Non-intubated thoracoscopic bullectomy under sedation is safe and comfortable in the perioperative period

Abstract

Background: Non-intubated thoracoscopic surgery can be performed under sedation using adjuvant regional anesthesia, however, the benefits of non-intubated thoracoscopic surgery under sedation have not yet been completely verified. In this study, we compare the perioperative safety and pain complaints of sedation without intubation in thoracoscopic bullectomy with that of conventional general anesthesia with double-lumen intubation and mechanical ventilation. Methods: Forty-one patients with primary spontaneous pneumothorax who were scheduled for thoracoscopic bullectomy were enrolled in this study. Twenty-one patients were under sedation anesthesia (SA group) and 20 patients were under general anesthesia (GA group). In SA group, sedation was done with dexmedetomidine (a loading dose of 1 μg/kg for 10 min and then maintained in dosages of 0.3-1 μg/kg/h) and ketamine (2-4 mg/kg/h intraoperatively). Meanwhile, in GA group, induction with propofol and rocuronium, intubation with double lumen endotracheal tube and maintenance with 1.0-2.5% sevoflurane was done. In both groups, thoracoscopic bullectomy was performed in the same manner and all operations were conducted by single surgeon. Time for anesthesia [including emergence time and post-anesthesia care unit (PACU) recovery time] and operation, postoperative pain, sore throat, hoarseness, adverse events (nausea, vomiting, hypotension and bradycardia), dose of rescue analgesic drug used for 24 hours post-operatively and perioperative arterial blood gas analysis were recorded. Results: The times for anesthesia, operation and emergence were significantly shorter in SA than GA.Incidence of sore throat were significantly lower in SA. The difference of other adverse events in the two groups was not significant. Conclusions:Our study demonstrated that compared to double-lumen intubation with general anesthesia, non-intubation with sedation for bullectomy for primary spontaneous pneumothorax was safe and efficient to reduce perioperative time.

Nonintubated Minimally Invasive Chest Wall Stabilization for Multiple Rib Fractures: a Prospective, Single-arm Study

“…Unlike previous studies [5][6][7][8][9], paravertebral block was performed before anesthesia induction in our study.…”

“…However, adverse events such as sore throat, pain, hoarseness, and respiratory complications are not uncommon after conversional intubation and general anesthesia [3][4]. Compared with general anesthesia with intubation, nonintubated anesthesia can obviously reduce the adverse events described above, a phenomenon that has aroused great interest of thoracic surgeons in the past decade [5][6][7][8][9]. A previous study con rmed that nonintubated video-assisted thoracoscopic surgery (VATS) is safe and feasible for multiple thoracic conditions, without risk of complications caused by conversional intubation or general anesthesia [10].…”

Non-intubated Minimally Invasive Chest Wall Stabilization for Multiple Rib Fractures: a Prospective, Single-arm Study

“…Unlike previous studies [5][6][7][8][9], paravertebral block was performed before anesthesia induction in our study. Previous study showed preemptive pharmacological blockade had been effectively used in surgical patients with satisfactory results [13].…”

“…However, adverse effects such as sore throat, pain, hoarseness, and respiratory complications are not uncommon after conversional intubation and general anesthesia [3][4]. Compared with general anesthesia with intubation, non-intubated anesthesia can obviously reduce above adverse events, which has aroused great interest in thoracic surgery in the past decade [5][6][7][8][9].…”

Comparison of tracheal intubation with controlled ventilation and laryngeal mask airway with spontaneous ventilation for thoracoscopic bullectomy

“…[ 20 , 21 ] And the intraoperative PaCO 2 level (mean 57.0 mm Hg) in the study group did increase significantly because of “re-breathing” of exhaled air and respiratory depression, but returned to normal values 1 hour after surgery, furthermore considering that many studies describe a transient intraoperative hypercapnia, this value is still tolerable. [ 22 – 24 ] In fact, the use of spontaneous breathing inhalation anesthesia can permit a self-limiting regulation of the inhaled gas, thus avoiding the occurrence of severe respiratory depression. In addition, the presence of ILMA can safely and easily manage any possible respiratory depression, which were reported during thoracoscopy performed under sedation-assisted local anesthesia by Chhajed et al [ 25 ] Therefore, in our study, because of the use of ILMA, no patients were converted to tracheal intubation due to hypoxemia and hypercapnia.…”