Intubated Versus Nonintubated General Anesthesia for Video-Assisted Thoracoscopic Surgery-A Case-Control Study.

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Abstract

OBJECTIVE

General anesthesia with endobronchial intubation and one-lung positive-pressure ventilation always has been considered mandatory for thoracic surgery. Recently, there has been interest in nonintubated techniques for video-assisted thoracoscopic surgery (VATS) in awake and sedated patients. The authors' center developed a nonintubated technique with spontaneous ventilation with the patient under general anesthesia using a supraglottic airway device. The authors believe that this was the first study to compare a nonintubated general anesthetic technique with an intubated general anesthetic technique for VATS.

DESIGN

Retrospective, observational study.

SETTING

Specialist cardiothoracic hospital in the United Kingdom.

PARTICIPANTS

All patients who underwent elective minor VATS over 8 months (n = 73).

INTERVENTIONS

A nonintubated general anesthetic technique with spontaneous ventilation via a supraglottic airway device was used for minor VATS procedures. This was compared with a case-matched intubated group.

MEASUREMENTS AND MAIN RESULTS

Both groups had comparable baseline characteristics and surgical procedures. The anesthetic time was shorter in the nonintubated group (13.6±8.3 v 24.1±10.9 minutes, p<0.001). Surgical operating time and feasibility were similar. Intraoperatively, there were increases in end-tidal carbon dioxide (59.1±12.9 v 41.8±4.6, p<0.001) and respiratory rate (17.8±5.6 v 13.5±2.0, p<0.001) in the nonintubated group. Fewer patients in the nonintubated group had moderate-severe pain during recovery (19.4% v 48.4%, p = 0.02) and pain on discharge to the ward (25.8% v 61.3%, p = 0.004). There was a trend toward shorter recovery times, reduced oxygen requirement, and shorter hospital stays in the nonintubated group.

CONCLUSIONS

A nonintubated general anesthetic technique is a feasible alternative to intubated general anesthesia for minor VATS procedures.

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