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