Intubated Versus Nonintubated General Anesthesia For Minimally Invasive VATS In Octogenerians (28)
Nenad Ilic1, Darko Ilic2, Josko Juricic1, Dragan Krnic1, Duje Orsulic1, Ivan Simundza1, Nives Frleta Ilic3, Nenad Karanovic2.
1University Surgical Hospital, Split, Croatia, 2Clinical Hospital, Anesthesiology Dept., Split, Croatia, 3Policlinic Cito, Split, Croatia.
BACKGROUND: In recent years, non-intubated video-assisted thoracic surgey (VATS) is gaining popularity worldwide, especially in elderly lung patients. The main goal of this surgical practice is to achieve an overall improvement of patients management and outcome thanks to the avoidance of side-effects related to general anesthesia (GA) and single-lung ventilation. In this study we tried to compare a nonintubated general anesthetic technique with an intubated general anesthetic technique for VATS. METHODS: Sixty patients aged 80 and more scheduled for VATS lung surgery, were allocated randomly into two groups with 30 patients each. First group received standard general anesthesia with double lumen tube. Second group went under non-intubated anesthetic technique. Heart rate, mean arterial pressure, end-tidel CO2 and the visual analog pain score (VAS) measurements were recorded during the surgery and 24 hours after the surgery. Both group received ultrasound guided paravertebral block before surgery with single injection of 20 ml of 0.25% levobupivacaine. VATS lung biopsy, sublobar or lobar resection were equally distributed in both groups of patients. RESULTS: Time for anesthetic procedure was shorter in the nonintubated group. VATS was performed in usual manner in all patients without any intraoperative complications. Final surgical outcome was similar for both groups. VAS score in the first 24 hours was comperable. We found significantlly shorter recovery time, reduced oxygen requirement, and shorter hospital stay in the non-intubated group. There where no significant difference in intraoperative blood loss, the operation time or postoperative complications between the nonintubated group and the intubated group of patients. CONCLUSIONS: In this study, our experience has shown that non-intubated VATS is a safe and feasible surgery for elderly lung cancer patients with certain advantages for the patients undergoing VATS.. Our results indicated that we can achieve day surgery for selected patients. Further clinical studies should be carried out in order to improve surgical outcome in elderly LC patients.
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