One-lung ventilation plays a pivotal role in obtaining optimal surgical visualization during thoracoscopic surgery for primary spontaneous pneumothorax. However, this may increase complications, time and cost to what is an otherwise very short and simple operation. This prospective study was conducted to evaluate feasibility and safety of two-lung ventilation with low tidal volume anesthesia (TL) comparing to one-lung ventilation anesthesia (OL) for 2mm sized thoracoscopic (needlescopic) bleb resection.
The patients with spontaneous pneumothorax were underwent bleb resection via 2mm sized thoracoscope and grasper ports and one 11.5mm endostapler port. During the operation, tidal volume was set at 4.0ml/kg (TL) and 8.0ml/kg (OL) and respiration rate was set at 23/min (TL) and 12/min (OL) at same FiO2 (50%).
A total of 108 patients (55 patients in SL, 53 in DL) were included in this study. Patient's age and the number of resected bleb were not different between the two groups. Peak airway pressure (6.9±2.52 mmHg in TL vs. 22.3± 3.17 in OL, p=0.006) and PO2 (238.3±43.47 mmHg in TL vs. 107.7±29.78 in OL, p=0.000) were significantly different. However, PCO2 (42.8±3.88 mmHg in TL vs. 40.4±5.46 in OL, p=0.104) and End-tidal CO2 (34.1±4.19 in TL vs. 30.6± 7.07 in OL, p=0.054) were not significantly different. Operation time was not different between the two group (33.2±19.27 minutes in TL, 30.7±13.51 in OL, p=0.634). However, time duration from anesthesia induction to incision (26.5±6.78 minutes in TL, 39.5±7.57 in OL, p=0.000) and total anesthesia time (70.7±16.56 minutes in TL vs. 93.2±24.52 in OL, p=0.001) were significantly different.
Needlescopic bleb resection using two-lung ventilation anesthesia with low tidal volume is technically feasible to thoracic surgeon, makes it easier to anesthesiologist and safe for patients.
The results of this study suggest that for a relatively short and simple procedure such as bleb resection the two-lung ventilation anesthesia with low tidal volume should be considered as an alternative option.
Hyun Koo Kim, No Financial Disclosure Information; No Product/Research Disclosure Information