Cardiothoracic Surgery: Cardiothoracic Surgery |

Is Non-Intubated Thoracoscopic Surgery More Safe and Less Painful Than Conventional Thoracosopic Surgery in Thorascopic Bleb Resection? FREE TO VIEW

Jinwook Hwang, MD; Byoung-Ju Min, MD; Jae-Seung Shin, MD; Won-min Jo, MD
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Korea University Ansan Hospital, Ansan, Korea (the Republic of)

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):33A. doi:10.1016/j.chest.2016.08.040
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SESSION TITLE: Cardiothoracic Surgery

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Non-intubated thoracoscopic surgery is accomplished by patient-drived active single lung ventilation. This is performed under sedation without endotracheal intubation. Conventional thoracoscopic surgery is performed under general anesthesia with double lumen endotracheal tube. This is drived by mechanical ventilator resulting passive single lung ventilation. Thoracoscopic bleb resection is a short and simple procedure to prevent recurrent pneumothorax. In this study, we compared the perioperative pain and safety of non-intubated thorascoscopic surgery and conventional thoracoscopic surgery in thorascopic bleb resection.

METHODS: Forty-four consecutive patients were randomly assigned to 1 of 2 groups: PV (passive single lung ventilation under general anesthesia with endotracheal intubation using a 35 or 37 Fr left-sided double-lumen tracheal tube, n=22 ), or AV (Active single lung ventilation under sedation without endotracheal intubation using dexmedetomidine and ketamine to achieve a bispectral index value between 40 and 60, n=22). Perioperative arterial blood gas analysis (PaO2, PaCO2, SPO2), postoperative pain, sore throat, hoarseness, dose of rescue analgesic drug used within 24 hours post-operatively, and any adverse events (nausea, vomiting, hypotension and bradycardia) were recorded.

RESULTS: There were no conversions to endotracheal intubation in the AV group. Arterial blood gas analysis could be managed within safe ranges during surgery for both groups (PaO2: 197.55±121.54 , PaCO2: 47.17±11.85, SPO2: 98.05±2.17). Pain and sore throat at 1 hour after surgery, in the AV group, were significantly lower than in the PV group (VAS: 1.43±1.43 vs. 4.35±2.39; p=0.000, Sore throat: 0.05±0.22 vs. 0.70±0.80; p=0.002), whereas other discomforts after surgery showed no significant differences.

CONCLUSIONS: Non-intubated thoracoscopic surgery (AV) showed safe respiratory maintanance, no sore throat, and less post-operative pain, compared to conventional thorascopic surgery (PV). We propose that non-intubated thoracoscopic surgery under sedation with active ventilation can be safe and more comfortable than general anesthesia with passive ventilation in thoracoscopic bleb resection.

CLINICAL IMPLICATIONS: Thoracosopic bleb resection is simple and short procedure. However, double lumen endotracheal tube,mechanical ventilation, and general anesthesia have been applied to this short operation as same manner as in other major thoracoscopic surgery. Active single lung ventilation under sedation without intubation might be used for this operation as most minimally invasive technique. Because it is natural and non-invasive ventilation technique. We think if the safety and benefit of active single lung ventilation would be completley verified, non-intubated thorascopic surgery could be performed more various types of surgery.

DISCLOSURE: The following authors have nothing to disclose: Jinwook Hwang, Byoung-Ju Min, Jae-Seung Shin, Won-min Jo

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