The Anesthesiologist's Perspective Regarding Non-intubated Thoracic Surgery: A Scoping Review

Abstract

Non-intubated thoracic surgery (NITS) is a growing practice, alongside minimally invasive thoracic surgery. To date, only a consensus of experts provided opinions on NITS leaving a number of questions unresolved. We then conducted a scoping review to clarify the state of the art regarding NITS. The systematic review of all randomized and non-randomized clinical trials dealing with NITS, based on Pubmed, EMBASE, and Scopus, retrieved 665 articles. After the exclusion of ineligible studies, 53 were assessed examining: study type, Country of origin, surgical procedure, age, body mass index, American Society of Anesthesiologist's physical status, airway management device, conversion to orotracheal intubation and pulmonary complications rates and length of hospital stay. It emerged that NITS is a procedure performed predominantly in Asia, and certain European Countries. In China, NITS is more frequently performed for parenchymal resection surgery, whereas in Europe, it is mainly employed for pleural pathologies. The most commonly used device for airway management is the laryngeal mask. The conversion rate to orotracheal intubation is a~3%. The results of the scoping review seem to suggest that NITS procedures are becoming increasingly popular, but its role needs to be better defined. Further randomized clinical trials are needed to better define the role of the clinical variables possibly impacting on the technique effectiveness.Systematic Review Registrationhttps://osf.io/mfvp3/, identifier: 10.17605/OSF.IO/MFVP3.

Postoperative pulmonary complications in awake video-assisted thoracoscopic surgery: Our 10-year experience

“…Another significant risk factor for PPC is the nature of surgery. Rosboch et al[ 6 ] underlined increased risk for lung surgery compared to pleural interventions. One remarkable study comparing major versus minor surgery in AVATS revealed significantly higher pulmonary complications for the first one.…”

“…Pain control has been reported in a wide spectrum starting with local anesthetic infiltration to thoracic epidural block. [ 6 ] Intercostal nerve blockade and thoracic epidural block are mostly preferred regional techniques. [ 6 ] Thoracic chest wall blocks, local infiltration and paravertebral block are the other alternatives.…”

“…[ 1 - 3 ] Meanwhile, large variety of procedures is associated with different approaches for airway control and analgesia. [ 4 - 6 ]…”

Awake cardiac surgery using the novel pectoralis‐intercostal‐rectus sheath (PIRS) plane block and subxiphoid approach

“…To our knowledge, PIRS block has never been used for procedures in awake cardiac surgery. However, we believe that, following the path of thoracic surgery that is increasingly evolving towards a minimally invasive approach often involving nonintubated and awake procedures, 9 cardiac surgery should also take the same direction. This is especially true in surgical procedures not requiring full median sternotomies and in frail patients where orotracheal intubation poses a risk to patients.…”

Awake cardiac surgery using the novel Pectoralis-Intercostal-Rectus Sheath (PIRS) Plane Block and Subxiphoid approach

“…To our knowledge, PIRS block has never been used for procedures in awake cardiac surgery. However, we believe that, following the path of thoracic surgery that is increasingly evolving towards a minimally invasive approach often involving non-intubated and awake procedures (9) , cardiac surgery should also take the same direction. This is especially true in surgical procedures not requiring full median sternotomies and in frail patients where orotracheal intubation poses a risk to patients.…”