Technical Issues and Patient Safety in Nonintubated Thoracic Anesthesia

Kiss, G.

doi:10.1016/j.thorsurg.2019.09.001

Cited by 8 publications

(20 citation statements)

References 72 publications

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“…Intrathoracic ICNB is reliable and adequate local anesthetic delivery to intercostal nerves beneath the parietal pleura is ensured [8]. A previous retrospective cohort study concluded that patients receiving ICNB had shorter anesthesia induction time, shorter operation time, less duration of chest tube drainage, and more stable hemodynamics, less frequency conversion to intubation, less blood loss and shorter hos- Cumulative morphine consumption during 24 hrs, mg 5 (0-16) 0 (0-6) 18 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) Intraoperative complications, n (%) Hypotension (SBP < 90 mmHg)…”

Section: Discussionmentioning

confidence: 99%

“…thoracic epidural analgesia (TEA) [5,7,[11][12][13][14], thoracic paravertebral block (TPVB) [15], intercostal nerve block (ICNB) [8,16,17], and serratus anterior block [18] have been successfully used during NIVATS. In addition to analgesia, intraoperative sedation is usually required to ease the patient, minimize patient's movement, and optimize the surgical condition, particularly in major non-intubated thoracic surgery [1,19]. However, oversedation may compromise the airway patency, and subsequently induce severe hypoxemia and hypercarbia resulting in conversion to GA.…”

Section: Introductionmentioning

confidence: 99%

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Role of loco-regional anesthesia for non-intubated video-assisted thoracoscopic surgery: A tertiary care hospital in northern Thailand

et al. 2021

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Background: A few studies have focused on the role of regional anesthesia for non-intubated thoracoscopic surgery (NIVATS) in Thailand. The purpose of the present study was to review the feasibility and safety of loco-regional anesthesia for NIVATS in a tertiary care hospital. Methods: All patients undergoing scheduled NIVATS under loco-regional anesthesia including thoracic epidural analgesia (TEA), intercostal nerve block (ICNB), thoracic paravertebral block, and local wound infiltration from 2018 to 2021 were assessed by a retrospective chart review. Sedation was performed with propofol infusion and bispectral index monitoring. Primary outcomes were the feasibility of surgery and safety related to loco-regional anesthesia techniques. Results: Twenty-three patients were included. The average age was 43 (26-59) years. The two most common regional anesthesia techniques in this study were TEA and ICNB. The most common surgical procedure was wedge resection (13 patients, 56.5%) followed by pleurectomy (5 patients, 21.7%). The overall median technical feasible scores were 3 (2-3). Intraoperative hypotension (62.5% for TEA vs 20% for ICNB) and urinary retention (25% for TEA vs 0 for ICNB) were found. Among four patients with severe cough, three patients received intrathoracic vagal block and one patient required general anesthesia due to severe hypoxemia. Patients with ICNB had a higher degree of incisional pain and a higher amount of postoperative morphine consumption. Conclusion: NIVATS under loco-regional anesthesia could be a feasible and safe technique. A further study is recommended to compare the efficacy and safety of TEA and ICNB for NIVATS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role of loco-regional anesthesia for non-intubated video-assisted thoracoscopic surgery: A tertiary care hospital in northern Thailand

et al. 2021

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“…Patients with expected difficult airway, type 2 respiratory failure, central hypoventilation syndrome, contralateral phrenic nerve palsy, high aspiration risk, and neurological disorders leading to high intracranial pressure or inability to cooperate, are not candidates for the techniques (33). In addition, need for contralateral lung isolation to protect the contralateral lung from contamination precludes usage of nonintubated techniques (28,33,34). Relative contraindications include hemodynamic instability, obesity with body mass index (BMI) greater than 30, high airway secretions, coagulopathy, and extensive adhesions from prior surgery leading to surgical difficulty (33).…”

Section: Nonintubated Spontaneous Breathingmentioning

confidence: 99%

“…Intercostal nerve block, paravertebral nerve block, and epidural anesthesia have all been used to meet these goals (41). Preoperative lidocaine nebulization, stellar ganglion block or ipsilateral phrenic nerve block, and intrathoracic vagus nerve block by surgeons can all be utilized to minimize the cough reflex during operations (28,32,34). Most patients require some amount of intravenous sedation in addition to the above techniques for comfort during the operation.…”

