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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...

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Autores principales: Szabo, Zsolt, Fabo, Csongor, Szarvas, Matyas, Matuz, Maria, Oszlanyi, Adam, Farkas, Attila, Paroczai, Dora, Lantos, Judit, Furak, Jozsef
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
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%).
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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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