Speaker: Dr. Robert Vach DESA
Topic: HISTORY OF NON-INTUBATED ANAESTHESIA FOR THORACIC SURGERY AT THE FACULTY HOSPITAL BRNO & OUR FIRST EXPERIENCES
Institution: Department of Anesthesiology, Resuscitation and Intensive Medicine Faculty Hospital Brno, Faculty of Medicine, Masaryk University Brno
Non-intubated thoracic surgery is a recently reintroduced concept as an alternative for general anaesthesia, muscle relaxation and one-lung positive pressure ventilation. This concept is gaining popularity because there are data suggesting that non-intubated anaesthesia is safe and can be used with growing experience not only for young and fit, but also for higher risk patients.
The purpose of the presentation is to describe a short history of non-intubated anaesthesia at our hospital. We would like to share with the audience our first experiences and encountered difficulties following completion of ten cases.
At the end of the presentation there is our updated non-intubated anaesthesia manual. The update was made following our participation in clinical training program at National Taiwan University Hospital. Because non-intubated anaesthesia for thoracic surgery is a new procedure in our practise the crisis resource management is also attached.
Speaker: Man-Ling Wang, M.D.
Topic: Anesthesia in Patients Undergoing Nonintubated Thoracoscopic Surgery
Departmenf of Anesthesiology National Taiwan University Hospital Taipei TW
Nonintubated thoracoscopic surgery (NITS) has been extensively used in the recent decade to ensure acceptable postoperative outcomes with preserved respiratory function and without residual muscle relaxation and airway trauma. In contrast to the potential adverse effects of intubated general anaesthesia, NITS may result in a more complete physiological, immunological and neuromuscular recovery after surgery, reducing morbidity, and shortening hospital stay. Perioperative anaesthetic management presents itself as a fresh issue for the iatrogenic open pneumothorax, which is intended for ipsilateral lung collapse to create a steady surgical field, and the ensuing physiologic consequences involving both ventilatory and hemodynamic perspectives. With appropriate monitoring, meticulous employment of regional anaesthesia, targeted sedation, vagal block, and ventilatory support, NITS is proved to be a safe alternative to the conventional intubated general anaesthesia as an ideal treatment of choice for early lung cancer patients.
Speaker: Zsolt Szabo, M.D.
Topic: Non intubated
thoracoscopic surgery: our story in Szeged
Institution: University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy
Keywords: non intubated,
thoracoscopy, spontaneous breathing, double lumen tube, bispectral index, target
controlled infusion, ventillation
Introduction: Video assisted thoracoscopic surgery (VATS) has became frequently used and widely accepted procedure in the thoracic surgery. Conventionally, isolated lung ventilation has been performed by the aid of double lumen tubes (DLT) or bronchial blockers (BB) . Nevertheless, a novel anaesthetic approach has developed during the last decade, when intravenous anaesthesia combined with regional anaesthetic techniques was used without intubation (NITS) and with the maintenance of spontaneous breathing, applied mainly for biopsy, small anatomical resections and mediastinal tumour removal. The theoretical benefit of this technique is avoiding the potential harmful effect of mechanical ventilation .
Methods: The NITS method has been used in out institute as a routine for complete anatomical resections since January 2017. Anaesthesia is induced and maintained with target control infusion of propofol. Depth of anaesthesia is monitored by Bispectral Index targeting a value of 40-60. Spontaneous breathing was preserved and airway secured by laryngeal mask during NITS procedure. Unilateral vagal blockade and paravertebral blockade were performed by the surgeon.
Results and Discussion: Over a period of 16 months 123 patients were involved, 106 undergone NITS and 17 patients had conversion (planned and unplanned) to OLV or non intubated thoracotomy. According to our experience if conversion is needed due to surgical not anaesthetical problems, intubation is not the only way to continue the operation. The other option is the non intubated thoracotomy added with extra regional truncal block.
Conclusion: Our data suggest that NITS is at least a non-inferior alternative of OLV and may also provide benefits for patients undergoing lobectomy or other major pulmonary resections.
1.Jen-Ting Yang, Ming-Hui Hung et al: Anesthetic consideration for nonintubated VATS J Thorac Dis. 2014 Jan; 6(1): 10–13. doi: 10.3978/j.issn.2072-1439.2014.01.03
2. Bei Wang, Shengjin Ge: Nonintubated anesthesia for thoracic surgery J Thorac Dis. 2014 Dec; 6(12): 1868–1874. doi: 10.3978/j.issn.2072-1439.2014.11.39