Physiological pattern differences in non-intubated vs. intubated thoracic anesthesia based on time series analysis.

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Critical Care Medicine

Background:

• Evidence for targeted anesthesia management in non-intubated thoracic anesthesia is limited, often relying on experience.
• This study compares dynamic physiological parameters during one-lung ventilation in non-intubated versus intubated thoracic anesthesia.

Purpose of the Study:

• To elucidate differences in physiological parameters during non-intubated versus intubated thoracic anesthesia.
• To compare anesthetic use and postoperative outcomes between the two anesthesia methods.

Main Methods:

• Prospective, observational, controlled study with 131 non-intubated and 155 intubated VATS patients.
• Propensity score matching (PSM) used for sublobectomy (SubL); not applied for lobectomy (Lob).
• Real-time physiological data (SpO2, ETCO2, BIS, MAP, HR) recorded and analyzed.

Main Results:

• Non-intubated anesthesia reduced sevoflurane, sufentanil, remifentanil, and cisatracurium use.
• Higher BIS, similar SpO2, fluctuating ETCO2, lower MAP, and higher HR observed in non-intubated group.
• Improved Aldrete scores and shorter PACU stay for non-intubated lobectomy patients.

Conclusions:

• Non-intubated thoracic anesthesia, using regional blocks and spontaneous ventilation, demonstrates effective management with reduced anesthetics.
• This approach yields comparable postoperative outcomes to intubated anesthesia.
• Non-intubated anesthesia accelerates postoperative recovery, particularly for lobectomy procedures.