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Perioperative outcomes of non-intubated versus intubated video-assisted thoracoscopic surgery in different thoracic procedures: a propensity score-matched analysis. BMC Anesthesiol 2022; 22:154. [PMID: 35590238 PMCID: PMC9118677 DOI: 10.1186/s12871-022-01667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Non-intubated video-assisted thoracoscopic surgery (NIVATS) is increasingly performed in different types of thoracic procedures. Based on the anesthetic perspective, the outcomes of this method are limited. General anesthesia with intubation and controlled ventilation for video-assisted thoracoscopic surgery (IVATS) is a standard technique. The current study aimed to compare the pulmonary gas exchange between NIVATS and IVATS, with a focus on desaturation event. Methods This was a retrospective study conducted at Vajira Hospital. Data were collected from the hospital medical record database between January 9, 2019, and May 15, 2020. A propensity score-matched analysis was used to adjust the confounders by indications and contraindication between NIVATS and IVATS. The perioperative outcomes of VATS and NIVATS were compared by the regression analysis method. Results In total, 180 patients were included in the analysis. There were 98 and 82 patients in the NIVATS and IVATS groups, respectively. After a propensity score matching, the number of patients with similar characteristics decreased to 52 per group. None of the patients in both groups experienced desaturation. The lowest oxygen saturation of the NIVATS and IVATS groups did not significantly differ (96.5% vs. 99%, respectively; p = 0.185). The NIVATS group had a significantly higher ETCO2 peak than the IVATS group (43 vs. 36 mmHg, respectively; p < 0.001). According to the regression analysis, the NIVATS group had a significantly shorter anesthetic induction time (Mean difference (MD) = -5.135 min (95% CI = (- 8.878)- (-1.391)) and lower volume of blood loss (MD = -75.565 ml (95%CI = (- 131.08)—(- 20.65) but a higher intraoperative ETCO2 than the IVATS group (MD = 4.561 mmHg (95%CI = 1.852—7.269). Four patients in the NIVATS group required conversion to intubation due to difficulties encountered when using the surgical technique (7.7%, p = 0.041). Seven patients in the IVATS group, but none in the NIVATS group, presented with sore throat (13.5% vs. 0%, respectively; p = 0.006). Moreover, none of the patients in both groups experienced postoperative pneumonia, underwent reoperation, or died. Conclusions The anesthetic and surgical outcomes of NIVATS were comparable to those of IVATS.
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Janík M, Juhos P, Lučenič M, Tarabová K. Non-intubated Thoracoscopic Surgery-Pros and Cons. Front Surg 2021; 8:801718. [PMID: 34938770 PMCID: PMC8687085 DOI: 10.3389/fsurg.2021.801718] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Pulmonary resection by video-assisted thoracoscopic surgery with single-lung ventilation has become a standardized modality over the last decades. With the aim to reduce surgical stress during operation procedures, some have adopted a uniportal approach in pulmonary resection as an alternative to multiportal VATS. The ERAS program has been widely spread to achieve even better outcomes. In 2004, Pompeo reported the resection of pulmonary modules by conventional VATS under intravenous anesthesia without endotracheal intubation. Within less than a decade thereafter, complete VATS pulmonary resections under anesthesia without endotracheal intubation had been reported for a range of thoracoscopic procedures. Avoiding tracheal intubation under general anesthesia can reduce the incidence of complications such as intubation-related airway trauma, residual neuromuscular blockade, ventilation-induced lung injury, impaired cardiac performance, and postoperative nausea. Numerous studies can be found especially from Asian countries, focusing on comparison of intubated and non-intubated procedures showing that non-intubated VATS could reduce the rate of postoperative complications, shorten hospital stay and decrease the perioperative mortality rate, indicating that non-intubated VATS is a safe, effective and feasible technique for thoracic disease. However, if we look closely at all studies, it is obvious that there are no significant differences between intubated and non-intubated surgery in terms of the standard procedures and maneuvers. In non-intubated procedures it can be less comfortable for the surgeon to manipulate in the thoracic cavity, but the procedural steps remain the same. All the differences between the intubated and non-intubated operation procedure are found in perioperative management of the patient. The patient is still in deep anesthesia during the procedure and hypecapnia can occur. It is easier to manage this if the patient is intubated. In addition, if a complication occurs during the operation and intubation is required, this can cause an emergent situation, which means that not all patients are suitable for such a procedure, especially those with severe emphysema, obese patients and those with a problematic oropharyngeal configuration-Mallampati score. Moreover, studies on non-intubated thoracic surgery point to shortened hospitalization, faster recovery etc. But there are also studies on intubated uniportal VATS procedures in combination with ERAS protocol showing shortened hospitalization and better outcome for patients. Currently, especially with the use of optical intubation canylas, totally intravenous anesthesia (TIVA), BIS and relaxometer, anesthesia is safe for avoiding airway injury, hypercapnia, and there is minimal risk of residual curarization as well as one of the postoperative lung complications such as microaspiration and atelectasis. In addition, the patient recovers rapidly from anesthesia and can be verticalised and mobilized a couple of hours after the operation. It is desirable to take into consideration what type of patient and what lung disease is suitable for non-intubated technique and what is more convenient for intubation.
