Anesthesia for thoracoscopic surgery

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Abstract

Anesthesia for thoracoscopy is based on one lung ventilation. Lung separators in the airway are essential tools. An anatomical shunt as a result of the continued perfusion of a non-ventilated lung is the principal intraoperative concern. The combination of equipment, technique and process increase risks of hypoxia and dynamic hyperinflation, in turn, potential factors in the development of an unusual form of pulmonary edema. Analgesia management is modelled on that shown effective and therapeutic for thoracotomy. Perioperative management needs to reflect the concern for these complex, and complicating, processes to the morbidity of thoracoscopic surgery.

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Most cited references 21

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Preoperative multiple-injection thoracic paravertebral blocks reduce postoperative pain and analgesic requirements after video-assisted thoracic surgery.

Elif Basagan-Mogol, A. Bayram, Fatma Nur Kaya … (2006)

The hypothesis was tested that preoperative multiple-injection thoracic paravertebral blocks reduce opioid requirements and promote early ambulation after video-assisted thoracic surgery procedures. Prospective, randomized, controlled, blinded study. Single-university hospital. Fifty consenting patients undergoing video-assisted thoracic surgery. Patients were randomly assigned to receive preoperative multiple-injection thoracic paravertebral blocks (PVB group, n = 25) or preoperative multiple subcutaneous saline injections at the same site as in the PVB group (control group, n = 25). Intraoperative fentanyl consumption was lower in the PVB group (p < 0.01). The time to first analgesic requirement was longer, and pain score at this time was lower in the PVB group (p < 0.05 and p < 0.01, respectively). Postoperative pain scores both at rest and coughing were lower during the first 4 hours in the PVB group than those in the control group (p < 0.01 for 0 hours and p < 0.05 for 1, 2, and 4 hours). Cumulative morphine consumption was significantly less in the PVB group at all time points (p < 0.05 for 12 hours and p < 0.01 for all other time points), but there were no significant differences in sedation scores between the 2 groups. There were no complications because of the blocks. Patient satisfaction with the analgesia was significantly greater (p < 0.05), and first mobilization and hospital discharge were quicker (p < 0.01 and p < 0.05, respectively) in the PVB group. Perioperative multiple-injection thoracic paravertebral blocks with bupivacaine containing epinephrine provided effective pain relief and a significant reduction in opioid requirements. This approach may also contribute to earlier postoperative ambulation after video-assisted thoracic surgery.

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Propofol or sevoflurane anesthesia without muscle relaxants allow the early extubation of myasthenic patients.

Giorgio Della Rocca, Cecilia Coccia, Laura Diana … (2015)

To compare two non-muscle relaxant anesthetic techniques in myasthenic patients undergoing trans-sternal thymectomy, evaluating the intra- and postoperative conditions including the early extubation in the operating room. Sixty-eight consecutive myasthenic patients undergoing trans-sternal thymectomy were prospectively randomized in two groups: propofol and sevoflurane. In both groups anesthesia was induced with propofol (1-2 mg x kg(-1)) and intubation performed after topical anesthesia of the airway with lidocaine. Anesthesia was maintained in the propofol group (36 patients) with a continuous propofol infusion (3-6 mg x kg(-1) x hr(-1)) and nitrous oxide and, in the sevoflurane group (32 patients), with sevoflurane (end-tidal 1-1.5%) in O2:N2O. Intubating conditions, hemodynamic changes, neuromuscular transmission, postoperative intensive care unit and hospital length of stay and complications were evaluated. Data were analyzed with repeated measure two-way analysis of variance (ANOVA), Chi square test and Student's t test. Intubating conditions were good in all patients. There were no hemodynamic changes. All patients were extubated in the operating room and none had to be re-intubated for postoperative respiratory depression. Neuromuscular transmission showed minimal changes, more important in the sevoflurane group, and at the end of the procedure the recovery was complete in all patients. We did not observe any other significant differences between the two groups studied. Our data show that these two anesthetic techniques allow the early extubation of myasthenic patients in the operating room.

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Hemodynamic effects of carbon dioxide insufflation during thoracoscopy.

Lee Wolfer, J U Hasnain, Mike McLaughlin … (1994)

As more complex thoracoscopic procedures are performed, adequate exposure becomes increasingly more important. The insufflation of CO2 has been demonstrated to aid in the compression of lung parenchyma and the effacement of subpleural lesions, and to act as a retractor when combined with changes in patient position. However, a recent study demonstrated that CO2 insufflation during thoracoscopy in the pig had adverse hemodynamic consequences. We prospectively studied 32 patients undergoing thoracoscopy to evaluate the effects of CO2 insufflation in the clinical setting. The end-tidal CO2 pressure, arterial oxygen saturation, mean arterial pressure, heart rate, and central venous pressure were monitored. Measurements were determined at baseline, at the initiation of one-lung ventilation, and at intrapleural pressures of 2 to 14 mm Hg. We found that the insufflation of CO2 of 2 to 14 mm Hg had no significant effect on the end-tidal CO2 pressure, arterial oxygen saturation, heart rate, or mean arterial pressure, but the central venous pressure did rise from 7.00 +/- 1.5 mm Hg to 17.30 +/- 2.53 mm Hg (p < 0.05). We conclude from this that the insufflation of CO2 during thoracoscopy does not have adverse hemodynamic effects in the clinical setting. Therefore, we propose that low-pressure (< 10 mm Hg) insufflation is a safe adjunct to the conduct of routine thoracoscopic surgical procedures.

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Author and article information

Journal

Journal ID (nlm-ta): J Minim Access Surg

Journal ID (publisher-id): JMAS

Title: Journal of Minimal Access Surgery

Publisher: Medknow Publications (India )

ISSN (Print): 0972-9941

ISSN (Electronic): 1998-3921

Publication date (Print): Oct-Dec 2007

Volume: 3

Issue: 4

Pages: 127-131

Affiliations

Department of Thoracic Anesthesia, Freeman Hospital, Newcastle Upon Tyne Nhs Hospital Trust, Freeman Road, Newcastle Upon Tyne, NE7 7DN, England

Author notes

Address for correspondence: Dr I. D. Conacher MB, FRCP (Ed), MD, FFARCS. Consultant Anaesthetist: Freeman Hospital, Newcastle upon Tyne, NE7 7DN. England. Email: i.d.conacher@ 123456btinternet.com

Article

Publisher ID: JMAS-03-127

DOI: 10.4103/0972-9941.38906

PMC ID: 2749195

PubMed ID: 19789673

SO-VID: 315d9eff-1050-4694-830d-2d5c9e796b60

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Anesthesia for thoracoscopic surgery

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SICOT-J (Orthopedic surgery and traumatology)

Most cited references 21

Preoperative multiple-injection thoracic paravertebral blocks reduce postoperative pain and analgesic requirements after video-assisted thoracic surgery.

Propofol or sevoflurane anesthesia without muscle relaxants allow the early extubation of myasthenic patients.

Hemodynamic effects of carbon dioxide insufflation during thoracoscopy.

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