Non-intubated, intravenous anesthesia with spontaneous ventilation <i>versus</i> routine intravenous anesthesia in video-assisted thoracoscopic surgery: A randomized controlled trial _Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DENG Yufeng ¹ , QI Fenqiang ¹ , LU Jianhua ² , LIN Ying ² ,  YUAN Tianzhu ¹

1. Department of Cardiothoracic Surgery, the 4th Affiliated Hospital of Guangxi Medical University, Liuzhou, 545005, Guangxi, P.R.China;
2. Department of Anesthesiology, the 4th Affiliated Hospital of Guangxi Medical University, Liuzhou, 545005, Guangxi, P.R.China;

Corresponding author：

YUAN Tianzhu, Email: ytzh0306@163.com

Keywords：

Spontaneous ventilation; non-intubated anesthesia; video-assisted thoracoscopic surgery

DOI：

10.7507/1007-4848.201708023

Video：

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Objective To compare the feasibility and safety of video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation. Methods A total of 80 patients undergoing VATS (48 wedge resections, 8 sympathectomies, 24 pleural biopsies) between January 2015 and June 2017 were included. Those patients were randomized into two groups. The 40 patients were enrolled as a treatment group (19 males and 21 females at age of 23.3±10.2 years) and received surgery under non-intubated intravenous anesthesia with spontaneous ventilation. And the other 40 patients were enrolled as a control group (21 males and 19 females at age of 22.2±9.9 years) and received surgery under routine intravenous anesthesia with intubated ventilation. Results Comparing with the control group, the patients of the treatment group had lower white blood cell count (5.8×10⁹±2.4×10⁹ vs. 7.3×10⁹±3.6×10⁹, P<0.001), lower gastrointestinal adverse reaction rate (7.5%vs. 27.5%, P=0.002), lower sore throat rate (5.0% vs. 30.0%, P<0.001), lower cough grade (0.9±0.3vs 2.1±0.5, P<0.050), shorter drainage time (1.8±1.6 dvs. 3.7±1.8 d, P<0.050) and shorter hospital stay (2.3±1.8 dvs. 5.8±2.3 d, P<0.050). Conclusion Video-assisted thoracoscopic surgery under non-intubated, intravenous anesthesia with spontaneous ventilation is safe and feasible, which also has certain advantages in reducing the postoperative complications and promoting patients' quick recovery from surgery.

Citation： DENG Yufeng, QI Fenqiang, LU Jianhua, LIN Ying, YUAN Tianzhu. Non-intubated, intravenous anesthesia with spontaneous ventilation versus routine intravenous anesthesia in video-assisted thoracoscopic surgery: A randomized controlled trial . Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(5): 411-415. doi: 10.7507/1007-4848.201708023 Copy

1.	Kiss G, Claret A, Desbordes J, et al. Thoracic epidural anaesthesia for awake thoracic surgery in severely dyspnoeic patients excluded from general anaesthesia Interact Cardiovasc Thorac Surg, 2014, 19(5): 816-823.
2.	Kiss G, Castillo M. Nonintubated anesthesia in thoracic surgery: general issues. Ann Transl Med, 2015, 3(8): 110.
3.	David P, Pompeo E, Fabbi E, et al. Surgical pneumothorax under spontaneous ventilation-effect on oxygenation and ventilation. Ann Transl Med, 2015, 3(8): 106.
4.	Ambrogi MC, Fanucchi O, Gemignani R, et al. Video-assisted thoracoscopic surgery with spontaneous breathing laryngeal mask anesthesia: preliminary experience. J Thorac Cardiovasc Surg, 2012, 144(2): 514-515.
5.	Liu J, Cui F, He J. Non-intubated video-assisted thoracoscopic surgery anatomical resections: a new perspective for treatment of lung cancer. Ann Transl Med, 2015, 3(8): 102.
6.	Trela-Stachurska K, Nestorowicz A, Kotlinska-Hasiec E, et al. Effects of unilateral PEEP on biomechanics of both lungs during independent lung ventilation in patients anaesthetised for thoracic surgery. Anaesthesiol Intensive Ther, 2015, 47(1): 1-6.
7.	Weiss CH, Baker DW, Weiner S, et al. Low tidal volume ventilation sse in acute respiratory distress syndrome. Crit Care Med, 2016, 44(8): 1515-1522.
8.	Pena-Lopez Y, Pujol M, Campins M, et al. Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: differences according to endotracheal or tracheostomy devices. Int J Infect Dis, 2016, 52: 43-48.
9.	Ambrogi MC, Fanucchi O, Gemignani R, et al. Video-assisted thoracoscopic surgery with spontaneous breathing laryngeal mask anesthesia: preliminary experience . J Thorac Cardiovasc Surg, 2012, 144(2)514-515.
10.	Li S, Jiang L, Ang KL, et al .New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules. Eur J Cardiothorac Surg, 2017, 51(4): 689-693.
11.	Mineo TC, Sellitri F, Tacconi F, et al. Quality of life and outcomes after nonintubated versus intubated video-thoracoscopic pleurodesis for malignant pleural effusion: comparison by a case-matched study. J Palliat Med, 2014, 17(7): 761-768.
12.	Cui F, Liu J, Li S, et al. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively. J Thorac Dis, 2016, 8(8): 2226-2232.
13.	毛松松, 马珏, 崔建修. 喉罩和气管内插管在成人 NUSS 手术麻醉中的对照研究. 广东药学院学报, 2014, 30(3): 366-369.
14.	Du X, Mao S, Cui J, et al. Use of laryngeal mask airway for non-endotracheal intubated anesthesia for patients with pectus excavatum undergoing thoracoscopic Nuss procedure. J Thorac Dis, 2016, 8(8): 2061-2067.

