwide because of its advantages of enhanced recovery after surgery (ERAS) ( 4 ). To minimize the perioperative risk of anesthetic management, NIVATS under spontaneous respiration might be an optimal therapeutic option for asthmatic patient who underwent thoracic surgery.…”

Section: Introductionmentioning

confidence: 99%

Application of multimodal analgesia combined with opioid-free anesthetics in a non-intubated video-assisted thoracoscopic surgery bullectomy: A case report

et al. 2023

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BackgroundNon-intubated video-assisted thoracoscopic surgery (NIVATS) has been increasingly applied worldwide owing to its benefits of enhanced recovery after surgery (ERAS). Anesthetic management for patients with asthma should focus on minimizing airway stimulation.Case descriptionA 23-year-old male patient with a history of asthma was diagnosed with left-sided spontaneous pneumothorax. The patient then underwent left-sided NIVATS bullectomy under general anesthesia with preserved spontaneous breathing. Left thoracic paravertebral nerve block (TPVB) with an injection of 0.375% ropivacaine (30 ml) was performed in the 6th paravertebral space under ultrasound guidance. Anesthesia induction commenced until the cold sensation in the surgical area had disappeared. General anesthesia was induced by midazolam, penehyclidine hydrochloride, esketamine, and propofol and then maintained using propofol and esketamine. Surgery commenced after the patient was positioned in the right lateral recumbency. The collapse of the left lung was satisfactory, and the operative field was ensured after artificial pneumothorax. The surgical procedure was uneventful, intraoperative arterial blood gases were within normal ranges, and vital signs were stable. The patient awakened rapidly without any adverse reactions at the end of the surgery and was then transferred to the ward. During the postoperative follow-up, the patient experienced mild pain 48 h after surgery. The patient was discharged from the hospital 2 days postoperatively and developed no nausea, vomiting, or any other complications.ConclusionThe present case suggests the feasibility of TPVB in combination with non-opioid anesthetics to provide high-quality anesthesia in patients undergoing NIVATS bullectomy.

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Clinical evaluation of the rapid recovery of patients who underwent video-assisted thoracoscopic lung surgery under non-intubated anesthesia

Cited by 12 publications

References 18 publications

Would the width of a metal rib spreader affect postoperative pain in patients who undergo video-assisted mini-thoracotomy (VAMT)?

Would the width of a metal rib spreader affect postoperative pain in patients who undergo video-assisted mini-thoracotomy (VAMT)?

The short-term outcomes of nonintubated anesthesia compared with intubated anesthesia in single-port video-assisted lung surgery in enhanced recovery after thoracic surgery: results from a single-center retrospective study

Application of multimodal analgesia combined with opioid-free anesthetics in a non-intubated video-assisted thoracoscopic surgery bullectomy: A case report

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