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Affiliation(s)
- Miroslav Janík
- 1st Department of Thoracic Surgery, University Hospital Bratislava and Slovak Medical University, Bratislava, Slovakia
| | - Peter Juhos
- 1st Department of Thoracic Surgery, University Hospital Bratislava and Slovak Medical University, Bratislava, Slovakia
| | - Martin Lučenič
- 1st Department of Thoracic Surgery, University Hospital Bratislava and Slovak Medical University, Bratislava, Slovakia
| | - Katarína Tarabová
- 1st Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bratislava and Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
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3
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Xiang X, Zhou H, Wu Y, Fang J, Lian Y. Impact of supraglottic device with assist ventilation under general anesthesia combined with nerve block in uniportal video-assisted thoracoscopic surgery. Medicine (Baltimore) 2020; 99:e19240. [PMID: 32150060 PMCID: PMC7478596 DOI: 10.1097/md.0000000000019240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND With the improvement of anesthesia and surgical techniques, supraglottic device with assist ventilation under general anesthesia (GA) combined with nerve block is gradually applied to video-assisted thoracoscopic surgery. However, the safety of assist ventilation has not been fully confirmed, and a large number of samples should be studied in clinical exploration. METHODS The subjects included 120 patients, undergoing elective thoracoscopic GA, with American Society of Anesthesiologists (ASA) physical status I or II, were randomly divided into 3 groups, 40 cases in each group. Group T: received double-lumen bronchial intubation, Group I: received intercostal nerve block using a supraglottic device, Group P: received paravertebral nerve block using a supraglottic device. Mean arterial pressure, heart rate, saturation of pulse oximetry and surgical field satisfaction, general anesthetic dosage and recovery time were recorded before induction of GA (T0), at the start of the surgical procedure (T1), 15 minutes later (T2), 30 minutes later (T3), and before the end of the surgical procedure (T4). Static and dynamic pain rating (NRS) and Ramsay sedation score were recorded 2 hours after surgery (T5), 12 hours after surgery (T6), 24 hours after surgery (T7), time to get out of bed, hospitalization time and cost, patient satisfaction and adverse reactions. RESULTS There was no significant difference with the surgical visual field of the 3 groups (P > .05). The MAP, HR and SpO2 of the 3 groups were decreased from T2 to T3 compared with T0(P < .05). Compared with group T: the total dosage of GA was reduced in group I and group P, the recovery time was shorter, the time to get out of bed was earlier (P < .05), the hospitalization time was shortened, the hospitalization cost was lower, and the patient satisfaction was higher (P < .05). The static and dynamic NRS scores were lower from T5 to T7 (P < .05). Ramsay sedation scores were higher (P < .05), and the incidence of adverse reactions was lower (P < .05). Comparison between group I and group P: Dynamic NRS score of group P was lower from T6 to T7 (P < .05). CONCLUSION Supraglottic device with assist ventilation under general anesthesia combined with nerve block in uniportal video-assisted thoracoscopic surgery is safe and feasible.
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Affiliation(s)
- Xiaobing Xiang
- Institute of Cancer and Basic Medicine (ICBM)
- Cancer Hospital of the University of Chinese Academy of Sciences
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Huidan Zhou
- Institute of Cancer and Basic Medicine (ICBM)
- Cancer Hospital of the University of Chinese Academy of Sciences
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Yingli Wu
- Institute of Cancer and Basic Medicine (ICBM)
- Cancer Hospital of the University of Chinese Academy of Sciences
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Jun Fang
- Institute of Cancer and Basic Medicine (ICBM)
- Cancer Hospital of the University of Chinese Academy of Sciences
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Yanhong Lian
- Institute of Cancer and Basic Medicine (ICBM)
- Cancer Hospital of the University of Chinese Academy of Sciences
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
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4
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Soultanis KM, Gonzalez-Rivas D. Devising the guidelines: the concept of uniportal video-assisted thoracoscopic surgery-incisions and anesthetic management. J Thorac Dis 2019; 11:S2053-S2061. [PMID: 31637038 DOI: 10.21037/jtd.2019.02.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Uniportal video-assisted thoracoscopic surgery (VATS) is an already established minimally invasive technique in the field of thoracic surgery. The feasibility, safety and efficacy of the technique are already well documented. Comparative studies and meta-analyses have shown a clear advantage over open surgery and other minimally invasive techniques in terms of pain, length of stay (LOS), chest drain duration and morbidity. It covers a broad spectrum of indications for both malignant and benign diseases, including pulmonary and mediastinal tumor resections, diaphragm procedures (plication), esophageal surgery and airway surgery (bronchial resections, carinal resections). Its swift and wide adoption has resulted into many variations, all of whom are common in the fact they utilize a single incision to enter the chest and conduct the planned procedure. With this article, we attempt to standardize the technique as to the incision and the anesthetic management.
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Affiliation(s)
- Konstantinos Marios Soultanis
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai 200433, China.,Thoracic Surgery Department, Hellenic Airforce General Hospital, Athens, Greece
| | - Diego Gonzalez-Rivas
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai 200433, China.,Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
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5
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Solli P, Brandolini J, Bertolaccini L. Tubeless thoracic surgery: ready for prime time? J Thorac Dis 2019; 11:652-656. [PMID: 31019751 DOI: 10.21037/jtd.2019.03.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Piergiorgio Solli
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | - Jury Brandolini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
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6
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Li X, Wang X, Zhang H, Cheng H, Cao Q. Unilateral single-port thoracoscopic surgery for bilateral pneumothorax or pulmonary bullae. J Cardiothorac Surg 2019; 14:71. [PMID: 30971282 PMCID: PMC6458681 DOI: 10.1186/s13019-019-0894-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/01/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Rapid rehabilitation surgery has become a widely accepted approach. Thoracic surgeons have attempted in many ways to make surgery less invasive. We combined tubeless technology, single-port technology and mediastinum approach for the treatment of simultaneous bilateral primary spontaneous pneumothorax(PSP)or pulmonary bullae. And we evaluated its therapeutic effect. This study aimed to investigate if tubeless single-port video-assisted thoracic surgery (Tubeless-SPVATS) via anterior mediastinum can be used as an alternative surgical treatment for bilateral lung diseases, especially for concurrent or contralateral recurrence PSP. METHODS From November 2014 to December 2016, 18 patients with simultaneous bilateral PSP or pulmonary bullae were treated with tubeless -SPVATS via anterior mediastinum. They were 13 males and 5 females with an average age of 20.2 ± 2.3 years (17 to 24 years). They all had preoperative chest CT and were diagnosed with simultaneous bilateral PSP or pulmonary bullae. RESULTS Fifteen patients underwent bilateral bullae resection with Tubeless-SPVATS via anterior mediastinum. Three patients underwent bilateral single-port video-assisted thoracic surgery. No thoracotomy was performed. No death and grade 3-4 mobidity were found. All the patients started eating 6 hours after surgery. The average operation time was 44.56±17.8min. The patients were discharged 3. 5±1.0 days postoperatively. CONCLUSIONS Tubeless-SPVATS via anterior mediastinum is a safe and feasible treatment for patients with simultaneous bilateral PSP or pulmonary bullae. However,contralateral thoracic is not explored fully enough. And when contralateral lung bullae are located near the hilum, endoscopic linear stapler cannot be easily used to conduct suture. Thus, the recurrence rate after performing Tubeless-SPVATS may be increased compared to performing thoracotomy. However, compared to bilateral thoracic surgery, this method reduced postoperative pain. And it took significantly less time than bilateral thoracic surgery. Thus, this method has some clinic value.
