Non-intubated Thoracoscopic Surgery-Tips and Tricks From
Anesthesiological Aspects: A Mini Review

J 2022

Non-intubated Thoracoscopic Surgery-Tips and Tricks From Anesthesiological Aspects: A Mini Review

FABO, Csongor, Adam OSZLANYI, Judit LANTOS, Ferenc RAROSI, Teodor HORVÁTH et. al.

Basic information

Original name

Non-intubated Thoracoscopic Surgery-Tips and Tricks From Anesthesiological Aspects: A Mini Review

Authors

FABO, Csongor, Adam OSZLANYI, Judit LANTOS, Ferenc RAROSI, Teodor HORVÁTH (203 Czech Republic, belonging to the institution), Zsanett BARTA, Tibor NEMETH and Zsolt SZABO

Edition

FRONTIERS IN SURGERY, LAUSANNE, FRONTIERS MEDIA SA, 2022, 2296-875X

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30212 Surgery

Country of publisher

Switzerland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 1.800

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.3389/fsurg.2021.818456

UT WoS

000761013100001

Keywords in English

non-intubated thoracic surgery; VATS; spontaneous breathing; mechanical ventilation; V; Q mismatch; SVI

Abstract

V originále

BackgroundIn the last few decades, surgical techniques have been developed in thoracic surgery, and minimally invasive strategies such as multi-and uniportal video-assisted thoracic surgery (VATS) have become more favorable even for major pulmonary resections. With this surgical evolution, the aesthetic approach has also changed, and a paradigm shift has occurred. The traditional conception of general anesthesia, muscle relaxation, and intubation has been re-evaluated, and spontaneous breathing plays a central role in our practice by performing non-intubated thoracoscopic surgeries (NITS-VATS). MethodsWe performed a computerized search of the medical literature (PubMed, Google Scholar, Scopus) to identify relevant articles in non-intubated thoracoscopic surgery using the following terms [(non-intubated) OR (non-intubated) OR (awake) OR (tubeless) OR (regional anesthesia)] AND [(VATS) OR (NIVATS)], as well as their Medical Subject Headings (MeSH) terms. ResultsBased on the outcomes of the reviewed literature and our practice, it seems that pathophysiological concerns can be overcome by proper surgical and anesthetic management. All risks are compensated by the advantageous physiological changes that result in better patient outcomes. With the maintenance of spontaneous breathing, the incidence of potential adverse effects of mechanical ventilation, such as ventilator-induced lung injury and consequent postoperative pulmonary complications, can be reduced. The avoidance of muscle relaxants also results in the maintenance of contraction of the dependent hemidiaphragm and lower airway pressure levels, which may lead to better ventilation-perfusion matching. These techniques can be challenging for surgeons as well as for anesthetists; hence, a good knowledge of physiological and pathophysiological changes, clear inclusion and exclusion and intraoperative conversion criteria, and good communication between team members are essential. ConclusionNITS-VATS seems to be a feasible and safe method in selected patients with evolving importance as a part of the minimally invasive surgical and anesthetic conception and has a role in reducing perioperative complications, which is crucial in the thoracic surgical patient population.

Citovat

FABO, Csongor, Adam OSZLANYI, Judit LANTOS, Ferenc RAROSI, Teodor HORVÁTH, Zsanett BARTA, Tibor NEMETH and Zsolt SZABO. Non-intubated Thoracoscopic Surgery-Tips and Tricks From Anesthesiological Aspects: A Mini Review. FRONTIERS IN SURGERY. LAUSANNE: FRONTIERS MEDIA SA, 2022, vol. 8, February 2022, p. 1-8. ISSN 2296-875X. Available from: https://dx.doi.org/10.3389/fsurg.2021.818456.