Section: Nonintubated Spontaneous Breathingmentioning

confidence: 99%

“…Contingency airway plans must be in place such as oral intubation, cross-field ventilation, or jet ventilation if patients become hypoxemic, hemodynamic unstable, or have persistent coughing or excessive movement. Conversion may also be necessary in case of surgical complications like insufficient lung collapse, dense adhesions, and excessive bleeding (33,34). The average conversion rate from nonintubated to intubated surgery is 2% to 3%, with the range depending on the complexity of the surgery: minorintermediate procedures have a conversion rate of 1% while major procedures are around 10% (33,44).…”

Section: Nonintubated Spontaneous Breathingmentioning

confidence: 99%

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Airway management and anesthesia for airway surgery: a narrative review

Li¹,

Chitilian²,

Alfille³

et al. 2021

Transl Lung Cancer Res

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Objective: To discuss and summarize the literature for airway and anesthetic management tools the anesthesiologist can use for airway surgery to both successfully manage the patient's physiological needs and provide the surgeon the optimal surgical conditions with which to perform the surgery safely. Background:The airway and anesthetic management of patients presenting for thoracic surgery poses the anesthesiologist with a unique set of challenges, but also a unique set of opportunities to artfully utilize and adapt a variety of management options that has developed over several decades of innovation. Sixty years ago, airway surgery was initially performed with the patient spontaneously breathing and providing anesthesia with halogenated agents and airway topicalization. As medicine entered the latter half of the twentieth century with its development of new airway devices and modern anesthetic agents, most airway surgeries could be safely performed under general anesthesia with secured airways. Today, with continued technological advancements in surgical techniques and an expanding population of challenging patients, the application of nonintubated anesthetic techniques and extracorporeal support is on the rise. Methods:We conduct a narrative review of the literature on the history of airway and anesthetic management for thoracic surgery, the current management methods and evidence for each modality, and discuss future directions for the field.Conclusions: While the airway and anesthetic management for airway surgery is challenging, the anesthesiologist has a variety of options including cross-field ventilation, jet ventilation, nonintubated techniques, and extracorporeal support to safely care for the patient. Whichever methods are chosen for the patient and surgery, thoracic surgery remains uniquely positioned in its need for close sharing and collaboration of all airway and anesthetic management decisions between the anesthesiologist and the surgeon.

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S1-Leitlinie Interdisziplinäre Diagnostik interstitieller Lungenerkrankungen im Erwachsenenalter

et al. 2023

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ZusammenfassungDie Beurteilung von Patienten mit v. a. einer interstitiellen Lungenerkrankung (ILD) umfasst die Beurteilung klinischer, radiologischer und oft histopathologischer Daten. Da bislang noch keine dezidierten Empfehlungen für die Evaluation bei Verdacht auf eine ILD in Deutschland existierten, war es Ziel dieses interdisziplinären Konsensusstatements, eine praktische Orientierungshilfe für den klinischen Alltag in Bezug auf die interdisziplinäre Diagnostik der ILDs zu geben. Dazu gehören die umfassende klinisch-pneumologische und in vielen Fällen auch eine rheumatologische Beurteilung, radiologische Diagnostik sowie Probenentnahme zur histopathologischen Evaluation sowie die abschließende Diskussion im multidisziplinären Team.

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Technical Issues and Patient Safety in Nonintubated Thoracic Anesthesia

Cited by 8 publications

References 72 publications

Role of loco-regional anesthesia for non-intubated video-assisted thoracoscopic surgery: A tertiary care hospital in northern Thailand

Role of loco-regional anesthesia for non-intubated video-assisted thoracoscopic surgery: A tertiary care hospital in northern Thailand

Airway management and anesthesia for airway surgery: a narrative review

S1-Leitlinie Interdisziplinäre Diagnostik interstitieller Lungenerkrankungen im Erwachsenenalter

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