Objective: During the past 20 years, the use of video-assisted thoracoscopicsurgery has increasedas an important minimally invasive tool. To further reduce its invasiveness, after a preliminary experience, we decidedtouseanonintubatedspontaneousbreathinggeneralanesthesia, forvideo-assistedthoracoscopicsurgeryresectionoflungnodule,usinga laryngeal mask (LMA). This study aimed to verify the safety and the feasibility of this technique. Methods: Twentyconsecutivepatientswhounderwentthoracoscopic wedgeoflungnoduleunderspontaneousbreathinggeneral anesthesia withLMAarethesubjectsofthisstudy.Clinicaldata,AmericanSociety of Anesthesiologists status, Adult Comorbidity EvaluationY27 score, and Revised Cardiac Risk Index score were recorded for each patient. Generalinhalatoryanesthesia(sevoflurane)wasgiveninallcasesthrough an LMA, without muscle relaxants, thus allowing spontaneous breathing.Allprocedureswereperformedinthelateraldecubitusposition.The maximumandminimumvaluesofend-tidalcarbondioxidetensionand oxygen saturation were recorded during the procedure. The level of technicalfeasibilitywasstratifiedbytheoperatingsurgeonaccordingto four levels: excellent, good, satisfactory, and unsatisfactory. Results: Therewere 13 men and 7 women (mean age, 57 years). The mean induction anesthesia time was 6 minutes, whereas the mean operativetimewas38minutes.Thevaluesofoxygensaturationaswell as minimum and maximum end-tidal carbon dioxide tension were 99.1%, 33.6 mm Hg, and 39.1 mm Hg, respectively. No mask displacement occurred. The mean operative time was 38 minutes (range, 25Y90 minutes). The level of technical feasibility was defined as excellentin19casesandgoodin1case.Nomortalityoccurred.Morbidity consistedof pleural effusion (one case), which was medically resolved. Themeanpostoperativestaywas3.5days.Histopathologicresultswere one squamous cell lung cancer (lung primary), one adenocarcinoma (lung primary), five metastasis from colon cancer, four metastasis from breastcancer, three metastasis from renal cancer, three sarcoidosis,two amartocondroma, and one tuberculosis. Conclusions: Our experience suggests that thoracoscopic wedge resection oflungnodule issafeandfeasibleunder spontaneous breathing anesthesiawithLMA.Thistechniquepermits a confidentmanipulation oflungparenchymaandasafestapler positioning,withoutcough,pain, or panic attack described for awake epidural anesthesia, avoiding the risks related to tracheal intubation and mechanical ventilation.

Nonintubated thoracoscopic pulmonary nodule resection under spontaneous breathing aneshesia with laryngeal mask

AMBROGI, MARCELLO CARLO;MELFI, FRANCA;MUSSI, ALFREDO
2014-01-01

Abstract

Objective: During the past 20 years, the use of video-assisted thoracoscopicsurgery has increasedas an important minimally invasive tool. To further reduce its invasiveness, after a preliminary experience, we decidedtouseanonintubatedspontaneousbreathinggeneralanesthesia, forvideo-assistedthoracoscopicsurgeryresectionoflungnodule,usinga laryngeal mask (LMA). This study aimed to verify the safety and the feasibility of this technique. Methods: Twentyconsecutivepatientswhounderwentthoracoscopic wedgeoflungnoduleunderspontaneousbreathinggeneral anesthesia withLMAarethesubjectsofthisstudy.Clinicaldata,AmericanSociety of Anesthesiologists status, Adult Comorbidity EvaluationY27 score, and Revised Cardiac Risk Index score were recorded for each patient. Generalinhalatoryanesthesia(sevoflurane)wasgiveninallcasesthrough an LMA, without muscle relaxants, thus allowing spontaneous breathing.Allprocedureswereperformedinthelateraldecubitusposition.The maximumandminimumvaluesofend-tidalcarbondioxidetensionand oxygen saturation were recorded during the procedure. The level of technicalfeasibilitywasstratifiedbytheoperatingsurgeonaccordingto four levels: excellent, good, satisfactory, and unsatisfactory. Results: Therewere 13 men and 7 women (mean age, 57 years). The mean induction anesthesia time was 6 minutes, whereas the mean operativetimewas38minutes.Thevaluesofoxygensaturationaswell as minimum and maximum end-tidal carbon dioxide tension were 99.1%, 33.6 mm Hg, and 39.1 mm Hg, respectively. No mask displacement occurred. The mean operative time was 38 minutes (range, 25Y90 minutes). The level of technical feasibility was defined as excellentin19casesandgoodin1case.Nomortalityoccurred.Morbidity consistedof pleural effusion (one case), which was medically resolved. Themeanpostoperativestaywas3.5days.Histopathologicresultswere one squamous cell lung cancer (lung primary), one adenocarcinoma (lung primary), five metastasis from colon cancer, four metastasis from breastcancer, three metastasis from renal cancer, three sarcoidosis,two amartocondroma, and one tuberculosis. Conclusions: Our experience suggests that thoracoscopic wedge resection oflungnodule issafeandfeasibleunder spontaneous breathing anesthesiawithLMA.Thistechniquepermits a confidentmanipulation oflungparenchymaandasafestapler positioning,withoutcough,pain, or panic attack described for awake epidural anesthesia, avoiding the risks related to tracheal intubation and mechanical ventilation.
2014
Ambrogi, MARCELLO CARLO; Fanucchi, O; Korasidis, S; Davini, F; Gemignani, R; Guarracino, F; Melfi, Franca; Mussi, Alfredo
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/691663
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