Thoracoscopic surgery under epidural anesthesia for intractable secondary spontaneous pneumothorax

Abstract

In case with patients having intractable SSP with compromised pulmonary function, VATS under EA could be an effective and safe option to approach the appropriate goals of air leak control and less recurrence of pneumothorax.

The feasibility and safety of thoracoscopic surgery under epidural and/or local anesthesia for spontaneous pneumothorax: a meta-analysis.

“…The data of recurrence were reported in four studies [ 8 , 19 , 21 , 22 ]. Because of the homogeneity among these studies ( p = 0.840 and I 2 = 0%), a fixed effect analysis model was used and suggested no difference between the ELA group and GA group (OR = 0.49; 95% CI: 0.15 to 1.55; p = 0.223) ( Figure 7 ).…”

“…Because of the homogeneity among these studies ( p = 0.840 and I 2 = 0%), a fixed effect analysis model was used and suggested no difference between the ELA group and GA group (OR = 0.49; 95% CI: 0.15 to 1.55; p = 0.223) ( Figure 7 ). The four studies [ 19 – 22 ] reported the related information of perioperative mortality and 6 deaths were recorded in two studies [ 20 , 21 ]. Of them, 2 came from the ELA group [ 21 ] and 4 from the GA group [ 20 ].…”

“…The four studies [ 19 – 22 ] reported the related information of perioperative mortality and 6 deaths were recorded in two studies [ 20 , 21 ]. Of them, 2 came from the ELA group [ 21 ] and 4 from the GA group [ 20 ]. Concerning their cause of death, Yeong Ahn et al [ 21 ] reported that one died of pneumonia and the other one was underlying lung disease, and Noda et al [ 20 ] reported pneumonia in 2 patients and ARDS in 2 patients.…”

“…Of them, 2 came from the ELA group [ 21 ] and 4 from the GA group [ 20 ]. Concerning their cause of death, Yeong Ahn et al [ 21 ] reported that one died of pneumonia and the other one was underlying lung disease, and Noda et al [ 20 ] reported pneumonia in 2 patients and ARDS in 2 patients.…”

“…However, ELA still correlates with some potential complications, including unsatisfactory exposure of the surgical field, the emotional stress of patients due to awake surgery, dyspnea even with using the air-locking trocar, coughing reflexes during lung manipulation, hyperventilation induced by permissive hypercapnia, unexpected thoracic pain requiring additional local anesthesia, epidural hematoma, spinal cord injury and phrenic nerve palsy caused by inadvertently high anesthetic level [ 19 , 21 , 29 ]. What is worse, the process of ELA to GA conversion may induce significant mediastinal or lung movement, persistent hypoxaemia, unstable hemodynamic status or uncontrolled bleeding [ 30 ].…”