The impact of tubeless anesthesia versus intubated anesthesia on cerebral oxygen saturation and postoperative cognitive function in patients undergoing video-assisted thoracoscopic surgery: a randomized trial

Huang, Yu; Yun, Bo La; Li, Yujin; Zhao, Yanhua; Li, Xinnan; Chen, Dalin; Deng, Na; Li, Jun; Li, Junjie; Zhu, Mingzhen; Liu, Rongsheng; Peng, Jun; Jiang, Hua

doi:10.21037/jtd-22-1165

Cited by 10 publications

(5 citation statements)

References 56 publications

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“…[20] Non-intubated thoracoscopic surgery can increase the incidence of hypercapnia and intraoperative cerebral oxygen saturation, reduce systemic inflammation, promote early postoperative activities, and accelerate the postoperative recovery of patients. [21] This is also demonstrated in the present patient, who was returned to the ward 6 minutes after the end of surgery. Notably, he was able to move freely after surgery and eat normally 6 hours later.…”

Section: Discussionsupporting

confidence: 80%

Application of OFA-based ERAS for video-assisted thoracoscopic surgery in elderly patients with airway stenosis: A case report

Yang,

Wang,

et al. 2024

Medicine

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Background: Thoracic surgery without general anesthesia can be traced back to the First World War, and thoracic epidural block was used to complete the operation due to a large number of patients with gunshot wounds who needed emergency thoracic surgery. By reducing the intraoperative opioid dose, intraoperative and postoperative opioid-related adverse events such as respiratory depression, nausea and vomiting, delirium, hyperalgesia, and other side effects can be reduced to the benefit of patients. Methods: A 72-year-old male patient was admitted to the hospital with a 5-day history of multifocal pain throughout the body caused by a fall. The injury was not treated at that time, and the pain gradually increased, accompanied by cough with difficulty expelling sputum. Diagnoses: Left lung contusion; traumatic pneumonia; multiple left rib fractures; left fluid pneumothorax; thyroid tumor of unknown nature, possibly malignant. Grade I tracheal stenosis; Sequelae of cerebral infarction. Because of goiter and severe tracheal compression, the patient was not intubated and received deopiated general anesthesia combined with epidural anesthesia to preserve spontaneous breathing. Outcomes: At the end of the video-assisted thoracoscopic exploration, the patient was immediately conscious and returned directly to the ward 6 min later. The patient was able to move freely after surgery and eat normally within 6 h of surgery. The postoperative visual analog scale score was 2 points, and there were no anesthetic complications during the follow-up. Conclusion: The opioid-free anesthesia strategy of tubeless general anesthesia, allowing spontaneous breathing combined with epidural anesthesia in elderly patients with tracheal stenosis undergoing video-assisted thoracoscopic surgery can not only avoid accidents and injuries caused by tracheal intubation and mechanical ventilation, but can also significantly reduce postoperative respiratory complications, optimize postoperative analgesia, and help achieve enhanced recovery after surgery.

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Section: Discussionsupporting

confidence: 80%

Application of OFA-based ERAS for video-assisted thoracoscopic surgery in elderly patients with airway stenosis: A case report

Yang,

Wang,

et al. 2024

Medicine

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“…During spontaneous breathing, preserving general anesthesia, hypoxemia, and hypercapnia are the major challenges faced by anesthesiologists [22] . In this study, patients in both groups were treated with laryngeal mask intubation to relieve upper respiratory tract obstruction after repeated preliminary tests to avoid hypoxia caused by upper respiratory obstruction.…”

Section: Discussionmentioning

confidence: 99%

Assessing the clinical advantage of opioid-reduced anesthesia in thoracoscopic sympathectomy: A prospective randomized controlled trial