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Affiliation(s)
- Xiaojian Li
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China
| | - Xiaojin Wang
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China
| | - Huayong Zhang
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China
| | - Hua Cheng
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China
| | - Qingdong Cao
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China.
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7
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Ahn S, Moon Y, AlGhamdi ZM, Sung SW. Nonintubated Uniportal Video-Assisted Thoracoscopic Surgery: A Single-Center Experience. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:344-349. [PMID: 30402395 PMCID: PMC6200173 DOI: 10.5090/kjtcs.2018.51.5.344] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/29/2018] [Accepted: 01/29/2018] [Indexed: 12/19/2022]
Abstract
Background We report our surgical technique for nonintubated uniportal video-assisted thoracoscopic surgery (VATS) pulmonary resection and early postoperative outcomes at a single center. Methods Between January and July 2017, 40 consecutive patients underwent nonintubated uniportal VATS pulmonary resection. Multilevel intercostal nerve block was performed using local anesthesia in all patients, and an intrathoracic vagal blockade was performed in 35 patients (87.5%). Results Twenty-nine procedures (72.5%) were performed in patients with lung cancer (21 lobectomies, 6 segmentectomies, and 2 wedge resections), and 11 (27.5%) in patients with pulmonary metastases, benign lung disease, or pleural disease. The mean anesthesia time was 166.8 minutes, and the mean operative duration was 125.9 minutes. The mean postoperative chest tube duration was 3.2 days, and the mean hospital stay was 5.8 days. There were 3 conversions (7.5%) to intubation due to intraoperative hypoxemia and 1 conversion (2.5%) to multiportal VATS due to injury of the segmental artery. There were 7 complications (17.5%), including 3 cases of prolonged air leak, 2 cases of chylothorax, 1 case of pleural effusion, and 1 case of pneumonia. There was no in-hospital mortality. Conclusion Nonintubated uniportal VATS appears to be a feasible and valid surgical option, depending on the surgeon’s experience, for appropriately selected patients.
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Affiliation(s)
- Seha Ahn
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Youngkyu Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Zeead M AlGhamdi
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea.,Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University
| | - Sook Whan Sung
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
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8
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AlGhamdi ZM, Lynhiavu L, Moon YK, Moon MH, Ahn S, Kim Y, Sung SW. Comparison of non-intubated versus intubated video-assisted thoracoscopic lobectomy for lung cancer. J Thorac Dis 2018; 10:4236-4243. [PMID: 30174869 DOI: 10.21037/jtd.2018.06.163] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Non-intubated, or awake, video-assisted thoracoscopic surgery has been implemented for non-anatomical lung resection and the results obtained were encouraging to consider the approach for anatomical pulmonary resection. This study was conducted to evaluate the perioperative outcomes of the non-intubated and intubated video-assisted thoracoscopic lobectomy in lung cancer in regards to feasibility and safety. Methods A retrospective analysis of 62 consecutive video-assisted thoracoscopic lobectomies (31 lobectomies as non-intubated, 31 lobectomies as intubated) performed in Seoul St. Mary's Hospital, The Catholic University of Korea between January and December 2016. Results Both groups share comparable clinical characteristics including the age, sex, BMI, FEV1, DLCO, smoking history, lung lobes procedure, histological type and pathological staging. There was no difference in the mean of postoperative hospitalization period (6.9 versus 7.6 days, P=0.578) and the total chest tube duration (5.6 versus 5.4 days, P=0.943) between non-intubated and intubated lobectomy respectively. Both groups had a comparable surgical outcome for the anesthesia duration, operative time, blood loss and postoperative complications. The operative time required for lobe-specific surgery was shorter in the non-intubated group except for the LLL (mean 121.7 minutes for non-intubated group versus 118.3 minutes for the intubated group). The only statistically significant surgical outcome was for the number of dissected lymph nodes between both groups (the mean number of nodes for the non-intubated group was 12.6 versus 18.0 nodes for the intubated group, P=0.003). One patient in the non-intubated group required conversion to single lung intubation and mini-thoracotomy because of bleeding with no conversion in the intubated group. No mortality encountered in either group. Conclusions The perioperative surgical outcomes for the non-intubated video-assisted thoracoscopic lobectomy are comparable to the intubated technique. Non-intubated video-assisted thoracoscopic lobectomy is safe and is technically feasible. However, further prospective randomized studies are needed for a better comparison between non-intubated and intubated VATS lobectomy.
