Anaesthetic considerations for non-intubated thoracic surgery

Area of Science:

• Thoracic Surgery
• Anesthesiology
• Minimally Invasive Procedures

Background:

• Traditionally, general anesthesia with intubation and single lung ventilation has been standard for thoracic surgery.
• Minimally invasive techniques, including multiport and uniportal approaches, have evolved significantly.
• Non-intubated techniques are emerging as a safe alternative, performed under sedation or local/regional anesthesia.

Purpose of the Study:

• To explore the growing acceptance and application of non-intubated thoracic surgery techniques.
• To highlight the advantages and considerations of performing thoracic surgery without endotracheal intubation.
• To provide recommendations for centers adopting these innovative anesthetic approaches.

Main Methods:

• Performing thoracic surgery on spontaneously ventilating patients under minimal sedation with local/regional anesthesia or general anesthesia with a supraglottic airway device.
• Utilizing the concept of spontaneous pneumothorax for lung isolation without positive pressure ventilation.
• Employing multimodal analgesia, with regional techniques being essential for non-intubated thoracic surgery.

Main Results:

• Non-intubated techniques can provide excellent lung isolation and maintain physiological status.
• Awake/sedation methods avoid general anesthesia complications like postoperative nausea and vomiting.
• General anesthesia with a supraglottic airway offers a stable airway for potential conversion to open thoracotomy.

Conclusions:

• Non-intubated thoracic surgery is an innovative approach to reduce procedure invasiveness.
• Centers should start with minor video-assisted thoracic surgery (VATS) in low-risk patients.
• Further research is needed to identify optimal patient selection and assess perioperative outcomes.