Non-Intubated Video-Assisted Thoracoscopic Surgery

Area of Science:

• Thoracic Surgery
• Anesthesiology
• Pulmonology

Background:

• Double-lumen intubation under general anesthesia is standard for thoracic procedures like pneumonectomy, lobectomy, and wedge resection.
• General anesthesia with tracheal intubation is associated with a high incidence of pulmonary complications, including airway trauma and ventilation-induced lung injury.
• Non-intubated anesthesia preserving voluntary breathing offers an alternative to mitigate these adverse effects.

Purpose of the Study:

• To present a concise protocol for non-intubated video-assisted thoracoscopic surgery (VATS) with preserved autonomic breathing.
• To identify conditions for converting from non-intubated to intubated anesthesia during VATS.
• To discuss the advantages and limitations of non-intubated anesthesia for thoracic procedures.

Main Methods:

• Development and application of a non-intubated protocol for VATS.
• Retrospective study involving 58 patients undergoing non-intubated VATS.
• Comparison of outcomes between non-intubated VATS and traditional intubated general anesthesia.

Main Results:

• Patients in the non-intubated VATS group exhibited lower rates of post-operative pulmonary complications compared to the intubated group.
• Non-intubated VATS was associated with shorter operative times, reduced intraoperative blood loss, and shorter post-anesthesia care unit (PACU) stays.
• The non-intubated approach led to fewer days for chest drain removal, less post-operative drainage, and shorter overall hospital stays.

Conclusions:

• Non-intubated VATS with preserved autonomic breathing is a viable and advantageous alternative to intubated general anesthesia for specific thoracic surgeries.
• This technique significantly reduces pulmonary complications and improves recovery metrics, including operative time, blood loss, and hospital duration.
• The presented protocol and conversion criteria facilitate the safe implementation of non-intubated anesthesia in thoracic surgery.