MING-HUI HUNGHSAO-HSUN HSUKUANG-CHENG CHANKE-CHENG CHENJR-CHI YIEYA-JUNG CHENGJIN-SHING CHEN2021-10-272021-10-2720141010-7940https://www.scopus.com/inward/record.uri?eid=2-s2.0-84908175543&doi=10.1093%2fejcts%2fezu054&partnerID=40&md5=dc74d841ddc9465c891b946f9de86bb0https://scholars.lib.ntu.edu.tw/handle/123456789/585871OBJECTIVES: 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.en[SDGs]SDG3morphine; adult; aged; anesthesia induction; Article; atelectasis; cancer surgery; child; female; headache; human; intercostal nerve block; lung lobectomy; lung tumor; major clinical study; male; mediastinum tumor; nerve block; non intubated thoracoscopic surgery; one lung ventilation; operative blood loss; pleura tumor; pneumothorax; positive end expiratory pressure; postoperative analgesia; postoperative care; postoperative delirium; postoperative pain; postoperative vomiting; priority journal; prospective study; sedation; sore throat; surgical technique; thoracoscopy; thoracotomy; thorax drainage; thorax epidural anesthesia; vagus nerve; vagus nerve block; very elderly; video assisted thoracoscopic surgery; wedge resection; adolescent; adverse effects; intercostal nerve; Lung Neoplasms; middle aged; nerve block; physiology; procedures; retrospective study; vagus nerve; video assisted thoracoscopic surgery; young adult; Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Intercostal Nerves; Lung Neoplasms; Male; Middle Aged; Nerve Block; Retrospective Studies; Thoracic Surgery, Video-Assisted; Vagus Nerve; Young Adultjournal article10.1093/ejcts/ezu054245855502-s2.0-84908175543