Intubated Versus Nonintubated General Anesthesia for Video-Assisted Thoracoscopic Surgery-A Case-Control Study

Abstract

Objective: General anesthesia with endobronchial intubation and one-lung positive-pressure ventilation always has been considered mandatory for thoracic surgery. Recently, there has been interest in nonintubated techniques for video-assisted thoracoscopic surgery (VATS) in awake and sedated patients. The authors' center developed a nonintubated technique with spontaneous ventilation with the patient under general anesthesia using a supraglottic airway device. The authors believe that this was the first study to compare a nonintubated general anesthetic technique with an intubated general anesthetic technique for VATS.

Design: Retrospective, observational study.

Setting: Specialist cardiothoracic hospital in the United Kingdom.

Participants: All patients who underwent elective minor VATS over 8 months (n = 73).

Interventions: A nonintubated general anesthetic technique with spontaneous ventilation via a supraglottic airway device was used for minor VATS procedures. This was compared with a case-matched intubated group.

Measurements and main results: Both groups had comparable baseline characteristics and surgical procedures. The anesthetic time was shorter in the nonintubated group (13.6±8.3 v 24.1±10.9 minutes, p<0.001). Surgical operating time and feasibility were similar. Intraoperatively, there were increases in end-tidal carbon dioxide (59.1±12.9 v 41.8±4.6, p<0.001) and respiratory rate (17.8±5.6 v 13.5±2.0, p<0.001) in the nonintubated group. Fewer patients in the nonintubated group had moderate-severe pain during recovery (19.4% v 48.4%, p = 0.02) and pain on discharge to the ward (25.8% v 61.3%, p = 0.004). There was a trend toward shorter recovery times, reduced oxygen requirement, and shorter hospital stays in the nonintubated group.

Conclusions: A nonintubated general anesthetic technique is a feasible alternative to intubated general anesthesia for minor VATS procedures.

Keywords: intubation; laryngeal mask; spontaneous ventilation; thoracic anesthesia; thoracic surgery.