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Affiliation(s)
- Zeead M AlGhamdi
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea.,Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Lyfuxu Lynhiavu
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea.,Department of Surgery, University Sciences of Health, Vientiane, Lao People's Democratic Republic
| | - Young Kyu Moon
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Mi Hyoung Moon
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Seha Ahn
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Yunho Kim
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Sook Whan Sung
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
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Umari M, Falini S, Segat M, Zuliani M, Crisman M, Comuzzi L, Pagos F, Lovadina S, Lucangelo U. Anesthesia and fast-track in video-assisted thoracic surgery (VATS): from evidence to practice. J Thorac Dis 2018; 10:S542-S554. [PMID: 29629201 PMCID: PMC5880994 DOI: 10.21037/jtd.2017.12.83] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/11/2017] [Indexed: 12/18/2022]
Abstract
In thoracic surgery, the introduction of video-assisted thoracoscopic techniques has allowed the development of fast-track protocols, with shorter hospital lengths of stay and improved outcomes. The perioperative management needs to be optimized accordingly, with the goal of reducing postoperative complications and speeding recovery times. Premedication performed in the operative room should be wisely administered because often linked to late discharge from the post-anesthesia care unit (PACU). Inhalatory anesthesia, when possible, should be preferred based on protective effects on postoperative lung inflammation. Deep neuromuscular blockade should be pursued and carefully monitored, and an appropriate reversal administered before extubation. Management of one-lung ventilation (OLV) needs to be optimized to prevent not only intraoperative hypoxemia but also postoperative acute lung injury (ALI): protective ventilation strategies are therefore to be implemented. Locoregional techniques should be favored over intravenous analgesia: the thoracic epidural, the paravertebral block (PVB), the intercostal nerve block (ICNB), and the serratus anterior plane block (SAPB) are thoroughly reviewed and the most common dosages are reported. Fluid therapy needs to be administered critically, to avoid both overload and cardiovascular compromisation. All these practices are analyzed singularly with the aid of the most recent evidences aimed at the best patient care. Finally, a few notes on some of the latest trends in research are presented, such as non-intubated video-assisted thoracoscopic surgery (VATS) and intravenous lidocaine.
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Affiliation(s)
- Marzia Umari
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Stefano Falini
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Matteo Segat
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Michele Zuliani
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Marco Crisman
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Lucia Comuzzi
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Francesco Pagos
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Stefano Lovadina
- Department of General and Thoracic Surgery, Cattinara University Hospital, Trieste, Italy
| | - Umberto Lucangelo
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
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10
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Hwang J, Shin JS, Son JH, Min TJ. Non-intubated thoracoscopic bullectomy under sedation is safe and comfortable in the perioperative period. J Thorac Dis 2018; 10:1703-1710. [PMID: 29707324 DOI: 10.21037/jtd.2018.02.10] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Non-intubated thoracoscopic surgery can be performed under sedation using adjuvant regional anesthesia, however, the benefits of non-intubated thoracoscopic surgery under sedation have not yet been completely verified. In this study, we compare the perioperative safety and pain complaints of sedation without intubation in thoracoscopic bullectomy with that of conventional general anesthesia with double-lumen intubation and mechanical ventilation. Methods Forty-one patients with primary spontaneous pneumothorax who were scheduled for thoracoscopic bullectomy were enrolled in this study. Twenty-one patients were under sedation anesthesia (SA group) and 20 patients were under general anesthesia (GA group). In SA group, sedation was done with dexmedetomidine (a loading dose of 1 µg/kg for 10 min and then maintained in dosages of 0.3-1 µg/kg/h) and ketamine (2-4 mg/kg/h intraoperatively). Meanwhile, in GA group, induction with propofol and rocuronium, intubation with double lumen endotracheal tube and maintenance with 1.0-2.5% sevoflurane was done. In both groups, thoracoscopic bullectomy was performed in the same manner and all operations were conducted by single surgeon. Time for anesthesia [including emergence time and post-anesthesia care unit (PACU) recovery time] and operation, postoperative pain, sore throat, hoarseness, adverse events (nausea, vomiting, hypotension and bradycardia), dose of rescue analgesic drug used for 24 hours post-operatively and perioperative arterial blood gas analysis were recorded. Results The times for anesthesia, operation and emergence were significantly shorter in SA than GA. Incidence of sore throat were significantly lower in SA. The difference of other adverse events in the two groups was not significant. Conclusions Our study demonstrated that compared to double-lumen intubation with general anesthesia, non-intubation with sedation for bullectomy for primary spontaneous pneumothorax was safe and efficient to reduce perioperative time.
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Affiliation(s)
- Jinwook Hwang
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae Seung Shin
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Joo Hyung Son
- Korea University Post-Graduate School of Medicine, Seoul, Korea
| | - Too Jae Min
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, Korea
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11
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Bedetti B, Patrini D, Bertolaccini L, Crisci R, Solli P, Schmidt J, Scarci M. Uniportal non-intubated thoracic surgery. J Vis Surg 2018; 4:18. [PMID: 29445604 DOI: 10.21037/jovs.2017.12.09] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/07/2017] [Indexed: 11/06/2022]
Abstract
Uniportal video-assisted thoracoscopic surgery (VATS) is the most advanced evolution of the minimally invasive technique, which allows often the possibility to include patients in enhanced recovery programs in order to optimize the therapeutic pathway, shorten the length of stay and reduce hospital costs. Non-intubated VATS procedures allow the performance of surgeries with minimal sedation without general anesthesia, maintaining throughout the operation spontaneous breathing. The principle is to create an iatrogenic spontaneous pneumothorax, which can provide a good lung isolation without the need of a double lumen tube. A survey between the members of the European Society of Thoracic Surgery (ESTS) showed that non-intubated VATS procedures are already performed by a large number of ESTS members for minor procedures. With the publication of new data and the spreading of uniportal VATS in many centers worldwide in the last decades, the application of the non-intubated technique in major procedure like anatomic resections is expected to grow. This technique can potentially be beneficial for high-risk patients but also could be used for the routine procedures as well, but more data are needed to establish the real benefit for these groups of patients.
