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Feasibility of non-intubated anesthesia and regional block for thoracoscopic surgery under spontaneous respiration: a prospective cohort study
Li, Hanwei; Huang, Daiqiang; Qiao, Kun; Wang, Zheng; Xu, Shiyuan.
  • Li, Hanwei; Zhujiang Hospital of Southern Medical University. Department of Anesthesiology. Guangzhou. CN
  • Huang, Daiqiang; Shenzhen People's Hospital, Shenzhen Anesthesiology Engineering Center. Department of Anesthesiology. Shenzhen. CN
  • Qiao, Kun; Shenzhen Third People's Hospital, Guangdong Medical College. Department of Thoracic Surgery. Shenzhen. CN
  • Wang, Zheng; Shenzhen People's Hospital. Department of Thoracic Surgery. Shenzhen. CN
  • Xu, Shiyuan; Zhujiang Hospital of Southern Medical University. Department of Anesthesiology. Guangzhou. CN
Braz. j. med. biol. res ; 53(1): e8645, Jan. 2020. tab, graf
Article in English | LILACS | ID: biblio-1055484
ABSTRACT
Data about the feasibility and safety of thoracoscopic surgery under non-intubated anesthesia and regional block are limited. In this prospective study, 57 consecutive patients scheduled for thoracoscopic surgery were enrolled. Patients were sedated with dexmedetomidine and anesthetized with propofol and remifentanil. Ropivacaine was used for intercostal nerve and paravertebral block. Lidocaine was used for vagal block. The primary outcomes were mean arterial pressure (MAP), heart rate (HR), oxygen saturation, and end-tidal carbon dioxide partial pressure (ETCO2) at T0 (pre-anesthesia), T1 (immediately after laryngeal mask/nasopharyngeal airway placement), T2 (immediately after skin incision), T3 (10 min after opening the chest), T4 (end of surgery), and T5 (immediately after laryngeal mask/nasopharyngeal airway removal). One patient required conversion to intubation, 15 developed intraoperative hypotension, and two had hypoxemia. MAP at T0 and T5 was higher than at T1-T4; MAP at T3 was lower (P<0.05 vs other time points). HR at T0 and T5 was higher (P<0.05 vs other time points). ETCO2 at T2 and T3 was higher (P<0.05 vs other time points). Arterial pH, PCO2, and lactic acid at T1 differed from values at T0 and T2 (P<0.05). The Quality of Recovery-15 (QoR-15) score at 24 h was lower (P<0.05). One patient experienced dysphoria during recovery. Thoracoscopic surgery with regional block under direct thoracoscopic vision is a feasible and safe alternative to conventional surgery under general anesthesia, intubation, and one-lung ventilation.
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Full text: Available Index: LILACS (Americas) Main subject: Thoracoscopy / Laryngeal Masks / Anesthesia, General / Nerve Block Type of study: Etiology study / Observational study Limits: Adolescent / Adult / Female / Humans / Male Language: English Journal: Braz. j. med. biol. res Journal subject: Biology / Medicine Year: 2020 Type: Article Affiliation country: China Institution/Affiliation country: Shenzhen People's Hospital/CN / Shenzhen People's Hospital, Shenzhen Anesthesiology Engineering Center/CN / Shenzhen Third People's Hospital, Guangdong Medical College/CN / Zhujiang Hospital of Southern Medical University/CN

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Full text: Available Index: LILACS (Americas) Main subject: Thoracoscopy / Laryngeal Masks / Anesthesia, General / Nerve Block Type of study: Etiology study / Observational study Limits: Adolescent / Adult / Female / Humans / Male Language: English Journal: Braz. j. med. biol. res Journal subject: Biology / Medicine Year: 2020 Type: Article Affiliation country: China Institution/Affiliation country: Shenzhen People's Hospital/CN / Shenzhen People's Hospital, Shenzhen Anesthesiology Engineering Center/CN / Shenzhen Third People's Hospital, Guangdong Medical College/CN / Zhujiang Hospital of Southern Medical University/CN