Compared with ETT, the application of LMA for general anaesthesia may demonstrate promising advantages in airway management for the VATS-NUSS procedure.

Background:The aim of the present study was to determine the safety and feasibility of the use of laryngeal mask airway (LMA) for non-endotracheal intubated anesthesia for patients with pectus excavatum (PE) undergoing thoracoscopic Nuss procedure.Methods: Between July 2015 and December 2015, 30 selected patients with PE were planned to undergo a thoracoscopic Nuss procedure using LMA for non-endotracheal intubated anesthesia in the Guangdong General Hospital. The clinical data were analyzed to evaluate the safety and feasibility of this technique.Results: Of the 30 selected patients, two were female, the mean age was 16.04±5.09 years and the average Haller index was 3.37±0.88. A total of 27 cases (90%) succeeded at the first attempt, one patient required conversion to an endotracheal tube (ETT) because of continuous air leak. The peripheral O 2 saturation (SpO 2 ), end-tidal carbon dioxide (EtCO 2 ) values, heart rate (HR), and mean arterial blood pressure (MAP) remained stable throughout the procedure in all cases. All of the 30 patients were successfully corrected without requiring conversion to an open surgery. Two patients experienced postoperative nausea and one reported a sore throat. Neither gastro-esophageal reflux nor in-hospital mortality occurred. Conclusions:The use of LMA for non-endotracheal intubated anesthesia for selected patients with PE undergoing thoracoscopic Nuss procedure is clinically safe and technically feasible. as intubation-related trauma, increased risk of pneumonia, impaired cardiac performance, postoperative nausea and voice hoarseness, have prompted some surgeons to prefer the thoracoscopic procedure under non-endotracheal intubated anesthesia. The laryngeal mask airway (LMA) is a relatively new device that was introduced to clinical practice in the 1980s. Unlike ETT, the LMA is supraglottic and usually inserted blindly, thereby avoiding laryngoscopy. Therefore, it inevitably causes less intubation-related adverse events, such as vomiting, cough, hoarseness, sore throat, increased risk of pneumonia and impaired cardiac performance.Considering these benefits, the choice of thoracoscopic Nuss procedure in combination with non-endotracheal intubated anesthesia could have the latent possibility of decreasing the invasiveness of the procedure and allowing quicker postoperative recovery. Therefore, we conducted the present study to determine the safety and feasibility of using the LMA for non-endotracheal intubated anesthesia for patients with PE undergoing the thoracoscopic Nuss procedure. Methods Patient recruitmentThe study was designed as a pilot study and approved by the Human Ethics Committee of Guangdong General Hospital (Guangzhou, China). Written informed consent was obtained from the parents or legal guardians after they had been informed about the investigational nature of the study, the differences between LMA and ETT, the possibility that require conversion to an ETT may be necessary during the procedure, and the foreseeable outcomes. Eligibility criteria included a de...

Despite the complex vascular effects of dexmedetomidine (DEX), its actions on human pulmonary resistance arteries remain unknown. The present study tested the hypothesis that DEX inhibits vascular tension in human pulmonary arteries through the endothelial nitric oxide synthase (eNOS) mediated production of nitric oxide (NO). Pulmonary artery segments were obtained from 62 patients who underwent lung resection. The direct effects of DEX on human pulmonary artery tension and changes in vascular tension were determined by isometric force measurements recorded on a myograph. Arterial contractions caused by increasing concentrations of serotonin with DEX in the presence or absence of L-NAME (endothelial nitric oxide synthase inhibitor), yohimbine (α2-adrenoceptor antagonist) and indomethacin (cyclooxygenase inhibitor) as antagonists were also measured. DEX had no effect on endothelium-intact pulmonary arteries, whereas at concentrations of 10–8~10–6 mol/L, it elicited contractions in endothelium-denuded pulmonary arteries. DEX (0.3, 1, or 3×10–9 mmol/L) inhibited serotonin-induced contraction in arteries with intact endothelium in a dose-dependent manner. L-NAME and yohimbine abolished DEX-induced inhibition, whereas indomethacin had no effect. No inhibitory effect was observed in endothelium-denuded pulmonary arteries. DEX-induced inhibition of vasoconstriction in human pulmonary arteries is mediated by NO production induced by the activation of endothelial α2-adrenoceptor and nitric oxide synthase.