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Affiliation(s)
| | - Davide Patrini
- Department of Thoracic Surgery, University College of London Hospitals, London, UK
| | - Luca Bertolaccini
- Department of Thoracic Surgery, Bellaria and Maggiore Hospitals, Bologna, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, Mazzini Hospital, University of L'Aquila, Teramo, Italy
| | - Piergiorgio Solli
- Department of Thoracic Surgery, Bellaria and Maggiore Hospitals, Bologna, Italy
| | - Joachim Schmidt
- Department of Thoracic Surgery, Malteser Hospital, Bonn, Germany
| | - Marco Scarci
- Department of Thoracic Surgery, University College of London Hospitals, London, UK
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12
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Mineo TC, Ambrogi V. A glance at the history of uniportal video-assisted thoracic surgery. J Vis Surg 2017; 3:157. [PMID: 29302433 DOI: 10.21037/jovs.2017.10.11] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/03/2017] [Indexed: 01/26/2023]
Abstract
In the history of thoracic surgery, the advent of video-assisted thoracic surgery (VATS) had on effect equivalent to that provoked by a true revolution. VATS successfully allowed minor, major and complex procedures for various lung and mediastinal pathologies with small incision instead of the traditional accesses. These small incisions abolished ugly scars, generated less acute and chronic pain, reduced hospital stay and costs, allowed faster return to normal day life activities. Conventional VATS was initially performed through 3-4 ports and rapidly evolved to uniportal or single portal access [uniportal video-assisted thoracic surgery (uniVATS)]. First uniportal procedures were published in 2000. In 2010, uniportal technique for lobectomy was described. Focused experimental courses, live surgery events, the internet media favored the rapid diffusion of this technique over the world. Major and complex uniVATS lung resections involving segmentectomy, pneumonectomy, bronchoplasty and vascular reconstruction, redo VATS, en bloc chest wall resections have been accomplished with satisfactory outcomes. Interestingly, different uniportal approaches and techniques are emerging from a number of VATS centers particularly experienced in the mini-invasive thoracic surgery. As confidence grew, in 2014, the first uniVATS left upper lobectomy via the subxiphoid approach was reported. This novel technique is quite challenging but appropriate patient selection as well as availability of dedicated instruments allowed to perform procedures safely. The diffusion of uniVATS paralleled with the development of nonintubated awake anesthesia technique. In 2007 the first nonintubated lobectomy was described. In 2014 the first single port VATS lobectomy in a nonintubated patient with lung cancer of the right middle lobe was accomplished. The nonintubated uniVATS represents an intriguing technique, so that very experienced thoracoscopic surgeons may enroll to surgery elderly and high risk patients. Decreased postoperative pain and hospitalization, faster access to the radio-chemotherapy and diminished inflammatory response are important benefits of the modern approach to the thoracic pathologies. The history of uniVATS documented a constant and irresistible progress. This technique may further provide unthinkable surprises in next future.
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Affiliation(s)
- Tommaso Claudio Mineo
- Department of Surgery and Experimental Medicine, Official Group of Awake Thoracic Surgery Research, Policlinico Tor Vergata University, Rome, Italy
| | - Vincenzo Ambrogi
- Department of Surgery and Experimental Medicine, Official Group of Awake Thoracic Surgery Research, Policlinico Tor Vergata University, Rome, Italy.,Thoracic Surgery, Official Group of Awake Thoracic Surgery Research, Policlinico Tor Vergata University, Rome, Italy
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13
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Peng G, Liu M, Luo Q, Chen H, Yin W, Wang W, Huang J, Qiu Y, Guo Z, Liang L, Dong Q, Xu X, He J. Spontaneous ventilation anesthesia combined with uniportal and tubeless thoracoscopic lung biopsy in selected patients with interstitial lung diseases. J Thorac Dis 2017; 9:4494-4501. [PMID: 29268519 DOI: 10.21037/jtd.2017.10.76] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background The current guidelines emphasize the significant role of video-assisted thoracic surgical lung biopsy (VATS-LB) for a definite diagnosis of interstitial lung diseases (ILD), but they also encourage physicians to maintain the balance between the surgical benefits as well as risks. Both spontaneous ventilation video-assisted thoracic surgery (VATS) and uniportal VATS have emerged as remarkable progresses in VATS. We combined these two types of VATS and refined them to uniportal spontaneous ventilation VATS without urinary catheterization and chest tube drainage [uniportal and tubeless VATS (UT-VATS)] to perform LB in selected patients with ILD. Methods From January 2014 to May 2015, 43 patients were included in the study. The surgical data was retrospectively analyzed. Results The mean diffusion capacity for carbon monoxide (DLCO) of patients was 57.6%±13.0%, forced vital capacity (FVC) was 73.1%±17.0%. There was no 30-day mortality. No patient required a switch to intubated anesthesia. The mean age was 49.6±10.7 years. The general median operative duration was 22±5 minutes, with 25±3 minutes for multiple specimens and 15±2 minutes for single specimen, respectively. Intra-operative conversion to 2-portal VATS followed by chest tube drainage and urinary catheterization occurred in 3 (7.0%) patients due to extensive pleural adhesion, and postoperative chest tube insertion was documented in 1 (2.3%) patient due to subcutaneous emphysema. No postoperative mechanical ventilation was noted. Precise histopathological diagnosis was achieved in 38 (88.4%) patients. Conclusions Uniportal and tubeless thoracoscopic LB using spontaneous ventilation anesthesia can be considered a feasible and safe operation method for selected patients with ILD.
