Back to 2015 Thoracic Track Program Overview
Non-Intubated Single Incision VATS (NISIVATS) for bullectomy under sedation and local anesthesia
Jinwook Hwang, MD, PhD, Byung-Ju Min, MD, PhD, Won-Min Jo, MD, PhD, Jae-Seung Shin, MD, PhD.
Korea University Ansan Hospital, Ansan, Korea, Republic of.
OBJECTIVE: VATS bullectomy in primary spontaneous pneumothorax is relatively short and simple procedure in thoracic surgery. Generally, double lumen endotracheal intubation and bronchoscopy examination under positive mechanical ventilation and IV neuromuscular blockers were essential for this operation. We would like to introduce minimally invasive single incision VATS bullectomy under sedation and local anesthesia without endotracheal intubation.
METHODS: We demonstrate Non-intubated single incision VATS under continuous IV infusion of sedatives (dexmedetomidine and ketamine) and local anesthesia (2% lidocaine) around the single site for a chest tube. We do not perform an epidural, intercostal or vagal nerve block. During operations, bispectral index should be maintained between 40 and 60 by anesthesiologists. We do not any kinds of intraoperative pleurodesis. About 15 minutes before finishing operations, we stop IV infusion of sedatives. Patients are transferred to the recovery room under sedation.
RESULTS: Twenty two patients underwent NISIVATS bullectomy for primary spontaneous pneumothorax. Operation time was 30.76±6.51 minutes. Sedation time was 75.0±9.08 minutes. There are no morbidity and no conversion to endotracheal intubation and general anesthesia. After 2 hours later finishing operation, patients were allowed to eat foods without post-operative nausea or vomiting.
CONCLUSIONS: We think that this anesthetic procedure is extremely minimally invasive to patients. Almost every primary spontaneous pneumothorax patients have no underlying anesthetic risk factor to keep self-one lung respiration safe. Especially, only single site local anesthesia is needed for blocking pleural irritation in single incision VATS. We suggest that NISIVATS is feasible option in VATS bullectomy for primary spontaneous pneumothorax.
Back to 2015 Thoracic Track Program Overview