Consideraciones anestésicas para cirugía torácica videoasistida (VATS) sin intubación
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Anesthetic consideration for nonintubated VATS
Jen-Ting Yang, Ming-Hui Hung, Jin-Shing Chen, Ya-Jung Cheng
Department of Anesthesiology, Graduate Institute of Clinical Medicine, Division of Thoracic Surgery, Division of Experimental Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Corresponding to: Ya-Jung Cheng, MD, PhD. Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; 7, Chung-Shan South Road, Taipei 10002, Taiwan. Email: chengyj@ntu.edu.tw.
Abstract:
In the recent decade, nonintubated-intubated video-assisted thoracoscopic surgery (VATS) has been extensively performed and evaluated. The indicated surgical procedures and suitable patient groups are steadily increasing. Perioperative anesthetic management presents itself as a fresh issue for the iatrogenic open pneumothorax, which is intended for unilateral lung collapse to create a steady surgical field, and the ensuing physiologic derangement involving ventilatory and hemodynamic perspectives. With appropriate monitoring, meticulous employment of regional anesthesia, sedation, vagal block, and ventilatory support, nonintubated VATS is proved to be a safe alternative to the conventional intubated general anesthesia.
Keywords: Anesthesia; thoracoscopy; nonintubated; thoracic epidural anesthesia (TEA); intercostal nerve block; bispectral inde
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Cirugía toracoscópica sin intubación: Estado del arte y direcciones futuras
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Nonintubated thoracoscopic surgery: state of the art and future directions.
Hung MH, Hsu HH, Cheng YJ, Chen JS.
Author information
J Thorac Dis. 2014 Jan;6(1):2-9.
Abstract
Video-assisted thoracoscopic surgery (VATS) has become a common and globally accepted surgical approach for a variety of thoracic diseases. Conventionally, it is performed under tracheal intubation with double lumen tube or bronchial blocker to achieve single lung ventilation. Recently, VATS without tracheal intubation were reported to be feasible and safe in a series of VATS procedures, including management of pneumothorax, wedge resection of pulmonary tumors, excision of mediastinal tumors, lung volume reduction surgery, segmentectomy, and lobectomy. Patients undergoing nonintubated VATS are anesthetized using regional anesthesia in a spontaneously single lung breathing status after iatrogenic open pneumothorax. Conscious sedation is usually necessary for longer and intensively manipulating procedures and intraoperative cough reflex can be effectively inhibited with intrathoracic vagal blockade on the surgical side. The early outcomes of nonintubated VATS include a faster postoperative recovery and less complication rate comparing with its counterpart of intubated general anesthesia, by which may translate into a fast track VATS program. The future directions of nonintubated VATS should focus on its long-term outcomes, especially on oncological perspectives of survival in lung cancer patients. For now, it is still early to conclude the benefits of this technique, however, an educating and training program may be needed to enable both thoracic surgeons and anesthesiologists providing an alternative surgical option in their caring patients.
KEYWORDS:Thoracoscopy, intubation, anesthesia, intercostal nerve block, lung cancer, thoracic epidural anesthesia
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| Cirugía toracoscópica sin intubación usando anestesia regional, bloqueo vagal y sedación diana |
Nonintubated thoracoscopic surgery using regional anesthesia and vagal block and targeted sedation
Ke-Cheng Chen, Ya-Jung Cheng, Ming-Hui Hung, Yu-Ding Tseng, Jin-Shing Chen
J Thorac Dis. 2014 Jan;6(1):31-6. doi: 10.3978/j.issn.2072-1439.2014.01.01.
Abstract
OBJECTIVE: Thoracoscopic surgery without endotracheal intubation is a novel technique for diagnosis and treatment of thoracic diseases. This study reported the experience of nonintubated thoracoscopic surgery in a tertiary medical center in Taiwan. METHODS: From August 2009 through August 2013, 446 consecutive patients with lung or pleural diseases were treated by nonintubatedthoracoscopic surgery. Regional anesthesia was achieved by thoracic epidural anesthesia or internal intercostal blockade. Targeted sedation was performed with propofol infusion to achieve a bispectral index value between 40 and 60. The demographic data and clinical outcomes were evaluated by retrospective chart review. RESULTS: Thoracic epidural anesthesia was used in 290 patients (65.0%) while internal intercostal blockade was used in 156 patients (35.0%). The final diagnosis were primary lung cancer in 263 patients (59.0%), metastatic lung cancer in 38 (8.5%), benign lung tumor in 140 (31.4%), and pneumothorax in 5 (1.1%). The median anesthetic induction time was 30 minutes by thoracic epidural anesthesia and was 10 minutes by internal intercostal blockade. The operative procedures included lobectomy in 189 patients (42.4%), wedge resection in 229 (51.3%), and segmentectomy in 28 (6.3%). Sixteen patients (3.6%) required conversion to tracheal intubation because of significant mediastinal movement (seven patients), persistent hypoxemia (two patients), dense pleural adhesions (two patients), ineffective epidural anesthesia (two patients), bleeding (two patients), and tachypnea (one patient). One patient (0.4%) was converted to thoracotomy because of bleeding. No mortality was noted in our patients. CONCLUSIONS:
Nonintubated thoracoscopic surgery is technically feasible and safe and can be a less invasive alternative for diagnosis and treatment of thoracic diseases.
KEYWORDS: Anesthesia, lobectomy, lung cancer, segmentectomy, thoracoscopy, tracheal intubation, wedge resection
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