肺手術を受ける患者の術後横隔膜機能および肺合併症に対する非挿管麻酔下ビデオ支援胸腔鏡手術の効果：ランダム化臨床試験

Postoperative diaphragmatic dysfunction (PDD) and pulmonary complications (PPCs) are common complications in patients undergoing video-assisted thoracoscopic (VATS) lung surgery. There is increasing evidence for the safety and advantages of non-intubated anaesthesia in VATS lung surgery. It remains, however, to be demonstrated whether non-intubated anaesthesia in these patients improved PDD and PPCs.

Between 9 October 2022 and 26 November 2023, 160 patients scheduled for VATS lung surgery were enrolled and randomly allocated to non-intubated anaesthesia (NIVATS) group or intubated anaesthesia (IVATS) group. The primary outcome was the incidence of PDD at 24 hours postoperatively defined as a diaphragmatic excursion less than 10 mm evaluated by ultrasound. The occurrence of PPCs was assessed up to 7 days after surgery.

The incidence of PDD at 24 h was significantly lower in the NIVATS group (28 of 80, [35.0%]) than IVATS group (46 of 80 [57.5%]; relative risk [95% confidence interval], 0.61 [0.43-0.87]; P<0.001). The rate of PPCs was significantly lower in the NIVATS group (14 of 80, [17.5%]) than IVATS group (27 of 80 [33.8%]; relative risk [95% confidence interval], 0.52 [0.29-0.91]; P = 0.019).

Non-intubated anaesthesia reduced the incidence of PDD and PPCs for patients undergoing VATS lung surgery. These findings indicated that NIVATS offers more benefits and may be a superior option compared to IVATS for selected patients.