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Five Hundred Seventy-Six Cases of Video-Assisted Thoracic Surgery Using Local Anesthesia and Sedation: Lessons
1Department of Surgery, Sinai Hospital and Northwest Hospital, Baltimore, MD.
Background:
General anesthesia and endotracheal intubation are a luxury rather than a necessity for many video-assisted thoracic surgery (VATS) operations. Twenty-three years ago, I began using local anesthesia and sedation for pleural disease and subsequently, for pericardial and lung disease.
Study Design:
The records of all patients undergoing VATS using local anesthesia and sedation at hospitals of the Geisinger Health System (Danville and Wilkes-Barre, PA), from June 1, 2002 to June 30, 2011, and the Lifebridge Health System (Baltimore, MD) from July 1, 2011 to March 1, 2017, were retrospectively reviewed. There was 1 unsuccessful attempt at this technique, and it was eligible for inclusion. No patient was excluded based on age, BMI, or comorbidities. No patient had endotracheal intubation, laryngeal mask airway, or epidural or nerve block analgesia; all patients breathed spontaneously.
Results:
Five hundred twenty-nine patients ranging in age from 21 to 104 years (mean 67 years) underwent 576 procedures: pleural biopsy-drainage with or without talc (n = 368); drainage of empyema (n = 112); lung biopsy (n = 56); evacuation of chronic hemothorax (n = 23); pericardial window (n = 10); treatment of chylothorax (n = 2); lung abscess draining (n = 2); treatment of pneumothorax (n = 2); and mediastinal mass biopsy (n = 1). No patient required intubation or conversion to thoracotomy. There were 12 complications (2%). There were no deaths due to operation.
Conclusions:
Video-assisted thoracic surgery using local anesthesia and sedation is safe and effective for many indications. A review of the lessons learned caring for 529 patients will allow any thoracic surgeon and any anesthesiologist to practice this technique.