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Affiliation(s)
- Guilin Peng
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Mengyang Liu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Qun Luo
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,Department of Respiratory, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Hanzhang Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Weiqiang Yin
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wei Wang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jun Huang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yuan Qiu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Zhihua Guo
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Lixia Liang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Qinglong Dong
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xin Xu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jianxing He
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
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Abstract
Surgical treatment for lung cancer including airway resection following reconstruction is typically performed under general anesthesia with single-lung ventilation because it is necessary to maintain a sufficient working space and to adjust the airway pressure for the leak test. However, non-intubated thoracic surgery has been gradually developed in recent years for thoracoscopic surgery, due to its lower rate of postoperative complications, shorter hospitalization duration, and lower invasiveness than the usual single-lung anesthesia. Initially, only minor thoracoscopic surgery, including wedge resection for pneumothorax and the diagnosis of solitary pulmonary nodules, was performed under waking anesthesia. However, major thoracoscopic surgery, including segmentectomy and lobectomy, has also been performed under these conditions in some institutions due to its advantages with respect to the postoperative recovery and in-operating room time. In addition, non-intubated thoracic surgery has been performed for tracheal resection followed by reconstruction to fully explore the advantages of this surgical modality. In this article, the merits and demerits of non-intubated thoracoscopic surgery and the postoperative complications, perioperative problems and optimum selection criteria for patients for thoracic surgery (mainly airway surgery) are discussed.
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Affiliation(s)
- Katsuhiro Okuda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Ryoichi Nakanishi
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
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15
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Cui F, Liu J, Li S, Yin W, Xin X, Shao W, He J. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively. J Thorac Dis 2016; 8:2226-32. [PMID: 27621880 DOI: 10.21037/jtd.2016.08.02] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To assess the feasibility and safety of tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of a chest tube postoperatively compared with VATS under intubated anesthesia with single-lung mechanical ventilation. METHODS A total of 91 patients undergoing tubeless VATS (60 sympathectomies, 22 bullae resections, and 9 mediastinal tumor resections) between December 2012 and December 2015 were included. Additionally, 82 patients were treated by VATS by the same team while under intubated general anesthesia (52 sympathectomies, 19 bullae resections, and 11 mediastinal tumor resections). Comprehensive early outcome data, including intraoperative and postoperative variables, were compared between the subgroups. RESULTS In total, 89 patients in the tubeless group underwent an effective operation and exhibited good postoperative recovery, while 2 (one sympathectomy and one bullae resection) had their operation aborted for some reason. The tubeless group showed advantages in the postoperative fasting time, the mean duration of the postoperative hospital stay, and postoperative pain scores, while no significant difference was found in intraoperative blood loss, the operation time or postoperative complications between the tubeless group and the intubated group. Furthermore, 83% (49/59) of sympathectomies, 81% (17/21) of bullae resections, and 56% (5/9) of mediastinal tumor resections were achieved via day surgery. CONCLUSIONS In this study, our experience has shown that tubeless VATS is a safe and feasible surgery with certain advantages in selected patients with thoracic disease and that we can achieve day surgery in these cases.
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Affiliation(s)
- Fei Cui
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Jun Liu
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Shuben Li
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Weiqiang Yin
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Xu Xin
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Wenlong Shao
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Jianxing He
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
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16
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He J. [Comprehensive Treatment for Lung Cancer
Based on Minimally Invasive Thoracic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:329-31. [PMID: 27335290 PMCID: PMC6015200 DOI: 10.3779/j.issn.1009-3419.2016.06.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
当今可切除肺癌的治疗已发展成为以微创外科为中心的综合治疗。微创肺癌外科不光表现为切口的缩小,更表现在切口的个体化、精细化。同时,微创外科手术的其它一系列的微创化,如麻醉的微创化(如不插管),又如裸眼3D胸腔镜为代表的手术器械的微创化、精细化与个体化等。即便是晚期肺癌的患者也因从手术中得到更多组织基因的信息而得到更精准的治疗。因此当今肺癌的治疗应该是微创胸外科为核心的综合治疗。
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Affiliation(s)
- Jianxing He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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17
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Dai X, Song P, Zhang B. [Application of Non-intubated Anesthesia in VATS]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:312-6. [PMID: 27215461 PMCID: PMC5973052 DOI: 10.3779/j.issn.1009-3419.2016.05.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
气管插管全麻技术可提高手术安全性,因此在电视胸腔镜手术(video-assisted thoracic surgery, VATS)中得到广泛应用,但气管插管的并发症却无法避免。如何发展一种“整体微创”手术(包括麻醉微损伤),已经成为微创胸外科领域的一个研究热点。随着麻醉管理技术与对手术风险管理的进步,非气管插管技术成功应用于VATS,即采用局部麻醉以维持患者的术中自主通气,术中仅需轻微镇静或者完全清醒的状态下实施VATS,因而又称清醒状态下VATS。此麻醉方式不但减少气管插管的麻醉损伤,而且符合快速康复外科的理念。本文对非气管插管应用在胸外科VATS中的发展简史、麻醉选择、手术优势、手术风险及管理、面临的问题等方面作一综述。
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Affiliation(s)
- Xiaotan Dai
- School of Medicine and Life Sclences, University of Jinan, Jinan 250117, China
| | - Pingping Song
- School of Medicine and Life Sclences, University of Jinan, Jinan 250117, China
| | - Baijiang Zhang
- Shandong Academy of Medical Sciences, Jinan 250117, China
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18
