Clinical analysis of nonintubated anesthesia in subxiphoid uniportal video-assisted thoracic surgery

doi:10.3877/cma.j.issn.1674-6899.2020.06.006

Abstract

Abstract:

Objective

To investigate the feasibility and security of nonintubated anesthesia(NA) in subxiphoid uniportal video-assisted thoracic surgery (SVATS).

Methods

A total of 60 consecutive cases underwent non-intubated SVATS between Apr. 2019 to Apr. 2020 in our hospital were performed. The perioperative complications and treatment measures, postoperative recovery and length of stay were summarized and analyzed. The safety and feasibility of NA in SVATS were evaluated.

Results

All the 60 patients successfully underwent SVATS with NA, including lobectomy in 21 cases, segmental resection in 7 cases, wedge resection in 24 cases, and thymotomy in 8 cases. The operation time was(71.8 ± 25.7)min, (68.9 ± 27.3)min, (41.5 ± 11.1)min and (103.9 ± 22.3)min respectively. The blood loss was (47.6 ± 18.4)ml, (45.6 ± 16.8)ml, (26.5 ± 13.3)ml and(65.8 ± 24.5)ml respectively. Among them, 29 (48.3%) cases needed to insert oropharyngeal airway; 17 (28.3%) cases had intraoperative hypotension; 9 (15.0%) cases had arrhythmia; 4 (6.7%) cases had postoperative complications; There was no serious adverse events of these patients. The average length of stay was (7 ± 4.0) days.

Conclusions

NA is feasibility and has certain advantages in SVATS, large-scale clinical controlled studies are needed to provide more convincing evidence.

Key words: Nonintubated anesthesia, Subxiphoid uniportal video-assisted, Thoracic surgery

Zhigang Chen, Jiamin Shi, Zhe Shi, Jianqiao Cai, Yuming Zhu, Lihua Dai, Xin Lyu, Lei Jiang. Clinical analysis of nonintubated anesthesia in subxiphoid uniportal video-assisted thoracic surgery[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2020, 13(06): 342-346.

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URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2020.06.006

https://zhqjwkzz.cma-cmc.com.cn/EN/Y2020/V13/I06/342

Figures/Tables 7

References 18

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项目		肺叶切除术(21例)	肺段切除术(7例)	肺楔形切除术(24例)	纵隔肿瘤切除术(8例)
手术时间(min， ±s)		71.8±25.7	68.9±27.3	41.5±11.1	103.9±22.3
术中出血量(ml， ±s)		47.6±18.4	45.6±16.8	26.5±13.3	65.8±24.5
呛咳(例)		4	2	1	1
低血压(例)		8	2	3	4
心律失常(例)
	室性期前收缩	2	1	0	1
	心房纤颤	1	0	0	1
	窦性心律失常	1	1	1	0

项目		肺叶切除术(21例)	肺段切除术(7例)	肺楔形切除术(24例)	纵隔肿瘤切除术(8例)
手术时间(min， ±s)		71.8±25.7	68.9±27.3	41.5±11.1	103.9±22.3
术中出血量(ml， ±s)		47.6±18.4	45.6±16.8	26.5±13.3	65.8±24.5
呛咳(例)		4	2	1	1
低血压(例)		8	2	3	4
心律失常(例)
	室性期前收缩	2	1	0	1
	心房纤颤	1	0	0	1
	窦性心律失常	1	1	1	0

项目	肺叶切除术(21例)	肺段切除术(7例)	肺楔形切除术(24例)	纵隔肿瘤切除术(8例)
低氧血症(例)	4	1	2	3
术毕PaO₂(mmHg， ±s)	142.8±50.5	136.3±28.6	146.1±57.8	103.8±48.3
术毕PaCO₂(mmHg， ±s)	68.5±9.7	66.5±8.3	63.3±7.4	70.1±7.8
置入口咽通气道(例)	11	4	10	4
口腔分泌物(例)	2	1	0	1

项目	肺叶切除术(21例)	肺段切除术(7例)	肺楔形切除术(24例)	纵隔肿瘤切除术(8例)
低氧血症(例)	4	1	2	3
术毕PaO₂(mmHg， ±s)	142.8±50.5	136.3±28.6	146.1±57.8	103.8±48.3
术毕PaCO₂(mmHg， ±s)	68.5±9.7	66.5±8.3	63.3±7.4	70.1±7.8
置入口咽通气道(例)	11	4	10	4
口腔分泌物(例)	2	1	0	1

项目		肺叶切除术(21例)	肺段切除术(7例)	肺楔形切除术(24例)	纵隔肿瘤切除术(8例)
术后PaO₂(mmHg， ±s)		157.8±27.6	145.3±21.2	161.1±23.5	120.8±22.7
术后PaCO₂(mmHg， ±s)		46.5±6.7	45.8±5.3	43.9±5.8	43.1±5.9
术后下床活动时间(h， ±s)		14.8±1.7	14.8±1.7	11.2±2.1	15.7±2.1
术后进食时间(h， ±s)		12.5±1.9	12.5±1.9	10.4±1.8	13.2±2.1
术后恶心、呕吐(例)		3	1	2	1
术后24 h VAS(分， ±s)		3.3±1.3	3.6±1.1	3.8±1.5	4.0±1.5
术后引流管拔除时间(d， ±s)		3±1.0	3±1.0	1±1.0	2±1.0
术后并发症(例)
	低氧血症	0	0	0	1
	漏气	1	0	0	0
	心律失常	1	0	0	1

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