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Feasibility, safety and effectiveness of videothoracoscopy performed under local anesthesia and sedation without tracheal intubation

OBJECTIVE: To evaluate the feasibility, safety and effectiveness of videothoracoscopy (VT) with local anesthesia and sedation, and if this combination can be a feasible choice in selected patients.
METHODS: A prospective study in which 23 patients underwent a VT with local anesthesia and sedation. Upon being admitted to the operating room, have been verified and recorded: oxygen saturation (O2 Sat), blood pressure (BP) and heart rate (HR). After that, fentanyl was administered intravenously 1.5 mcg / Kg, and this moment was standardized as time "0" and the continuous infusion of propofol 0.05 mg/kg/min was started. Intercostal block was performed at the point of introduction of the trocars. Changes in vital signs during the time of surgery were compared with the time "0". The feasibility was evaluated by the number of cases that we could perform the procedure and whether there was some kind of memory of pain or discomfort of the operation. Safety was assessed by changes in vital signs during the operation, the necessity to perform tracheal intubation during the procedure and the need for postoperative in intensive care unit.
RESULTS: No patients have remembered discomfort or pain of the operation, no required tracheal intubation or postoperatively in the intensive care unit have been needed. VT reached in all cases their diagnostic or therapeutic purposes. All patients remained with satisfactory levels of oxygen during the procedure, and in no case was required tracheal intubation. Variations of BP and HR no compromising the procedure even in elderly or patients with cardiovascular risk. Cancer patients with worse functional status showed significant fall in vital signs during the operation, compared with the group with the best score.
CONCLUSIONS: VT with local anesthesia and sedation is feasible and safe, was successfully performed in all patients, without tracheal intubation, admission to the intensive care unit or dead.

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