Nonintubated Video-Assisted Thoracoscopic Surgery Under Epidural Anesthesia Compared With Conventional Anesthetic Option

Abstract

VATS under anesthesia with nontracheal intubation is safe and feasible, and has demonstrated advantages, including shorter postoperative fasting time, shorter duration of antibiotic use, and shorter hospital stay, compared with VATS under general anesthesia with double lumen tube.

Nonintubated uniportal VATS pulmonary anatomical resections

“…Despite the initial reports of the team from Rome (Italy) with severe emphysematous patients, most surgical teams that have experienced with nonintubated anatomical resections have globally selected a propitious profile of population: non-obese patients without severe comorbidities neither pulmonary underlying disease with early stage lung cancer, metastatic or benign disease (21)(22)(23).…”

Non-intubated video-assisted thoracoscopic biopsy surgery of a large anterior mediastinal mass via epidural anesthesia -A case report-

“…Local anesthesia under monitored anesthesia care for non-intubated VATS was successfully performed in previous reports [11,12]. However, it can be challenging to control the exact level of sedation and analgesia to meet both the requirements of the surgeon and patient, whilst also maintaining adequate respiration.…”

“…Intercostal nerve block can be used for non-intubated VATS, and is associated with relatively minor patient discomfort and pain; however, obtaining an adequate blockade of the thoracic region may be complex and the block duration may be limited. Moreover, complications, such as pneumothorax, may occur as well as instances of local anesthetic systemic toxicity [11,12]. An alternative method for non-intubated VATS includes epidural catheter insertion, which has several advantages over the previously mentioned approaches, including potential for additional local anesthetic injection during operation, increased anesthetic duration, and the potential provision of postoperative analgesia, where required.…”

“…Recently, non-intubated VATS, a thoracoscopic technique without tracheal intubation, has grown in popularity given the potential to avoid intubation-related complications and thus expedite postoperative recovery [4]. However, current reports on non-intubated VATS relate to the management of lung tumors, spontaneous pneumothorax, pleural effusions, empyema and emphysema, as well as lung volume reduction surgeries and lung biopsies for interstitial lung disease [4,[8][9][10][11]. The use of non-intubated VATS for large mediastinal mass biopsies is currently underreported.…”

“…Secondly, urgent conversion to general anesthesia may have catastrophic results. Again, severe uncontrollable coughing is the most common cause of conversion to general anesthesia, but other causes include persistent hypoxemia, surgical difficulty, ineffective analgesia, bleeding, change of surgical plan, and an anxiety attack [4,10,11,14,15]. Despite extensive planning and caution, urgent conversion to general anesthesia is sometimes necessary and thus emergency preparation for should always be undertaken.…”