Non-intubated Thoracoscopic Surgery to Minimize Contamination From Airway Secretions During the COVID-19 Pandemic

Abstract

BackgroundGeneral anesthesia and tracheal intubation potentially pose a high risk to health care workers (HCWs) managing surgical patients during the coronavirus disease 2019 (COVID-19) pandemic. Non-intubated anesthesia is a rational way of managing patients undergoing thoracoscopic surgery that avoids tracheal intubation and minimizes the aerosols generated during airway instrumentation. The purpose of this study was to determine whether non-intubated anesthesia in combination with a face mask is safe and feasible in patients undergoing thoracoscopic surgery.MethodsA total of 18 patients who underwent non-intubated thoracoscopic surgery with a face mask during the perioperative period between March 9, 2020 and April 6, 2020 were included. The main outcomes were anesthetic management and postoperative results.ResultsThe 18 patients had a mean age of 64 years and a body mass index of 22.9 kg/m2. All patients wore a mask during induction of anesthesia and throughout surgery. Three patients underwent lobectomy, four segmentectomy, ten wedge resection, and one underwent anterior mediastinal tumor resection. No patient developed cough or vomiting during the perioperative period. All patients were transferred to the postoperative recovery unit within 15 min of the end of surgery (average 7.2 min). No patient required conversion to tracheal intubation or conversion to thoracotomy.ConclusionNon-intubated anesthesia with a mask was safe and feasible in patients undergoing thoracoscopic surgery. Avoidance of intubated general anesthesia and use of a lung separation device may reduce the risk to HCWs of contamination by airway secretions, thereby conserving personal protective equipment, especially during the COVID-19 pandemic.

Non-Intubated Thoracotomy Under an Opioid-Sparing Intravenous Sedation and Analgesia Protocol without Central or Peripheral Nerve Blocks: A Case Report with Insights into Shared Decisions

“…Non-intubated thoracic surgery is usually video-assisted (VATS), but it can also be carried out as an open procedure, especially when an initially thoracoscopically planned operation has to be converted into an open one [1,2]. Such operations can be facilitated by regional anaesthesia (thoracic epidural, paravertebral blocks, erector spinae plane block, serratus anterior plane block, intercostal nerve block, or pectoralis nerve block) and sedation, avoiding neuromuscular blockade, endotracheal intubation and positive pressure ventilation [1][2][3][4][5]. Therefore, this approach could be appropriate for high-risk patients, such as the elderly or the ones with cardiac, respiratory or muscular disease [1].…”

Spontán légző, nem intubált, valamint intubált és gépi lélegeztetett betegeken végzett videoasszisztált torakoszkópos tüdőlebeny-eltávolítások összehasonlítása

“…Adjuváns ke-EREDETI KÖZLEMÉNY moterápia iránt nagyobb az együttműködési készség, kisebb gyógyszertoxicitás mellett [24]. Nem utolsósorban az egészségügyi dolgozók kórokozóval történő kontaminációját is segíthet elkerülni az intubáció mellőzése, ami a COVID-fertőzés miatt kiemelt jelentőségűvé vált az elmúlt években [25]. Hátránya, hogy műtét közben fellépő szövődmény esetén az intubálás, illetve átállás nyitott műtétre technikai nehézséget jelenthet [26].…”