|Title:||Non-intubated thoracoscopic surgery using internal intercostal nerve block, vagal block and targeted sedation||Authors:||Hung M.-H.
|Issue Date:||2014||Publisher:||European Association for Cardio-Thoracic Surgery||Journal Volume:||46||Journal Issue:||4||Start page/Pages:||620-625||Source:||European Journal of Cardio-thoracic Surgery||Abstract:||
OBJECTIVES: Thoracoscopic surgery using internal intercostal nerve block, vagal block and targeted sedation without endotracheal intubation is a promising technique for selected patients, but little is known about its feasibility and safety. METHODS: We evaluated 109 patients with lung (105), mediastinal (3) or pleural (1) tumours treated using non-intubated thoracoscopic surgery. Internal, intercostal nerve block was performed at the T3-T8 intercostal level and vagal block was performed adjacent to the vagus nerve at the level of the lower trachea for right-sided operations and at the level of the aortopulmonary window for left-sided operations. Sedation was performed with propofol infusion to achieve a bispectral index value between 40 and 60. RESULTS: Thoracoscopic lobectomy was performed in 43 patients, wedge resection in 50, segmentectomy in 12 and mediastinal or pleural tumour excision in 4. Three patients (2.8%) required conversion to intubated one-lung ventilation because of vigorous mediastinal movement and dense diaphragmatic adhesions. Anaesthetic induction and operation had a median duration of 10.0 and 127.0 min, respectively. Operative complications developed in 13 patients with air leaks for more than 3 days and 1 patient required transfusion of blood products. The median postoperative chest drainage and hospital stay were 2.0 and 4.0 days, respectively. CONCLUSIONS: Non-intubated thoracoscopic surgery using internal intercostal nerve block, vagal block and targeted sedation is technically feasible and safe in surgical treatment of lung, mediastinal and pleural tumours in selected patients. ? The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
|Appears in Collections:||醫學院附設癌醫中心醫院(臺大癌醫)|
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