Non-intubated spontaneous ventilation in video-assisted thoracoscopic surgery: a meta-analysis

Abstract

It remains unclear whether non-intubated video-assisted thoracoscopic surgery (VATS) is comparable or advantageous compared with conventional intubated VATS. Thus, we systematically assessed the feasibility and safety of non-intubated VATS compared with intubated VATS perioperatively for the treatment of different thoracic diseases. An extensive search of literature databases was conducted. Perioperative outcomes were compared between 2 types of operations. The time trend of the overall results was evaluated through a cumulative meta-analysis. Subgroup analyses of different thoracic diseases and study types were examined. Twenty-seven studies including 2537 patients were included in the analysis. A total of 1283 patients underwent non-intubated VATS; intubated VATS was performed on the other 1254 patients. Overall, the non-intubated VATS group had fewer postoperative overall complications [odds ratios (OR) 0.505; P < 0.001]; shorter postoperative fasting times [standardized mean difference (SMD) −2.653; P < 0.001]; shorter hospital stays (SMD −0.581; P < 0.001); shorter operative times (SMD −0.174; P = 0.041); shorter anaesthesia times (SMD −0.710; P < 0.001) and a lower mortality rate (OR 0.123; P = 0.020). Non-intubated VATS may be a safe and feasible alternative to intubated VATS and provide a more rapid postoperative rehabilitation time than conventional intubated VATS.

Contralateral Spontaneous Rupture of the Esophagus Following severe Vomiting After Non-intubated Pulmonary Wedge Resection

“…However, the evidence supporting non-intubated VATS as the preferred approach for lung surgery is still limited. Previous meta-analyses reported that non-intubated procedure attenuated the in ammatory response and stress, followed by fewer postoperative complications as compared with the intubated VATS [15,16]. Moreover, the indications for VATS could be extended by this less-invasive procedure.…”

Contralateral spontaneous rupture of the esophagus following severe emesis after non-intubated pulmonary wedge resection

“…However, the evidence supporting non-intubated VATS as the preferred approach for lung surgery is still limited. Previous meta-analyses show that non-intubated procedures could attenuate surgery-related stress responses and decrease postoperative complications compared to intubated surgery [15,16]. Moreover, for patients who are considered as high-risk under intubated general anesthesia due to their compromised lung function, non-intubated procedure could be considered [17].…”

Videoassistierte Thorakoskopie unter Erhalt der Spontanatmung – eine anästhesiologische Perspektive

“…Inzwischen gibt es erste Metaanalysen, die einen Vorteil der Non-intubated VATS unter Erhalt der Spontanatmung bez. der postoperativen Komplikationsraten, der postoperativen Nüchternheitszeiten und kürzeren Narkose-und Operationszeiten im Vergleich zur konventionellen VATS in Allgemeinanästhesie zeigen [8,9] Bezüglich der präoperativen Patientenauswahl lassen sich in der Literatur einige Empfehlungen finden, die sich größtenteils decken und überschneiden [10 -12] Daten oder Empfehlungen zur intraoperativen Sedierung lassen sich nur sporadisch aus der Literatur entnehmen. Aufgrund der ultrakurzen kontextsensitiven Halbwertszeit von 4 min scheint sich Remifentanil als eines der bevorzugten Medikamente zur Sedierung während Thorakoskopien unter Erhalt der Spontanatmung zu bewähren [4].…”