Effect of epidural anesthesia <i>vs.</i> intubated anesthesia on the postoperative recovery of patients with thoracoscopic resection of lung bullae: A randomized controlled trial _Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Feng , YANG Liming , GUO Jun ,  YUAN Lan

Department of Anesthesiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, P.R.China;

Corresponding author：

YUAN Lan, Email: yuanlansan@hotmail.com

Keywords：

Epidural anesthesia; thoracoscopy; lung bullae

DOI：

10.7507/1007-4848.201610032

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To compare the effects of epidural anesthesia with intubated anesthesia in the postoperative recovery of patients with thoracoscopic resection of lung bullae. Methods Sixty patients (53 males, 7 females, aged 16-65 years) undergoing thoracoscopic resection of unilateral pulmonary bullae in our hospital from December 2014 to December 2015 were randomly divided into two groups: a group A (epidural anesthesia group) received thoracic epidural block combined with intraoperative interthoracic vagus nerve block; a group B (general anesthesia group) received general anesthesia with double lumen endobronchial intubation and pulmonary sequestration. Postoperative anesthesia-related complications and postoperative recovery were recorded. Results Both of the two anesthesia methods could meet the requirements of operation. The patients with the vocal cord injury and sore throat in the group B were more than those in the group A. The difference was statistically significant in the incidence of sore throat (P<0.01) . Arterial partial pressure of oxygen (PaO₂) in the group A was significantly higher than that of group B before lung recruitment (P<0.01). Compared with the group B, the group A had less visual analogue scale (VAS) score (P<0.05), earlier activity and feeding, less postoperative ICU and hospital stay (P<0.01). Conclusion Epidural anesthesia combined with intraoperative interthoracic vagus nerve block can meet thoracoscopic bullectomy surgery requirements with few complications and fast postoperative recovery.

Citation： GUO Feng, YANG Liming, GUO Jun, YUAN Lan. Effect of epidural anesthesia vs. intubated anesthesia on the postoperative recovery of patients with thoracoscopic resection of lung bullae: A randomized controlled trial . Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(9): 706-710. doi: 10.7507/1007-4848.201610032 Copy

1.	李田, 梅新宇, 解明然, 等. 单操作孔电视胸腔镜肺大疱切除术的临床应用. 安徽医科大学学报, 2016, 51(5): 699-702.
2.	车国卫, 刘伦旭. 单孔电视胸腔镜手术临床应用的现状与进展. 中国胸心血管外科临床杂志, 2012, 19(2): 181-184.
3.	Chen JS, Cheng YJ, Hung MH, et al. Nonintubated thoracoscopic lobectomy for lung cancer. Ann Surg, 2011, 254(6): 1038-1043.
4.	Wu CY, Chen JS, Lin YS, et al. Feasibility and safety of nonintubated thoracoscopic lobectomy for geriatric lung cancer patients. Ann Thorac Surg, 2013, 95(2): 405-411.
5.	Hung MH, Hsu HH, Chan KC, et al. Non-intubated thoracoscopic surgery using internal intercostal nerve block, vagal block and targeted sedation. Eur J Cardiothorac Surg, 2014, 46(4): 620.
6.	魏玉红. 硬膜外麻醉在胸腔镜下行肺大疱切除术中的麻醉效果. 中国当代医药, 2013, 20(19): 76-77.
7.	Murphy GS, Szokol JW, Avram MJ, et al. Postoperative residual neuromuscular blockade is associated with impaired clinical recovery. Anesth Analg, 2013, 117(1): 133-141.
8.	Norton M, Xará D, Parente D, et al. Residual neuromuscular block as a risk factor for critical respiratory events in the post anesthesia care unit. Rev Esp Anestesiol Reanim, 2013, 60(4): 190-196.
9.	Gothard J. Lung injury after thoracic surgery and one-lung ventilation. Curr Opin Anaesthesiol, 2006, 19(1): 5-10.
10.	Fitzmaurice BG, Brodsky JB. Airway rupture from double-lumen tubes. J Cardiothorac Vasc Anesth, 1999, 13(3): 322-9.
11.	Guo Z, Shao W, Yin W, et al. Analysis of feasibility and safety of complete video-assisted thoracoscopic resection of anatomic pulmonary segments under non-intubated anesthesia. J Thorac Dis, 2014, 6(1): 37-44.
12.	Guo Z, Yin W, Pan H, et al. Video-assisted thoracoscopic surgery segmentectomy by non-intubated or intubated anesthesia: a comparative analysis of short-term outcome. J Thorac Dis, 2016, 8(3): 359-368.
13.	Dorgerloh C, Luessem J. Nonintubated Video-Assisted Thoracoscopic Surgery Under Epidural Anesthesia Compared With Conventional Anesthetic Option: A Randomized Control Study. Surg Inn, 2015, 22(2): 123-30.
14.	Katlic MR, Facktor MA. Video-Assisted Thoracic Surgery Utilizing Local Anesthesia and Sedation: 384 Consecutive Cases. Ann Thorac Surg, 2010, 90(1): 240-5.
15.	Piccioni F, Langer M, Fumagalli L, et al. Thoracic paravertebral anaesthesia for awake video-assisted thoracoscopic surgery daily. Anaesthesia, 2010, 65(12): 1221-1224.
16.	林文前, 李伟, 曾维安, 等. 全身麻醉复合硬膜外阻滞对单肺通气期间肺内分流的影响. 临床麻醉学杂志, 2002, 18(3): 121-123.
17.	Tacconi F, Pompeo E, Sellitri F, et al. Surgical stress hormones response is reduced after awake videothoracoscopy. Interact Cardiovasc Thorac Surg, 2010, 10(5): 666-671.
18.	Curley GF, Laffey JG, Kavanagh BP. CrossTalk proposal: There is added benefit to providing permissive hypercapnia in the treatment of ARDS. J Physiol, 2013, 591(11): 2763-2765.
19.	Sinclair SE, Kregenow DA, Lamm WJ, et al. Hypercapnic acidosis is protective in an in vivo model of ventilator-induced lung injury. Am J Resp Crit Care, 2002, 166(3): 403-408.

