Non-Intubated Video-Assisted Thoracoscopic Surgery

Summary

Here, we present a non-intubated protocol for performing video-assisted thoracoscopic surgery with preserved autonomic breathing.

Abstract

Double-lumen intubation under general anesthesia is currently the most commonly performed intubation technique for pneumonectomy, wedge resection of the lung, and lobectomy. However, there is a high incidence of pulmonary complications arising from general anesthesia with tracheal intubation. Non-intubation with the preservation of voluntary breathing is an alternative to anesthesia. Non-intubation procedures minimize the adverse effects of tracheal intubation and general anesthesia, such as intubation-related airway trauma, ventilation-induced lung injury, residual neuromuscular blockade, and post-operative nausea and vomiting. However, the steps for non-intubation procedures are not detailed in many studies. Here, we present a concise non-intubated protocol for the performance of video-assisted thoracoscopic surgery with preserved autonomic breathing. This article identifies the conditions necessary to convert from non-intubated to intubated anesthesia and also discusses the advantages and limitations of non-intubated anesthesia. In this work, this intervention was performed on 58 patients. In addition, the results of a retrospective study are presented. Compared with intubated general anesthesia, patients in the non-intubated video-assisted thoracic surgery group had lower rates of post-operative pulmonary complications, shorter operative times, less intraoperative blood loss, shorter PACU stays, a lower number of days to chest drain removal, less post-operative drainage, and shorter hospital stays.

Introduction

In the past decade, non-intubated video-assisted thoracic surgery (NIVATS) anesthesia has gradually been accepted in clinical practice^1,2,3. Although this novel strategy enhances the rapid recovery of patients and avoids the complications of general anesthesia (GA) and one-lung ventilation⁴, many surgeons regard this approach as less desirable than the traditional lung isolation technique.

Blood oxygen levels decline with age, and some patients may have decreased or borderline pulmonary function. GA may be associated with an....

Protocol

The study was approved by the Ethics Committee of the Affiliated Hospital of Ningbo University School of Medicine (KY20181215) on December 10, 2018.

1. Inclusion criteria

1. Include all patients (aged >18 years) undergoing pulmonary bullae resection, pulmonary wedge resection, or lobectomy.

2. Exclusion criteria

1. Exclude patients based on an American Society of Anesthesiologists (ASA) physical status c.......

Discussion

The advantages of this protocol are as follows: (i) providing a sevoflurane inhalation anesthesia regimen to reduce the cough reflex during thoracoscopic surgery; (ii) minimizing over-sedation while providing a safe and pain-free operating environment for patients undergoing thoracic surgery; (iii) minimizing the patient's spontaneous breathing and mediastinal oscillations during the procedure, taking into account the associated technical challenges. This was achieved by providing pre-emptive intraoperative local ane.......

Materials

Name	Company	Catalog Number	Comments
20-G top-winged infusion needle	BD Intima II	383012	Puncture with a 20-G top-winged infusion needle into the dorsal vein of the non-operative side of the hand.
24-G top-winged infusion needle	BD Intima II	383033	Thoracoscopic vagal block techniques
Anesthesia machine	Drager	A300	Maintenance of respiratory function; Inhalation anesthesia; Monitor for electrocardiography, blood pressure, pulse oxygen saturation (SpO2), end-tidal carbon dioxide and respiratory rate
Atropine	Jiuquan Dadeli Pharma	H62020772	Control of heart rate
BIS	COVIDIEN	B277243	Monitor the level of consciousness
Disposable nerve block needle	Tuoren Medical Device	202303007	Nerve block
Facial mask	Emedica	EM01-105S	Provides an effective non-invasive breathing circuit
Fentanyl.	Renfu Pharma	21D04021	Analgesia
Flurbiprofen	Daan Pharma	H20183054	Analgesia
Laryngeal mask	Ambu Aura-i	2012-2664652	Airway management to preserve voluntary breathing
Levobupivacaine	Rundu Pharma	H20050403	Local Anaesthesia
Lidocaine	Kelun Pharma	F221129C	Local skin infiltration
Norepinephrine	Lijun Pharma	H61021666	Control of blood pressure
Portable color doppler ultrasound	SonoSite	M-Turbo	Guided nerve block
Propofol	Guorui Pharma	H20030114	Sedation and hypnosis
Ropivacaine	Aspen Pharma	6091403219940	Paravertebral nerve block
Saline	Kelun Pharma	c221201E1	Assisted subsonic localisation
Sevoflurane	Shanghai Hengrui Pharmaceutical Co.,Ltd	9081931	Anesthesia induction and maintenance
Sufentanil	Jiangsu Enhua Pharmaceutical Co., Ltd	H20203650	Postoperative analgesia