Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years

Szabo, Zsolt [Szabó, Zsolt (aneszteziológia é...), szerző] Multidiszciplináris Orvostudományok Doktori Iskola (SZTE / DI); Fabo, Csongor* ✉ [Fabó, Csongor (aneszteziológia é...), szerző] Aneszteziológiai és Intenzív Terápiás Intézet (SZTE / SZAOK); Szarvas, Matyas; Matuz, Maria [Matuz, Mária (Klinikai gyógysze...), szerző] Klinikai Gyógyszerészeti Intézet (SZTE / GYTK); Oszlanyi, Adam [Oszlányi, Ádám (aneszteziológia é...), szerző]; Farkas, Attila [Farkas, Attila (Mellkassebészet), szerző]; Paroczai, Dora [Paróczai, Dóra (mikrobiológia, pu...), szerző] Orvosi Mikrobiológiai Intézet (SZTE / SZAOK); Lantos, Judit; Furak, Jozsef [Furák, József (sebészet, mellkas...), szerző] Sebészeti Klinika (SZTE / SZAOK)

Angol nyelvű Szakcikk (Folyóiratcikk) Tudományos
Megjelent: JOURNAL OF CLINICAL MEDICINE 2077-0383 12 (20) Paper: 6457 , 18 p. 2023
  • SJR Scopus - Medicine (miscellaneous): Q1
Azonosítók
Szakterületek:
  • Orvos- és egészségtudomány
Background: Non-intubated thoracic surgery has not achieved widespread acceptance despite its potential to improve postoperative outcomes. To ensure airway safety, our institute has developed a technique combining spontaneous ventilation with double-lumen tube intubation (SVI). This study aimed to verify the feasibility and limitations of this SVI technique. Methods: For the SVI method, anesthesia induction involves fentanyl and propofol target-controlled infusion, with mivacurium administration. Bispectral index monitoring was used to ensure the optimal depth of anesthesia. Short-term muscle relaxation facilitated double-lumen tube intubation and early surgical steps. Chest opening preceded local infiltration, followed by a vagal nerve blockade to prevent the cough reflex and a paravertebral blockade for pain relief. Subsequently, the muscle relaxant was ceased. The patient underwent spontaneous breathing without coughing during surgical manipulation. Results: Between 10 March 2020 and 28 October 2022, 141 SVI surgeries were performed. Spontaneous respiration with positive end-expiratory pressure was sufficient in 65.96% (93/141) of cases, whereas 31.21% (44/141) required pressure support ventilation. Only 2.84% (4/141) of cases reversed to conventional anesthetic management, owing to technical or surgical difficulties. Results of the 141 cases: The mean maximal carbon dioxide pressure was 59.01 (34.4–92.9) mmHg, and the mean lowest oxygen saturation was 93.96% (81–100%). The mean one-lung, mechanical and spontaneous one-lung ventilation time was 74.88 (20–140), 17.55 (0–115) and 57.73 (0–130) min, respectively. Conclusions: Spontaneous ventilation with double-lumen tube intubation is safe and feasible for thoracic surgery. The mechanical one-lung ventilation time was reduced by 76.5%, and the rate of anesthetic conversion to relaxation was low (2.8%).
Hivatkozás stílusok: IEEEACMAPAChicagoHarvardCSLMásolásNyomtatás
2025-05-23 16:15