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Guo Z, Yin W, Pan H, Zhang X, Xu X, Shao W, Chen H, He J. Video-assisted thoracoscopic surgery segmentectomy by non-intubated or intubated anesthesia: a comparative analysis of short-term outcome. J Thorac Dis 2016; 8:359-68. [PMID: 27076930 DOI: 10.21037/jtd.2016.02.50] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The aim of this study was to reveal the short-term outcomes of video-assisted thoracoscopic surgery (VATS) segmentectomy without tracheal intubation compared with intubated general anesthesia with one-lung ventilation (OLV). METHODS We performed a retrospective review of our institutional database of consecutive 140 patients undergoing VATS anatomical segmentectomy from July 2011 to June 2015. Among them, 48 patients were treated without tracheal intubation using a combination of thoracic epidural anesthesia (TEA), intrathoracic vagal blockade, and sedation (non-intubated group). The other 92 patients were treated with intubated general anesthesia (intubated group). Safety and feasibility was evaluated by comparing the perioperative profiles and short-term outcomes of these two groups. RESULTS Two groups had comparable surgical durations, intraoperative blood loss, postoperative chest tube drainage volume, and numbers of dissected lymph nodes (P>0.05). Patients who underwent non-intubated segmentectomy had higher peak end-tidal carbon dioxide (EtCO2) during operation (44.81 vs. 33.15 mmHg, P<0.001), less white blood cell changes before and after surgery (△WBC) (6.08×10(9) vs. 7.75×10(9), P=0.004), earlier resumption of oral intake (6.76 vs. 17.58 hours, P<0.001), shorter duration of postoperative chest tube drainage (2.25 vs. 3.16 days, P=0.047), less cost of anesthesia (¥5,757.19 vs. ¥7,401.85, P<0.001), and a trend toward shorter postoperative hospital stay (6.04 vs. 7.83 days, P=0.057). One patient (2.1%) in the non-intubated group required conversion to intubated OLV since a significant mediastinal movement. In the intubated group, there was one patient (1.1%) required conversion to thoracotomy due to uncontrolled bleeding. The incidence difference of postoperative complications between groups was not significant (P=0.248). There was no in-hospital death in either group. CONCLUSIONS Compared with intubated general anesthesia, non-intubated thoracoscopic segmentectomy is a safe, technically feasible and economical alternative with comparable short-term outcomes. Patients underwent non-intubated thoracoscopic segmentectomy could gain a prompt recovery.
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Affiliation(s)
- Zhihua Guo
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Weiqiang Yin
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hui Pan
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Xin Zhang
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Xin Xu
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wenlong Shao
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hanzhang Chen
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jianxing He
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
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19
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Irons JF, Martinez G. Anaesthetic considerations for non-intubated thoracic surgery. J Vis Surg 2016; 2:61. [PMID: 29078489 DOI: 10.21037/jovs.2016.02.22] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 02/03/2016] [Indexed: 12/18/2022]
Abstract
General anaesthesia with intubation and single lung ventilation has always been considered essential for thoracic surgery. Over the last decade there has been a huge evolution in thoracic surgery with the development of multiport and uniportal minimally invasive techniques. The development of a non-intubated technique during which thoracic surgery is performed on patients who are spontaneously ventilating awake, under minimal sedation with the aid of local or regional anaesthesia or under general anaesthesia with a supraglottic airway device is winning acceptance as a valid alternative technique. The concept is to allow the creation of a spontaneous pneumothorax as the surgeon enters the chest. This can provide excellent lung isolation without the need for positive pressure ventilation on the dependant lung. Awake and minimal sedation techniques, which avoid the need for general anaesthesia, maintain a more physiological cardiopulmonary and neurological status and avoid postoperative nausea and vomiting. However, general anaesthesia with a supraglottic airway device is the technique that provides a more stable airway and facilitates oxygenation in cases where an unexpected conversion to open thoracotomy in needed. For non-intubated thoracic surgery a regional analgesic technique is essential; nonetheless a 'multimodal' approach to analgesia is recommended. Non-intubated anaesthetic techniques for thoracic surgery are innovative and exciting and drive to reduce the invasiveness of the procedures. We recommend that centres starting out with non-intubated techniques begin by performing minor video-assisted thoracic surgery (VATS) procedures in selected low risk patients. Early elective conversion should be employed in any unexpected surgical difficulty or cardiopulmonary problem during the learning curve to reduce the risk of emergency conversion and complications. Further research is needed to establish which patients benefit more from the technique and what is the real impact on perioperative mortality and morbidity.
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Affiliation(s)
- Joanne Frances Irons
- Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Guillermo Martinez
- Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, UK
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20
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He J, Wang W, Li J, Yin W, Xu X, Peng G, Chen Y, He P. Video-assisted thoracoscopic surgery tracheal resection and carinal reconstruction for tracheal adenoid cystic carcinoma. J Thorac Dis 2016; 8:198-203. [PMID: 26904230 DOI: 10.3978/j.issn.2072-1439.2016.01.45] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
We report a case of video-assisted thoracoscopic surgery (VATS) tracheal resection and carinal reconstruction in a patient with tracheal tumor. The patient presented with adenoid cystic carcinoma (ACC) of the distal trachea, extending along the right main bronchus with carinal invasion. The reconstruction procedure was assisted with cross-field ventilation. Postoperative clinical course of this case was good. The forced expiratory volume in the first second (FEV1) improved from 0.461 L (17% pred.) to 2.31 L (87% pred.) 1 month after the operation. VATS tracheal resection and carinal reconstruction is a feasible option for patients with tracheal tumor with carina involvement.
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Affiliation(s)
- Jianxing He
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Pathology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Wei Wang
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Pathology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jingpei Li
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Pathology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Weiqiang Yin
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Pathology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xin Xu
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Pathology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Guilin Peng
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Pathology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Youping Chen
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Pathology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Ping He
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Pathology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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21
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Kiss G, Castillo M. Nonintubated anesthesia in thoracic surgery: general issues. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:110. [PMID: 26046051 DOI: 10.3978/j.issn.2305-5839.2015.04.21] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 04/22/2015] [Indexed: 12/19/2022]
Abstract
Anesthetic management for awake thoracic surgery (ATS) is more difficult than under general anesthesia (GA), being technically extremely challenging for the anesthesiologist. Therefore, thorough preparation and vigilance are paramount for successful patient management. In this review, important considerations of nonintubated anesthesia for thoracic surgery are discussed in view of careful patient selection, anesthetic preparation, potential perioperative difficulties and the management of its complications.
