Arterial Oxygenation and Management of Hypoxemia During VATS

Walsh, Abigail; Lohser, Jens

doi:10.1007/s40140-014-0051-z

Cited by 8 publications

(6 citation statements)

References 57 publications

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“…In 20% of 2,015 patients that required lung isolation through a DLT, we recorded at least one episode of desaturation during OLV. The incidence in the literature varies from 27% of the 1970s-1990s (23,24) to 5-10% of the most recent studies of Walsh et al (25). This remarkable difference can be explained by the improving expertise, the new surgical and anesthetic techniques, including the use of BRO, newer volatile anesthetics that cause less inhibition of hypoxic pulmonary vasoconstriction (HPV) during OLV (26), and less invasive thoracic surgery.…”

Section: Discussionmentioning

confidence: 99%

Airway management in anesthesia for thoracic surgery: a “real life” observational study

Langiano¹,

Fiorelli²,

Deana³

et al. 2019

J. Thorac. Dis.

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Background: One-lung ventilation (OLV) in thoracic anesthesia is required to provide good surgical exposure. OLV is commonly achieved through a double lumen tube (DLT) or a bronchial blocker (BB). Malposition is a relevant issue related to these devices use. No prospective studies with adequately large sample size have been performed to evaluate the malposition rate of DLTs and BBs. Methods: A total of 2,127 patients requiring OLV during thoracic surgery were enrolled. The aim of this multicenter prospective observational study performed across 26 academic and community hospitals is to evaluate intraoperative malposition rate of DLTs and BBs. We also aim to assess: which device is the most used to achieve OLV, the frequency of bronchoscope (BRO) use, the incidence rate of desaturation during OLV and the role of other factors that can correlate to this event, and incidence of difficult airway. Results: Malposition rate for DLTs was 14%, for BBs 33%. DLTs were used in 95% of patients and BBs in 5%. Mean positioning time was shorter for DLT than BB (156±230 vs. 321±290 s). BRO was used in 54% of patients to check the correct positioning of the DLT. Desaturation occurred in 20% of all cases during OLV achieved through a DLT. Predicting factors of desaturation were dislocation (OR 2.03) and big size of DLT (OR 1.15). BRO use (OR 0.69) and left surgical side (OR 0.41) proved to be protective factors. Difficult

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Section: Discussionmentioning

confidence: 99%

Airway management in anesthesia for thoracic surgery: a “real life” observational study

Langiano¹,

Fiorelli²,

Deana³

et al. 2019

J. Thorac. Dis.

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“…Results showed that the NIVATS and IVATS groups did not experience desaturation. In previous studies, the incidence of desaturation during OLV via the tube was between 4% and 20% (13)(14)(15) .…”

Section: Discussionmentioning

confidence: 94%

Perioperative Outcomes of Non-intubated Versus Intubated Video-assisted Thoracoscopic Surgery in Different Thoracic Procedures: a Propensity Score-matched Analysis

Pathonsamit

Tantraworasin

Poopipatpab

et al. 2021

Preprint

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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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“…Results showed that the NIVATS and IVATS groups did not experience desaturation. In previous studies, the incidence of desaturation during OLV via the tube was between 4 and 20% [ 13 – 15 ].…”

Section: Discussionmentioning

confidence: 99%

Perioperative outcomes of non-intubated versus intubated video-assisted thoracoscopic surgery in different thoracic procedures: a propensity score-matched analysis

et al. 2022

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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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Arterial Oxygenation and Management of Hypoxemia During VATS

Cited by 8 publications

References 57 publications

Airway management in anesthesia for thoracic surgery: a “real life” observational study

Airway management in anesthesia for thoracic surgery: a “real life” observational study

Perioperative Outcomes of Non-intubated Versus Intubated Video-assisted Thoracoscopic Surgery in Different Thoracic Procedures: a Propensity Score-matched Analysis

Perioperative outcomes of non-intubated versus intubated video-assisted thoracoscopic surgery in different thoracic procedures: a propensity score-matched analysis

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