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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| Format: | Article |
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MDPI AG
2023-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/20/6457 |
| _version_ | 1797573440751796224 |
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| author | Zsolt Szabo Csongor Fabo Matyas Szarvas Maria Matuz Adam Oszlanyi Attila Farkas Dora Paroczai Judit Lantos Jozsef Furak |
| author_facet | Zsolt Szabo Csongor Fabo Matyas Szarvas Maria Matuz Adam Oszlanyi Attila Farkas Dora Paroczai Judit Lantos Jozsef Furak |
| author_sort | Zsolt Szabo |
| collection | DOAJ |
| 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%). |
| first_indexed | 2024-03-10T21:10:31Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T21:10:31Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-19ac0faaca5c4f6090e882cc44cb6f5f2023-11-19T16:51:23ZengMDPI AGJournal of Clinical Medicine2077-03832023-10-011220645710.3390/jcm12206457Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three YearsZsolt Szabo0Csongor Fabo1Matyas Szarvas2Maria Matuz3Adam Oszlanyi4Attila Farkas5Dora Paroczai6Judit Lantos7Jozsef Furak8Doctoral School of Multidisciplinary Medicine, University of Szeged, H-6720 Szeged, HungaryDepartment of Anesthesiology and Intensive Therapy, University of Szeged, H-6720 Szeged, HungaryDepartment of Anesthesiology and Intensive Therapy, University of Szeged, H-6720 Szeged, HungaryInstitute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, H-6720 Szeged, HungaryDepartment of Anesthesiology and Intensive Therapy, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, HungaryDepartment of Thoracic Surgery, Markusovszky University Teaching Hospital, H-9700 Szombathely, HungaryDepartment of Medical Microbiology, University of Szeged, H-6720 Szeged, HungaryDepartment of Neurology, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, HungaryDepartment of Surgery, University of Szeged, H-6720 Szeged, HungaryBackground: 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%).https://www.mdpi.com/2077-0383/12/20/6457non-intubated thoracic surgeryVATSspontaneous breathingmechanical ventilationSVI |
| spellingShingle | Zsolt Szabo Csongor Fabo Matyas Szarvas Maria Matuz Adam Oszlanyi Attila Farkas Dora Paroczai Judit Lantos Jozsef Furak Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years Journal of Clinical Medicine non-intubated thoracic surgery VATS spontaneous breathing mechanical ventilation SVI |
| 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 | non-intubated thoracic surgery VATS spontaneous breathing mechanical ventilation SVI |
| url | https://www.mdpi.com/2077-0383/12/20/6457 |
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