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Fan Q, Luo J, Zhou Q, Zhang Y, Zhang X, Li J, Jiang L, Lan L. Esketamine opioid-free intravenous anesthesia versus opioid intravenous anesthesia in spontaneous ventilation video-assisted thoracic surgery: a randomized controlled trial. Front Oncol 2023; 13:1145953. [PMID: 37324000 PMCID: PMC10266098 DOI: 10.3389/fonc.2023.1145953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/17/2023] [Indexed: 06/17/2023] Open
Abstract
Background Opioid-free anesthesia (OFA) provides adequate analgesia and can reduce postoperative opioid consumption, but its efficacy in spontaneous ventilation video-assisted thoracic surgery (SV-VATS) has not been demonstrated. We aimed to investigate the hypothesis that OFA could provide the same perioperative pain control as opioid anesthesia (OA), maintain safe and stable respiration and hemodynamics during surgery, and improve postoperative recovery. Methods Sixty eligible patients (OFA group: n=30; OA group: n=30) treated between September 15, 2022, and December 15, 2022, at The First Hospital of Guangzhou Medical University were included. They were randomized to receive standard balanced OFA with esketamine or OA with remifentanil combined with sufentanil. The primary outcome was the pain numeric rating score (NRS) at postoperative 24 h, and the secondary outcomes were intraoperative respiratory and hemodynamic data, opioid consumption, vasoactive drug dosage, and recovery in the post-anesthesia care unit and ward. Results There was no significant difference in the postoperative pain scores and recovery quality between the two groups. The OFA group had a significantly lower dose of phenylephrine (P=0.001) and a lower incidence of hypotension (P=0.004) during surgery. The OFA group resumed spontaneous respiration faster (P<0.001) and had a higher quality of lung collapse (P=0.02). However, the total doses of propofol and dexmetomidine were higher (P=0.03 and P=0.02), and the time to consciousness was longer (P=0.039) in the OFA group. Conclusions OFA provides the same level of postoperative pain control as OA, but it is more advantageous in maintaining circulatory and respiratory stability and improving the quality of pulmonary collapse in SV-VATS.
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Affiliation(s)
- Qisen Fan
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jinhui Luo
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qianling Zhou
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yaoliang Zhang
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Zhang
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiayang Li
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Long Jiang
- National Clinical Research Center for Respiratory Disease and Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lan Lan
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Li B, Niu L, Gu C, He K, Wu R, Pan Z, Chen S. Clinical analysis of subxiphoid vs. lateral approaches for treating early anterior mediastinal thymoma. Front Surg 2022; 9:984043. [PMID: 36338633 PMCID: PMC9632990 DOI: 10.3389/fsurg.2022.984043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the clinical efficacy of the subxiphoid approach for early anterior mediastinal thymoma and evaluate its advantages over the lateral intercostal approach. Methods A total of 345 patients with early anterior mediastinal thymoma were retrospectively analyzed from January 2016 to December 2020 in the First Affiliated Hospital of Soochow University. Out of these, 99 patients underwent subxiphoid video-assisted thoracoscopic thymectomy and 246 patients underwent transthoracic video-assisted thoracoscopic thymectomy. We compared the intraoperative conditions (such as operation time and intraoperative blood loss), postoperative conditions [such as postoperative pleural drainage volume, extubation time, postoperative hospital stay, and postoperative visual analogue scale (VAS) pain score], and postoperative complications (such as death, pneumonia, delayed wound healing, cardiac arrhythmia, and phrenic nerve injury) of the two groups and analyzed the clinical advantages of the subxiphoid approach for treating early anterior mediastinal thymoma. Results There was no significant difference between the two groups in terms of general clinical features, operation time, and postoperative complications (P > 0.05).However, there was a significant difference in terms of intraoperative blood loss, postoperative pleural drainage volume, tube extubation time, postoperative hospital stay, postoperative VAS pain score, and postoperative analgesics (a significantly decreased flurbiprofen axetil amount) (P < 0.05). Conclusion Compared with the lateral intercostal thoracic approach, the subxiphoid approach had advantages in terms of intraoperative blood loss, postoperative hospital stay, tube extubation time, postoperative pleural drainage volume, postoperative VAS pain score, and analgesics dosage. It could provide a better view of the bilateral pleural cavities and more thorough thymectomy and superior cosmesis, and it proved to be a safe and feasible minimally invasive surgical method.