1. Kiss G, Claret A, Desbordes J, et al. Thoracic epidural anaesthesia for awake thoracic surgery in severely dyspnoeic patients excluded from general anaesthesia Interact Cardiovasc Thorac Surg, 2014, 19(5): 816-823.
2. Kiss G, Castillo M. Nonintubated anesthesia in thoracic surgery: general issues. Ann Transl Med, 2015, 3(8): 110.
3. David P, Pompeo E, Fabbi E, et al. Surgical pneumothorax under spontaneous ventilation-effect on oxygenation and ventilation. Ann Transl Med, 2015, 3(8): 106.
4. Ambrogi MC, Fanucchi O, Gemignani R, et al. Video-assisted thoracoscopic surgery with spontaneous breathing laryngeal mask anesthesia: preliminary experience. J Thorac Cardiovasc Surg, 2012, 144(2): 514-515.
5. Liu J, Cui F, He J. Non-intubated video-assisted thoracoscopic surgery anatomical resections: a new perspective for treatment of lung cancer. Ann Transl Med, 2015, 3(8): 102.
6. Trela-Stachurska K, Nestorowicz A, Kotlinska-Hasiec E, et al. Effects of unilateral PEEP on biomechanics of both lungs during independent lung ventilation in patients anaesthetised for thoracic surgery. Anaesthesiol Intensive Ther, 2015, 47(1): 1-6.
7. Weiss CH, Baker DW, Weiner S, et al. Low tidal volume ventilation sse in acute respiratory distress syndrome. Crit Care Med, 2016, 44(8): 1515-1522.
8. Pena-Lopez Y, Pujol M, Campins M, et al. Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: differences according to endotracheal or tracheostomy devices. Int J Infect Dis, 2016, 52: 43-48.
9. Ambrogi MC, Fanucchi O, Gemignani R, et al. Video-assisted thoracoscopic surgery with spontaneous breathing laryngeal mask anesthesia: preliminary experience . J Thorac Cardiovasc Surg, 2012, 144(2)514-515.
10. Li S, Jiang L, Ang KL, et al .New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules. Eur J Cardiothorac Surg, 2017, 51(4): 689-693.
11. Mineo TC, Sellitri F, Tacconi F, et al. Quality of life and outcomes after nonintubated versus intubated video-thoracoscopic pleurodesis for malignant pleural effusion: comparison by a case-matched study. J Palliat Med, 2014, 17(7): 761-768.
12. Cui F, Liu J, Li S, et al. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively. J Thorac Dis, 2016, 8(8): 2226-2232.
13. 毛松松, 马珏, 崔建修. 喉罩和气管内插管在成人 NUSS 手术麻醉中的对照研究. 广东药学院学报, 2014, 30(3): 366-369.
14. Du X, Mao S, Cui J, et al. Use of laryngeal mask airway for non-endotracheal intubated anesthesia for patients with pectus excavatum undergoing thoracoscopic Nuss procedure. J Thorac Dis, 2016, 8(8): 2061-2067.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Non-intubated, intravenous anesthesia with spontaneous ventilation versus routine intravenous anesthesia in video-assisted thoracoscopic surgery: A randomized controlled trial

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