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05:39
Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
[Hemodynamic changes induced by positive pressure capnothorax during thoracoscopic thymectomy]
Dana Tomescu1, B Grigorescu, R Nitulescu
1Centrul de Anestezie şi Terapie Intensivă, Institutul Clinic Fundeni, Bucureşti. danatomescu@gmail.com
Chirurgia (Bucharest, Romania : 1990)
|August 11, 2007
Summary
Low-flow carbon dioxide insufflation during thoracoscopic surgery improves the surgical field. Despite initial concerns from animal studies, this study found minimal clinical significance in hemodynamic changes in human patients undergoing thymectomy.
Area of Science:
- Cardiothoracic Surgery
- Anesthesiology
- Medical Devices
Context:
- Thoracoscopic surgery utilizes carbon dioxide (CO2) insufflation to enhance the surgical field.
- Previous animal studies indicated potential negative hemodynamic effects of positive pressure capnothorax.
- This study investigates the hemodynamic impact of low-flow CO2 insufflation in human patients.
Purpose:
- To assess the hemodynamic effects of low-flow positive pressure capnothorax during thoracoscopic thymectomy.
- To evaluate the safety and clinical significance of CO2 insufflation in human subjects.
- To compare findings with previous animal research.
Summary:
- Twenty-four myasthenic patients undergoing thoracoscopic thymectomy were studied using thoracic electrical bioimpedance (TEB) to monitor cardiac index (CI), stroke index (SI), systemic stroke vascular resistance index (SSVRI), and end diastolic index (EDI).
- Sevoflurane with a low dose of fentanyl was used for anesthesia, ensuring hemodynamic stability.
- While statistically significant decreases in CI and SI were observed during 10 mm Hg capnothorax, the clinical significance was minimal.
Impact:
- The findings suggest that low-flow CO2 insufflation is a safe and effective technique for thoracoscopic procedures.
- This study challenges previous concerns regarding the hemodynamic impact of capnothorax in humans.
- The clinic now routinely applies this technique for most thoracoscopies based on these results.
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