Minqiang,

Mingfei,

Fengzhu

et al. 2024

Preprint

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Background: Opioid-reduced multimodal analgesia has been clinically used for years to reduce perioperative complications related to opioid drugs. We aimed to assess the clinical effects of opioid-reduced anesthesia during thoracoscopic sympathectomy. Methods: Surgical patients (n=151) with palmar hyperhidrosis were randomly divided into a control group (Group C, 73 patients) and a weak opioid group (Group W, 78 patients). All patients were administered general anesthesia using a laryngeal mask. In Group C, the patients were anesthetized with propofol, fentanyl, and cisatracurium, and mechanical ventilation was used during the operation. In Group W, the patients received propofol, dezocine, and dexmedetomidine (DEX), and spontaneous breathing was maintained during surgery. Perioperative complications related to opioids include hypotension, bradycardia, hypertension, tachycardia, hypoxemia, nausea, vomiting, urine retention, itching, and dizziness; vital signs, blood gas index, visual analog scale (VAS) score, and other adverse events; patient satisfaction between groups were also recorded. Results: Perioperative complications related to opioids were similar between groups. There were no significant differences in the type of perioperative sedation, analgesia index, respiratory and circulatory indicators, blood gas analysis, postoperative VAS scores, adverse reactions, propofol dosage, postoperative recovery time, and patient satisfaction (P > 0.05). Conclusions: In minimally invasive surgeries such as thoracoscopic sympathectomy, opioid-reduced anesthesia was safe and effective; however, this method did not show clinical advantages. Trial registration Chinese Clinical Trial Register: ChiCTR2100055005, on December 30, 2021.

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“…Immune activation appeared to be affected by the type of anesthesia used as well. NITS has a lower negative effect on the activation of the cellular and humoral immune systems, which tend to be important in postoperative infections, pain, and tumor progression (51)(52)(53).…”

Section: Nits (N = 32) Ivats (N = 35) P-valuementioning

confidence: 99%

Chronic postoperative pain after non-intubated uniportal VATS lobectomy

Farkas,

Csókási,

Fabó

et al. 2023

Front. Surg.

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IntroductionPatients undergoing thoracic surgery are at increased risk of developing, long-lasting pain. Beyond the non-surgical factors, the type of operation, including the number of incisions, and the anesthetic assessment seemed to be important factors, although some studies are controversial. The aim of our study was to examine the presence of chronic postoperative pain after non-intubated uniportal VATS lobectomy. We examined the difference between the intubated, relaxed and non-intubated spontaneous ventilation surgical approaches in patients who underwent video-assisted thoracoscopic (VATS) uniportal lobectomy.MethodsDemographic and postoperative data were retrospectively collected and analyzed, focusing on the use of pain medications, in 67 patients of the 140 patients selected by propensity score matching who underwent intubated (iVATS) or non-intubated (NITS) uniportal VATS lobectomy. This study focused on the use of analgesic medications 3, 6, and 12 months after surgery.ResultsThirty-five intubated and 32 non-intubated patients were compared. Although the analgesic consumption was nearly 2% higher among the iVATS patients during the follow-up period, there were no statistically significant differences at 3 months (15.6 vs. 17.1%) (p = 0.868), at 6 months (9.4 vs. 12.4%) (p = 0.785), and at 12 months (3.3 vs. 5.9%) (p = 0.633) between the NITS and iVATS groups, respectively. More female than male patients reported chronic pain, but the difference was not statistically significant (p = 0.616). Diabetes mellitus was a statistically significant cofactor associated with chronic pain (p = 0.03), while cardiac disease (p = 0.6), perioperative morbidity (p = 0.228), prolonged air leak (p = 0.057), and repeat drainage (p = 0.626) were not.ConclusionOur study suggests that after non-intubation VATS lobectomies, the postoperative pain was less at 3, 6, and 12 months in NITS patients compared to iVATS patients. The 2% difference was not significant, so it may not be appropriate to claim the advantages of NITS in terms of postoperative pain.

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The impact of tubeless anesthesia versus intubated anesthesia on cerebral oxygen saturation and postoperative cognitive function in patients undergoing video-assisted thoracoscopic surgery: a randomized trial

Cited by 10 publications

References 56 publications

Application of OFA-based ERAS for video-assisted thoracoscopic surgery in elderly patients with airway stenosis: A case report

Application of OFA-based ERAS for video-assisted thoracoscopic surgery in elderly patients with airway stenosis: A case report

Assessing the clinical advantage of opioid-reduced anesthesia in thoracoscopic sympathectomy: A prospective randomized controlled trial

Chronic postoperative pain after non-intubated uniportal VATS lobectomy

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