Management of Intraoperative Crisis During Nonintubated Thoracic Surgery

Navarro-Martínez, José; Galiana-Ivars, María; Rivera-Cogollos, María Jesús; Gálvez, Carlos; Nadal, Sergio Bolufer; Lamaignère, Marta Ortega; Mazo, Elena Díez

doi:10.1016/j.thorsurg.2019.08.009

Cited by 9 publications

(8 citation statements)

References 23 publications

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“…After reviewing related articles, very few references to lateral DLT intubation can be found. Martinez et al [36] mentioned in their article that an essential and unique issue for non-intubated thoracic surgery (NIVATS) was the mastering of lateral position intubation for emergencies. Patients in NIVATS were likely require to DLT intubation, and lateral intubation was not difficult according to their experiences.…”

Section: New Attempts Of Dlts and Intubating Methodsmentioning

confidence: 99%

Recent Advances in Double-Lumen Tube Malposition in Thoracic Surgery: A Bibliometric Analysis and Narrative Literature Review

Zhang¹,

Wang²,

Wei³

et al. 2022

Preprint

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The thoracic surgery has increased drastically in recent years, especially in the light of the severe outbreak of 2019 novel coronavirus disease (COVID-19). Routine “passive” computed tomography of the chest screening of inpatients detects some pulmonary disease requiring thoracic surgeries timely. As an essential equipment for thoracic anesthesia, the double-lumen tube (DLT) in precise position is particularly important for anesthesia and surgery. With the continuous up-grading of the DLTs and the widespread use of the fiberoptic bronchoscopy (FOB), the position of DLT in thoracic surgery is gradually becoming more stable and easier to observe or adjust. However, for reasons such as transferring the patient to the lateral position, the DLT malposition still occurs in thoracic surgery, leading to lung isolation failure and hypoxemia during one-lung ventilation (OLV). Recently some innovative DLTs based on traditional have shown good results in reducing the incidence of DLT malposition, and some studies also found a lower malposition rate through improved intervention methods. This review aims to discuss and summarize the recent rates of left-sided DLT malposition, the reasons and effects of malposition, and to sum up current methods of reducing DLT malposition as well as prospects for possible approaches. Meanwhile, we use bibliometric analysis to summarize the research trends and hot spots of the DLT research.

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Section: New Attempts Of Dlts and Intubating Methodsmentioning

confidence: 99%

Recent Advances in Double-Lumen Tube Malposition in Thoracic Surgery: A Bibliometric Analysis and Narrative Literature Review

Zhang¹,

Wang²,

Wei³

et al. 2022

Preprint

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“…Concerning emergency management during NITS, Navarro-Martínez et al proposed an efficient strategy to approach urgent situations applying crisis resource management (CRM) principles. Both clinical and surgical emergencies may occur during NiVATS: in these cases, a quick recognition of the problem and knowing how to deal with it, an established protocol to manage complications and a good teamwork are key points to successfully handle unexpected emergencies (15).…”

Section: Ventilationmentioning

confidence: 99%

Major lung resections with spontaneous ventilation: a narrative review

Diotti¹,

Tosi²

2022

AME Surg J

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In the last decades, technical improvements and the advance of innovative technologies have made thoracic surgery increasingly less invasive: video-assisted thoracic surgery (VATS) is now considered the best approach for early-stage non-small cell lung cancer (NSCLC) surgical treatment, and has become the first choice for many non-oncological thoracic diseases requiring surgery, with proved advantages in terms of less post-operative pain, fewer complications and a faster recovery. Combining minimally invasive surgical and anaesthetic techniques is one of the new frontiers of thoracic surgery: in this scenario nonintubated thoracic surgery (NITS) is a promising approach to minimize risks related to general anaesthesia and intubation, promote a faster recovery and reduce hospital stay. Since its first reported applications for minor thoracic procedures in the late 90s, NITS has emerged as a promising technique and it is recently being applied also to technical demanding major thoracic anatomical resections, such as lobectomies and segmentectomies, with encouraging results concerning feasibility, perioperative outcomes and complication rates. The oncological value of NITS is also being explored: recent studies show better compliance with adjuvant chemotherapy protocols and fewer events of toxicity in patients treated with NITS procedures. The aim of this narrative review is to investigate the role of NITS applied to major lung resections in terms of feasibility, short-term outcomes and applications in everyday clinical practice.

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“…The management of intraoperative complications may require orotracheal intubation and conversion to general anesthesia ( 29 ). In non-intubated wedge resection, anesthesiologic complications do not significantly differ from the ones characterizing other non-intubated procedures.…”

Section: Intraoperative Complications and Shift To General Anesthesia...mentioning

confidence: 99%

Non-intubated Thoracic Surgery: Wedge Resections for Peripheral Pulmonary Nodules

2022

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The feasibility of performing pulmonary resections of peripheral lung nodules has been one of the main objectives of non-intubated thoracic surgery. The aim was to obtain histological characterization and extend a radical intended treatment to oncological patients unfit for general anesthesia or anatomic pulmonary resections. There is mounting evidence for the role of wedge resection in early-stage lung cancer treatment, especially for frail patients unfit for general anesthesia and anatomic resections with nodules, demonstrating a non-aggressive biological behavior. General anesthesia with single lung ventilation has been associated with a higher risk of ventilator-induced barotrauma and volotrauma as well as atelectasis in both the dependent and non-dependent lungs. Nonetheless, general anesthesia has been shown to impair the host immune system, eventually favoring both tumoral relapses and post-operative complications. Thus, non-intubated wedge resection seems to definitely balance tolerability with oncological radicality in highly selected patients. Nonetheless, differently from other non-surgical techniques, non-intubated wedge resection allows for histological characterization and possible oncological targeted treatment. For these reasons, non-intubated wedge resection is a fundamental skill in the core training of a thoracic surgeon. Main indications, surgical tips, and post-operative management strategies are hereafter presented. Non-intubated wedge resection is one of the new frontiers in minimal invasive management of patients with lung cancer and may become a standard in the armamentarium of a thoracic surgeon. Appropriate patient selection and VATS expertise are crucial to obtaining good results.

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Management of Intraoperative Crisis During Nonintubated Thoracic Surgery

Cited by 9 publications

References 23 publications

Recent Advances in Double-Lumen Tube Malposition in Thoracic Surgery: A Bibliometric Analysis and Narrative Literature Review

Recent Advances in Double-Lumen Tube Malposition in Thoracic Surgery: A Bibliometric Analysis and Narrative Literature Review

Major lung resections with spontaneous ventilation: a narrative review

Non-intubated Thoracic Surgery: Wedge Resections for Peripheral Pulmonary Nodules

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