1. 李田, 梅新宇, 解明然, 等. 单操作孔电视胸腔镜肺大疱切除术的临床应用. 安徽医科大学学报, 2016, 51(5): 699-702.
2. 车国卫, 刘伦旭. 单孔电视胸腔镜手术临床应用的现状与进展. 中国胸心血管外科临床杂志, 2012, 19(2): 181-184.
3. Chen JS, Cheng YJ, Hung MH, et al. Nonintubated thoracoscopic lobectomy for lung cancer. Ann Surg, 2011, 254(6): 1038-1043.
4. Wu CY, Chen JS, Lin YS, et al. Feasibility and safety of nonintubated thoracoscopic lobectomy for geriatric lung cancer patients. Ann Thorac Surg, 2013, 95(2): 405-411.
5. Hung MH, Hsu HH, Chan KC, et al. Non-intubated thoracoscopic surgery using internal intercostal nerve block, vagal block and targeted sedation. Eur J Cardiothorac Surg, 2014, 46(4): 620.
6. 魏玉红. 硬膜外麻醉在胸腔镜下行肺大疱切除术中的麻醉效果. 中国当代医药, 2013, 20(19): 76-77.
7. Murphy GS, Szokol JW, Avram MJ, et al. Postoperative residual neuromuscular blockade is associated with impaired clinical recovery. Anesth Analg, 2013, 117(1): 133-141.
8. Norton M, Xará D, Parente D, et al. Residual neuromuscular block as a risk factor for critical respiratory events in the post anesthesia care unit. Rev Esp Anestesiol Reanim, 2013, 60(4): 190-196.
9. Gothard J. Lung injury after thoracic surgery and one-lung ventilation. Curr Opin Anaesthesiol, 2006, 19(1): 5-10.
10. Fitzmaurice BG, Brodsky JB. Airway rupture from double-lumen tubes. J Cardiothorac Vasc Anesth, 1999, 13(3): 322-9.
11. Guo Z, Shao W, Yin W, et al. Analysis of feasibility and safety of complete video-assisted thoracoscopic resection of anatomic pulmonary segments under non-intubated anesthesia. J Thorac Dis, 2014, 6(1): 37-44.
12. Guo Z, Yin W, Pan H, et al. Video-assisted thoracoscopic surgery segmentectomy by non-intubated or intubated anesthesia: a comparative analysis of short-term outcome. J Thorac Dis, 2016, 8(3): 359-368.
13. Dorgerloh C, Luessem J. Nonintubated Video-Assisted Thoracoscopic Surgery Under Epidural Anesthesia Compared With Conventional Anesthetic Option: A Randomized Control Study. Surg Inn, 2015, 22(2): 123-30.
14. Katlic MR, Facktor MA. Video-Assisted Thoracic Surgery Utilizing Local Anesthesia and Sedation: 384 Consecutive Cases. Ann Thorac Surg, 2010, 90(1): 240-5.
15. Piccioni F, Langer M, Fumagalli L, et al. Thoracic paravertebral anaesthesia for awake video-assisted thoracoscopic surgery daily. Anaesthesia, 2010, 65(12): 1221-1224.
16. 林文前, 李伟, 曾维安, 等. 全身麻醉复合硬膜外阻滞对单肺通气期间肺内分流的影响. 临床麻醉学杂志, 2002, 18(3): 121-123.
17. Tacconi F, Pompeo E, Sellitri F, et al. Surgical stress hormones response is reduced after awake videothoracoscopy. Interact Cardiovasc Thorac Surg, 2010, 10(5): 666-671.
18. Curley GF, Laffey JG, Kavanagh BP. CrossTalk proposal: There is added benefit to providing permissive hypercapnia in the treatment of ARDS. J Physiol, 2013, 591(11): 2763-2765.
19. Sinclair SE, Kregenow DA, Lamm WJ, et al. Hypercapnic acidosis is protective in an in vivo model of ventilator-induced lung injury. Am J Resp Crit Care, 2002, 166(3): 403-408.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of epidural anesthesia vs. intubated anesthesia on the postoperative recovery of patients with thoracoscopic resection of lung bullae: A randomized controlled trial

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content