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Affiliation(s)
- Bin Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lijuan Niu
- Department of Endocrinology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chenqi Gu
- Department of Imaging, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Kaiwen He
- Department of Thoracic Surgery, Changshu No.1 People's Hospital, Changshu, China
| | - Ruizhi Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhenfeng Pan
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
- Correspondence: Shaomu Chen Zhenfeng Pan
| | - Shaomu Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Correspondence: Shaomu Chen Zhenfeng Pan
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Rosboch GL, Lyberis P, Ceraolo E, Balzani E, Cedrone M, Piccioni F, Ruffini E, Brazzi L, Guerrera F. The Anesthesiologist's Perspective Regarding Non-intubated Thoracic Surgery: A Scoping Review. Front Surg 2022; 9:868287. [PMID: 35445075 PMCID: PMC9013756 DOI: 10.3389/fsurg.2022.868287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/24/2022] [Indexed: 12/24/2022] Open
Abstract
Non-intubated thoracic surgery (NITS) is a growing practice, alongside minimally invasive thoracic surgery. To date, only a consensus of experts provided opinions on NITS leaving a number of questions unresolved. We then conducted a scoping review to clarify the state of the art regarding NITS. The systematic review of all randomized and non-randomized clinical trials dealing with NITS, based on Pubmed, EMBASE, and Scopus, retrieved 665 articles. After the exclusion of ineligible studies, 53 were assessed examining: study type, Country of origin, surgical procedure, age, body mass index, American Society of Anesthesiologist's physical status, airway management device, conversion to orotracheal intubation and pulmonary complications rates and length of hospital stay. It emerged that NITS is a procedure performed predominantly in Asia, and certain European Countries. In China, NITS is more frequently performed for parenchymal resection surgery, whereas in Europe, it is mainly employed for pleural pathologies. The most commonly used device for airway management is the laryngeal mask. The conversion rate to orotracheal intubation is a~3%. The results of the scoping review seem to suggest that NITS procedures are becoming increasingly popular, but its role needs to be better defined. Further randomized clinical trials are needed to better define the role of the clinical variables possibly impacting on the technique effectiveness.Systematic Review Registrationhttps://osf.io/mfvp3/, identifier: 10.17605/OSF.IO/MFVP3.
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Affiliation(s)
- Giulio Luca Rosboch
- Department of Anesthesia, Intensive Care and Emergency, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
- *Correspondence: Giulio Luca Rosboch
| | - Paraskevas Lyberis
- Department of Cardiovascular and Thoracic Surgery, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
| | - Edoardo Ceraolo
- Department of Anesthesia, Intensive Care and Emergency, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
| | - Eleonora Balzani
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Martina Cedrone
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Federico Piccioni
- Anesthesia and Intensive Care Unit, General and Specialistic Surgical Department, Arcispedale Santa Maria Nuova, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Enrico Ruffini
- Department of Cardiovascular and Thoracic Surgery, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Luca Brazzi
- Department of Anesthesia, Intensive Care and Emergency, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Francesco Guerrera
- Department of Cardiovascular and Thoracic Surgery, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
- Department of Surgical Science, University of Turin, Torino, Italy
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Jie L, Meng W. Thoracoscopy-assisted treatment for mediastinal metastasis of thyroid cancer: a case report. J Int Med Res 2022; 50:3000605221078409. [PMID: 35317641 PMCID: PMC8950032 DOI: 10.1177/03000605221078409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Advanced thyroid cancer with upper mediastinal lymph node metastasis is not rare in the clinical setting. For patients with severe metastasis, a thoracocervical incision is usually performed for dissection of lymph nodes. However, the difficult operation of three-port thoracoscopy to support performance of a cervical incision in the treatment of upper mediastinal lymph node metastasis has rarely been reported to date. We herein describe a case involving the treatment of thyroid cancer with upper mediastinal lymph node metastasis. The lymph node metastasis was severe, closely adhered to the innominate vein, and fused into a mass. Thoracoscopy with a cervical incision was performed and proved to be a highly difficult surgical maneuver. The patient recovered quickly after the operation. Repeat computed tomography showed no swollen metastatic lymph nodes, indicating that the dissection was thorough. Thoracoscopy with a neck incision is more difficult than conventional longitudinal split sternotomy in the treatment of upper mediastinal lymph node metastasis, but its advantages are less severe trauma and faster recovery. This procedure may be performed by surgeons with proficient skill in cervical surgery and thoracoscopy techniques.
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Affiliation(s)
- Liu Jie
- Department of Head and Neck Surgery, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
| | - Wang Meng
- Department of Head and Neck Surgery, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, China
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Cao M, Wang Q, Yin H, Fu Y, Zhao X. Short-term analysis of uniport video-assisted thoracoscopic surgery via the subxiphoid approach without chest tube drainage for anterior mediastinal tumors: a comparative retrospective study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1687. [PMID: 34988196 PMCID: PMC8667127 DOI: 10.21037/atm-21-5790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022]
Abstract
Background Uniport video-assisted thoracoscopic surgery (VATS) via the subxiphoid approach has emerged as a safe and effective treatment for anterior mediastinal tumors. However, there is limited evidence of the necessity of chest tubes and the comparative efficacy with other approaches. Methods A total of 141 patients with anterior mediastinal tumors receiving VATS were enrolled in this retrospective study. The patients were divided into the lateral approach (LA) group, the uniport subxiphoid approach (USA) group, and the three-port subxiphoid approach (TSA) group. Short-term analysis including operation time, chest tube rates, drainage duration, visual analogue scale (VAS) score, and hospital stay were compared. Postoperative CT scans were analyzed to evaluate the amount of pleural effusion. Results There was no significant difference in demographic and baseline characteristics among the three groups (all P>0.05). The operation time, blood loss, and hospital stay of the subxiphoid approach group were significantly lower than the LA group (P<0.001). The postoperative CT scans demonstrated that the USA group had a similar amount of pleural effusion as the other groups (P=0.1605). The postoperative VAS score of the USA group was significantly lower than the other groups (P<0.001). There was no significant difference in complications, in-hospital death, and conversion to thoracotomy among the three groups (all P>0.05). Conclusions VATS via the subxiphoid approach is less invasive, equally safe, and same effective for anterior mediastinal tumors than the LA. The chest tube could be omitted for the USA.
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Affiliation(s)
- Min Cao
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Wang
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hang Yin
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujie Fu
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojing Zhao
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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