Anaesthetic considerations for non-intubated thoracic surgery

Journal of Visualized Surgery
Joanne Frances Irons, Guillermo Martinez

Abstract

General anaesthesia with intubation and single lung ventilation has always been considered essential for thoracic surgery. Over the last decade there has been a huge evolution in thoracic surgery with the development of multiport and uniportal minimally invasive techniques. The development of a non-intubated technique during which thoracic surgery is performed on patients who are spontaneously ventilating awake, under minimal sedation with the aid of local or regional anaesthesia or under general anaesthesia with a supraglottic airway device is winning acceptance as a valid alternative technique. The concept is to allow the creation of a spontaneous pneumothorax as the surgeon enters the chest. This can provide excellent lung isolation without the need for positive pressure ventilation on the dependant lung. Awake and minimal sedation techniques, which avoid the need for general anaesthesia, maintain a more physiological cardiopulmonary and neurological status and avoid postoperative nausea and vomiting. However, general anaesthesia with a supraglottic airway device is the technique that provides a more stable airway and facilitates oxygenation in cases where an unexpected conversion to open thoracotomy in needed. For non-intub...Continue Reading

Citations

Oct 13, 2019·General Thoracic and Cardiovascular Surgery·Wan-Ting HungJin-Shing Chen
Feb 13, 2021·BMC Anesthesiology·Isabella MetelmannSebastian Kraemer
Apr 22, 2021·Journal of Cardiothoracic Surgery·Mertol GokceBurak Bahadir

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