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Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years
Background: Non-intubated thoracic surgery has not achieved widespread acceptance despite its potential to improve postoperative outcomes. To ensure airway safety, our institute has developed a technique combining spontaneous ventilation with double-lumen tube intubation (SVI). This study aimed to v...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10607362/ https://www.ncbi.nlm.nih.gov/pubmed/37892595 http://dx.doi.org/10.3390/jcm12206457 |
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author | Szabo, Zsolt Fabo, Csongor Szarvas, Matyas Matuz, Maria Oszlanyi, Adam Farkas, Attila Paroczai, Dora Lantos, Judit Furak, Jozsef |
author_facet | Szabo, Zsolt Fabo, Csongor Szarvas, Matyas Matuz, Maria Oszlanyi, Adam Farkas, Attila Paroczai, Dora Lantos, Judit Furak, Jozsef |
author_sort | Szabo, Zsolt |
collection | PubMed |
description | Background: Non-intubated thoracic surgery has not achieved widespread acceptance despite its potential to improve postoperative outcomes. To ensure airway safety, our institute has developed a technique combining spontaneous ventilation with double-lumen tube intubation (SVI). This study aimed to verify the feasibility and limitations of this SVI technique. Methods: For the SVI method, anesthesia induction involves fentanyl and propofol target-controlled infusion, with mivacurium administration. Bispectral index monitoring was used to ensure the optimal depth of anesthesia. Short-term muscle relaxation facilitated double-lumen tube intubation and early surgical steps. Chest opening preceded local infiltration, followed by a vagal nerve blockade to prevent the cough reflex and a paravertebral blockade for pain relief. Subsequently, the muscle relaxant was ceased. The patient underwent spontaneous breathing without coughing during surgical manipulation. Results: Between 10 March 2020 and 28 October 2022, 141 SVI surgeries were performed. Spontaneous respiration with positive end-expiratory pressure was sufficient in 65.96% (93/141) of cases, whereas 31.21% (44/141) required pressure support ventilation. Only 2.84% (4/141) of cases reversed to conventional anesthetic management, owing to technical or surgical difficulties. Results of the 141 cases: The mean maximal carbon dioxide pressure was 59.01 (34.4–92.9) mmHg, and the mean lowest oxygen saturation was 93.96% (81–100%). The mean one-lung, mechanical and spontaneous one-lung ventilation time was 74.88 (20–140), 17.55 (0–115) and 57.73 (0–130) min, respectively. Conclusions: Spontaneous ventilation with double-lumen tube intubation is safe and feasible for thoracic surgery. The mechanical one-lung ventilation time was reduced by 76.5%, and the rate of anesthetic conversion to relaxation was low (2.8%). |
format | Online Article Text |
id | pubmed-10607362 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-106073622023-10-28 Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years Szabo, Zsolt Fabo, Csongor Szarvas, Matyas Matuz, Maria Oszlanyi, Adam Farkas, Attila Paroczai, Dora Lantos, Judit Furak, Jozsef J Clin Med Article Background: Non-intubated thoracic surgery has not achieved widespread acceptance despite its potential to improve postoperative outcomes. To ensure airway safety, our institute has developed a technique combining spontaneous ventilation with double-lumen tube intubation (SVI). This study aimed to verify the feasibility and limitations of this SVI technique. Methods: For the SVI method, anesthesia induction involves fentanyl and propofol target-controlled infusion, with mivacurium administration. Bispectral index monitoring was used to ensure the optimal depth of anesthesia. Short-term muscle relaxation facilitated double-lumen tube intubation and early surgical steps. Chest opening preceded local infiltration, followed by a vagal nerve blockade to prevent the cough reflex and a paravertebral blockade for pain relief. Subsequently, the muscle relaxant was ceased. The patient underwent spontaneous breathing without coughing during surgical manipulation. Results: Between 10 March 2020 and 28 October 2022, 141 SVI surgeries were performed. Spontaneous respiration with positive end-expiratory pressure was sufficient in 65.96% (93/141) of cases, whereas 31.21% (44/141) required pressure support ventilation. Only 2.84% (4/141) of cases reversed to conventional anesthetic management, owing to technical or surgical difficulties. Results of the 141 cases: The mean maximal carbon dioxide pressure was 59.01 (34.4–92.9) mmHg, and the mean lowest oxygen saturation was 93.96% (81–100%). The mean one-lung, mechanical and spontaneous one-lung ventilation time was 74.88 (20–140), 17.55 (0–115) and 57.73 (0–130) min, respectively. Conclusions: Spontaneous ventilation with double-lumen tube intubation is safe and feasible for thoracic surgery. The mechanical one-lung ventilation time was reduced by 76.5%, and the rate of anesthetic conversion to relaxation was low (2.8%). MDPI 2023-10-11 /pmc/articles/PMC10607362/ /pubmed/37892595 http://dx.doi.org/10.3390/jcm12206457 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Szabo, Zsolt Fabo, Csongor Szarvas, Matyas Matuz, Maria Oszlanyi, Adam Farkas, Attila Paroczai, Dora Lantos, Judit Furak, Jozsef Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years |
title | Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years |
title_full | Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years |
title_fullStr | Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years |
title_full_unstemmed | Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years |
title_short | Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years |
title_sort | spontaneous ventilation combined with double-lumen tube intubation during thoracic surgery: a new anesthesiologic method based on 141 cases over three years |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10607362/ https://www.ncbi.nlm.nih.gov/pubmed/37892595 http://dx.doi.org/10.3390/jcm12206457 |
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