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Affiliation(s)
- Gabor Kiss
- 1 Department of Cardiovascular and Thoracic Surgery, Anaesthesia and Surgical Intensive Care, University Hospital of Lille, Lille, France ; 2 Department of Anesthesiology, Icahn School of Medicine, Mount Sinai Medical Center, New York, USA
| | - Maria Castillo
- 1 Department of Cardiovascular and Thoracic Surgery, Anaesthesia and Surgical Intensive Care, University Hospital of Lille, Lille, France ; 2 Department of Anesthesiology, Icahn School of Medicine, Mount Sinai Medical Center, New York, USA
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22
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Liu YJ, Hung MH, Hsu HH, Chen JS, Cheng YJ. Effects on respiration of nonintubated anesthesia in thoracoscopic surgery under spontaneous ventilation. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:107. [PMID: 26046048 DOI: 10.3978/j.issn.2305-5839.2015.04.15] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 04/16/2015] [Indexed: 11/14/2022]
Abstract
Thoracoscopic surgery without tracheal intubation [nonintubated video-assisted thoracoscopic surgery (VATS)] is an emerging treatment modality for a wide variety of thoracic procedures. By surgically induced open pneumothorax, the operated lung collapse progressively while the dependent lung is responsible for sufficiency of respiratory function, including oxygenation and ventilation. Encouraging results showed that ventilatory changes and oxygenation could be adequately maintained in major lung resection surgery and in patients with impaired respiratory function. In spite of a relative hypoventilation, mild hypercapnia is inevitable but clinically well tolerated. An understanding the respiratory physiology during surgical pneumothorax, either in awake or sedative status, and an established protocol for conversion into tracheal intubation are essential for patient safety during nonintubated VATS.
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Affiliation(s)
- Ying-Ju Liu
- 1 Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30059, Taiwan ; 2 Department of Anesthesiology, 3 Graduate Institute of Clinical Medicine, 4 Division of Thoracic Surgery, Department of Surgery, 5 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - Ming-Hui Hung
- 1 Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30059, Taiwan ; 2 Department of Anesthesiology, 3 Graduate Institute of Clinical Medicine, 4 Division of Thoracic Surgery, Department of Surgery, 5 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - Hsao-Hsun Hsu
- 1 Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30059, Taiwan ; 2 Department of Anesthesiology, 3 Graduate Institute of Clinical Medicine, 4 Division of Thoracic Surgery, Department of Surgery, 5 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - Jin-Shing Chen
- 1 Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30059, Taiwan ; 2 Department of Anesthesiology, 3 Graduate Institute of Clinical Medicine, 4 Division of Thoracic Surgery, Department of Surgery, 5 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - Ya-Jung Cheng
- 1 Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30059, Taiwan ; 2 Department of Anesthesiology, 3 Graduate Institute of Clinical Medicine, 4 Division of Thoracic Surgery, Department of Surgery, 5 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
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23
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Liu J, Cui F, He J. Non-intubated video-assisted thoracoscopic surgery anatomical resections: a new perspective for treatment of lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:102. [PMID: 26046043 DOI: 10.3978/j.issn.2305-5839.2015.04.18] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/19/2015] [Indexed: 11/14/2022]
Abstract
The lung isolation under general anaesthesia with double lumen tubes has become an indispensable part of video-assisted thoracoscopic surgery (VATS) for lung cancer. However, with an attempt to avoid the residual effects of muscle relaxants and the systemic complications due to tracheal intubation, anesthesia without tracheal intubation has also been applied in VATS surgeries for lung cancer. Currently, non-intubated anesthesia under spontaneous breathing has been widely applied in VATS, contributing to more stable anesthesia and lower rate of switching to intubated anesthesia. It can be applied in most VATS procedures including anatomical pulmonary lobectomy, anatomical segmentectomy, and radical resection for lung cancer. In the selected lung cancer patients, non-intubated anesthesia under spontaneous breathing makes the VATS procedures safer and more feasible. With an equal chance for surgery as the intubated anesthesia, this technique lowers the incidences of peri-operative complications and speeds up post-operative recovery. As a novel surgical option, the anatomic VATS under non-intubated anesthesia under spontaneous breathing have shown to be promising. Nevertheless, the long-term outcomes require further evaluation in more multi-center prospective clinical trials with larger sample sizes.
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Affiliation(s)
- Jun Liu
- 1 Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Fei Cui
- 1 Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jianxing He
- 1 Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
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24
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Wang L, Wang Y, Lin S, Yin P, Xu Y. Nursing for the complete VATS lobectomy performed with non-tracheal intubation. J Thorac Dis 2014; 6:1007-10. [PMID: 25093100 DOI: 10.3978/j.issn.2072-1439.2014.06.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/02/2014] [Indexed: 11/14/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) has without doubt been the most important advance in thoracic surgery. The general anesthesia before the tracheal intubation for VATS was often accompanied with tracheal mucosa and lung injuries, which were typically manifested as painful throat, nausea, vomiting, and other symptoms. However, the non-intubated anesthesia VATS can avoid these shortcomings due to its shorter anesthesia time, simpler steps, and quicker post-operative recovery. A total of 63 patients underwent VATS lobectomy under non-intubated anesthesia from July 2012 to July 2013. Good teamwork, proper pre-operative visit, and comfortable intra-operative position had ensured the success of these operations. In conclusion, adequate pre-operative preparation, careful nursing, and close cooperation can achieve a successful non-intubated anesthesia VATS.
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Affiliation(s)
- Li Wang
- Operation Room, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yidong Wang
- Operation Room, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Suihong Lin
- Operation Room, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Pengying Yin
- Operation Room, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yanwen Xu
- Operation Room, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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25
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Affiliation(s)
- Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan, University College of Medicine, Taipei 10002, Taiwan
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