Non-intubated anesthesia in patients undergoing video-assisted thoracoscopic surgery: A systematic review and meta-analysis

Abstract

IntroductionNon-intubated anesthesia (NIA) has been proposed for video-assisted thoracoscopic surgery (VATS), although how the benefit-to-risk of NIA compares to that of intubated general anesthesia (IGA) for certain types of patients remains unclear. Therefore, the aim of the present meta-analysis was to understand whether NIA or IGA may be more beneficial for patients undergoing VATS.MethodsA systematic search of Cochrane Library, Pubmed and Embase databases from 1968 to April 2019 was performed using predefined criteria. Studies comparing the effects of NIA or IGA for adult VATS patients were considered. The primary outcome measure was hospital stay. Pooled data were meta-analyzed using a random-effects model to determine the standard mean difference (SMD) with 95% confidence intervals (CI).Results and discussionTwenty-eight studies with 2929 patients were included. The median age of participants was 56.8 years (range 21.9–76.4) and 1802 (61.5%) were male. Compared to IGA, NIA was associated with shorter hospital stay (SMD -0.57 days, 95%CI -0.78 to -0.36), lower estimated cost for hospitalization (SMD -2.83 US, 95% CI -4.33 to -1.34), shorter chest tube duration (SMD -0.32 days, 95% CI -0.47 to -0.17), and shorter postoperative fasting time (SMD, -2.76 days; 95% CI -2.98 to -2.54). NIA patients showed higher levels of total lymphocytes and natural killer cells and higher T helper/T suppressor cell ratio, but lower levels of interleukin (IL)-6, IL-8 and C-reactive protein (CRP). Moreover, NIA patients showed lower levels of fibrinogen, cortisol, procalcitonin and epinephrine.ConclusionsNIA enhances the recovery from VATS through attenuation of stress and inflammatory responses and stimulation of cellular immune function.

Risk Factors for the Development of Intraoperative Hypoxia in Patients Undergoing Nonintubated Video-Assisted Thoracic Surgery: A Retrospective Study from a Single Center

“…NIVATS is a safe and feasible alternative procedure and improves postoperative rehabilitation by reducing postoperative complications, hospital stay, and attenuating stress and inflammatory responses [ 10 , 13 , 14 ]. However, few specific analyses of risk factors for NIVATS have been conducted even though the procedure has been used in a large number of patients [ 27 – 31 ].…”

Contralateral Spontaneous Rupture of the Esophagus Following severe Vomiting After Non-intubated Pulmonary Wedge Resection

“…However, the evidence supporting non-intubated VATS as the preferred approach for lung surgery is still limited. Previous meta-analyses reported that non-intubated procedure attenuated the in ammatory response and stress, followed by fewer postoperative complications as compared with the intubated VATS [15,16]. Moreover, the indications for VATS could be extended by this less-invasive procedure.…”

A comparison of non-intubated video-assisted thoracic surgery with spontaneous ventilation and intubated video-assisted thoracic surgery: a meta-analysis based on 14 randomized controlled trials

“…The data from this metaanalysis support this. Previous meta-analyses showed that patients undergoing non-intubated thoracoscopic surgery had shorter hospital stays and postoperative fasting (43), less postoperative inflammation, and better immune function recovery (44). However, most of the included studies were retrospective studies, and the selection and reporting bias may have affected the study results.…”