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.
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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
Original language English
Type of outcome Article in a journal
Field of Study 30212 Surgery
Country of publisher Switzerland
Confidentiality degree is not subject to a state or trade secret
WWW 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
Tags 14110223, rivok
Tags International impact, Reviewed
Changed by Changed by: Mgr. Tereza Miškechová, učo 341652. Changed: 11/7/2024 08:12.
Abstract
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.
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