@article{2417951,
   author = {Fabo, Csongor and Oszlanyi, Adam and Lantos, Judit and Rarosi, Ferenc and Horváth, Teodor and Barta, Zsanett and Nemeth, Tibor and Szabo, Zsolt},
   article_location = {LAUSANNE},
   article_number = {February 2022},
   doi = {http://dx.doi.org/10.3389/fsurg.2021.818456},
   keywords = {non-intubated thoracic surgery; VATS; spontaneous breathing; mechanical ventilation; V; Q mismatch; SVI},
   language = {eng},
   issn = {2296-875X},
   journal = {FRONTIERS IN SURGERY},
   title = {Non-intubated Thoracoscopic Surgery-Tips and Tricks From Anesthesiological Aspects: A Mini Review},
   url = {https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2021.818456/full},
   volume = {8},
   year = {2022}
}

TY  - JOUR
ID  - 2417951
AU  - Fabo, Csongor - Oszlanyi, Adam - Lantos, Judit - Rarosi, Ferenc - Horváth, Teodor - Barta, Zsanett - Nemeth, Tibor - Szabo, Zsolt
PY  - 2022
TI  - Non-intubated Thoracoscopic Surgery-Tips and Tricks From Anesthesiological Aspects: A Mini Review
JF  - FRONTIERS IN SURGERY
VL  - 8
IS  - February 2022
SP  - 1-8
EP  - 1-8
PB  - FRONTIERS MEDIA SA
SN  - 2296875X
KW  - non-intubated thoracic surgery
KW  - VATS
KW  - spontaneous breathing
KW  - mechanical ventilation
KW  - V
KW  - Q mismatch
KW  - SVI
UR  - https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2021.818456/full
N2  - BackgroundIn the last few decades, surgical techniques have been developed in thoracic surgery, and minimally invasive strategies such as multi-and uniportal video-assisted thoracic surgery (VATS) have become more favorable even for major pulmonary resections. With this surgical evolution, the aesthetic approach has also changed, and a paradigm shift has occurred. The traditional conception of general anesthesia, muscle relaxation, and intubation has been re-evaluated, and spontaneous breathing plays a central role in our practice by performing non-intubated thoracoscopic surgeries (NITS-VATS). MethodsWe performed a computerized search of the medical literature (PubMed, Google Scholar, Scopus) to identify relevant articles in non-intubated thoracoscopic surgery using the following terms [(non-intubated) OR (non-intubated) OR (awake) OR (tubeless) OR (regional anesthesia)] AND [(VATS) OR (NIVATS)], as well as their Medical Subject Headings (MeSH) terms. ResultsBased on the outcomes of the reviewed literature and our practice, it seems that pathophysiological concerns can be overcome by proper surgical and anesthetic management. All risks are compensated by the advantageous physiological changes that result in better patient outcomes. With the maintenance of spontaneous breathing, the incidence of potential adverse effects of mechanical ventilation, such as ventilator-induced lung injury and consequent postoperative pulmonary complications, can be reduced. The avoidance of muscle relaxants also results in the maintenance of contraction of the dependent hemidiaphragm and lower airway pressure levels, which may lead to better ventilation-perfusion matching. These techniques can be challenging for surgeons as well as for anesthetists; hence, a good knowledge of physiological and pathophysiological changes, clear inclusion and exclusion and intraoperative conversion criteria, and good communication between team members are essential. ConclusionNITS-VATS seems to be a feasible and safe method in selected patients with evolving importance as a part of the minimally invasive surgical and anesthetic conception and has a role in reducing perioperative complications, which is crucial in the thoracic surgical patient population.
ER  -

FABO, Csongor, Adam OSZLANYI, Judit LANTOS, Ferenc RAROSI, Teodor HORVÁTH, Zsanett BARTA, Tibor NEMETH and Zsolt SZABO. Non-intubated Thoracoscopic Surgery-Tips and Tricks From Anesthesiological Aspects: A Mini Review. \textit{FRONTIERS IN SURGERY}. LAUSANNE: FRONTIERS MEDIA SA, 2022, vol.~8, February 2022, p.~1-8. ISSN~2296-875X. Available from: https://dx.doi.org/10.3389/fsurg.2021.818456.

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