Effects of non-endotracheal intubation versus endotracheal intubation in thoracic surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YU Yang ¹ , LI Yujin ² , NING Xiangu ¹ , CHEN Xinlong ¹ , XU Jiayang ³ , CAI Linsheng ³ , CUI Fengxian ¹ , JIN Hua ² ,  PENG Jun ¹

1. Department of Thoracic Surgery, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650200, P. R. China;
2. Department of Anesthesiology, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650200, P. R. China;
3. Kunming University of Science and Technology School of Medicine, Kunming, 650000, P. R. China;

Corresponding author：

PENG Jun, Email: 389647518@qq.com

Keywords：

Non-intubation anesthesia; thoracic surgery; postoperative rehabilitation; inflammatory response

DOI：

10.7507/1007-4848.202011064

Video：

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Objective To investigate the feasibility and safety of non-intubation anesthesia in thoracic surgery.Methods From September 2017 to December 2019, 296 patients were operated at department of thoracic surgery in our hospital. There were 167 males and 129 females with an average age of 50.69±12.95 years, ranging from 16 to 76 years. The patients were divided into two groups according to whether they were intubated: 150 patients were in a non-intubation group, including 83 males and 67 females with an average age of 49.91±13.59 years, ranging from 16 to 76 years, and 146 patients were in an intubation group including 84 males and 62 females with an average age of 51.49±12.26 years, ranging from 16 to 74 years. Intraoperative data, postoperative recovery, inflammatory response of the two groups were compared.Results There was no statistical difference between the two groups in operation time, blood loss, the lowest oxygen saturation or other indicators (P>0.05). But the highest partial pressure of carbon dioxide of the non-intubation group was higher than that of the intubation group (P=0.012). The non-intubation group was superior to the intubation group in postoperative recovery and inflammatory response (P<0.05).Conclusion The non-intubation anesthesia is safe and maneuverable in thoracic surgery, and it has some advantages in accelerating postoperative rehabilitation.

Citation： YU Yang, LI Yujin, NING Xiangu, CHEN Xinlong, XU Jiayang, CAI Linsheng, CUI Fengxian, JIN Hua, PENG Jun. Effects of non-endotracheal intubation versus endotracheal intubation in thoracic surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(5): 602-606. doi: 10.7507/1007-4848.202011064 Copy

1.	He J, Xu X. Thoracoscopic anatomic pulmonary resection. J Thorac Dis, 2012, 4(5): 520-547.
2.	Vilà E, García Guasch R, Ibáñez C, et al. Comparison of the double-lumen endotracheal tube and the Arndt bronchial blocker used by inexperienced anesthesiologists in right- and left-sided thoracic surgery. Rev Esp Anestesiol Reanim, 2007, 54(10): 602-607.
3.	罗柔, 谭建龙, 刘志光. 气管插管或切开后气管狭窄的危险因素分析. 中国呼吸与危重监护杂志, 2021, 20(5): 330-334.
4.	Liu CY, Hsu PK, Leong KI, et al. Is tubeless uniportal video-assisted thoracic surgery for pulmonary wedge resection a safe procedure? Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i70-i76.
5.	He J, Liang H, Wang W, et al. Tubeless video-assisted thoracic surgery for pulmonary ground-glass nodules: Expert consensus and protocol (Guangzhou). Transl Lung Cancer Res, 2021, 10(8): 3503-3519.
6.	Li S, Jiang L, Ang KL, et al. New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules. Eur J Cardiothorac Surg, 2017, 51(4): 689-693.
7.	Peng J, An S, Wang HP, et al. Video-assisted thoracoscopic surgery lobectomy for lung cancer versus thoracotomy: A less decrease in sVEGFR2 level after surgery. J Thorac Dis, 2016, 8(3): 323-328.
8.	Peng J, Chen XL, Mao X, et al. Video-assisted thoracoscopic left upper lobe apical trisegmentectomy with the Harmonic scalpel. J Thorac Dis, 2014, 6(12): 1822-1825.
9.	Campos JH. Progress in lung separation. Thorac Surg Clin, 2005, 15(1): 71-83.
10.	Kiss G, Castillo M. Nonintubated anesthesia in thoracic surgery: General issues. Ann Transl Med, 2015, 3(8): 110.
11.	Fabo C, Oszlanyi A, Lantos J, et al. Non-intubated thoracoscopic surgery-tips and tricks from anesthesiological aspects: A mini review. Front Surg, 2022, 8(11): 818456.
12.	Slinger P. Pro: Low tidal volume is indicated during one-lung ventilation. Anesth Analg, 2006, 103(2): 268-270.
13.	Liu J, Cui F, He J. Non-intubated video-assisted thoracoscopic surgery anatomical resections: A new perspective for treatment of lung cancer. Ann Transl Med, 2015, 3(8): 102.
14.	Xu JY, Li YJ, Ning XG, et al. SV-VATS exhibits dual intraoperative and postoperative advantages. Ann Transl Med, 2021, 9(12): 790.
15.	Hung MH, Chan KC, Liu YJ, et al. Nonintubated thoracoscopic lobectomy for lung cancer using epidural anesthesia and intercostal blockade: A retrospective cohort study of 238 cases. Medicine (Baltimore), 2015, 94(13): e727.
16.	蔡开灿, 王向东, 叶靖, 等. 喉罩全麻与气管插管全麻胸腔镜手术治疗肺大疱的临床对照研究. 南方医科大学学报, 2013, 33(5): 756-760.
17.	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.
18.	Pistelli F, Bottai M, Carrozzi L, et al. Changes in obesity status and lung function decline in a general population sample. Respir Med, 2008, 102(5): 674-680.

1. He J, Xu X. Thoracoscopic anatomic pulmonary resection. J Thorac Dis, 2012, 4(5): 520-547.
2. Vilà E, García Guasch R, Ibáñez C, et al. Comparison of the double-lumen endotracheal tube and the Arndt bronchial blocker used by inexperienced anesthesiologists in right- and left-sided thoracic surgery. Rev Esp Anestesiol Reanim, 2007, 54(10): 602-607.
3. 罗柔, 谭建龙, 刘志光. 气管插管或切开后气管狭窄的危险因素分析. 中国呼吸与危重监护杂志, 2021, 20(5): 330-334.
4. Liu CY, Hsu PK, Leong KI, et al. Is tubeless uniportal video-assisted thoracic surgery for pulmonary wedge resection a safe procedure? Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i70-i76.
5. He J, Liang H, Wang W, et al. Tubeless video-assisted thoracic surgery for pulmonary ground-glass nodules: Expert consensus and protocol (Guangzhou). Transl Lung Cancer Res, 2021, 10(8): 3503-3519.
6. Li S, Jiang L, Ang KL, et al. New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules. Eur J Cardiothorac Surg, 2017, 51(4): 689-693.
7. Peng J, An S, Wang HP, et al. Video-assisted thoracoscopic surgery lobectomy for lung cancer versus thoracotomy: A less decrease in sVEGFR2 level after surgery. J Thorac Dis, 2016, 8(3): 323-328.
8. Peng J, Chen XL, Mao X, et al. Video-assisted thoracoscopic left upper lobe apical trisegmentectomy with the Harmonic scalpel. J Thorac Dis, 2014, 6(12): 1822-1825.
9. Campos JH. Progress in lung separation. Thorac Surg Clin, 2005, 15(1): 71-83.
10. Kiss G, Castillo M. Nonintubated anesthesia in thoracic surgery: General issues. Ann Transl Med, 2015, 3(8): 110.
11. Fabo C, Oszlanyi A, Lantos J, et al. Non-intubated thoracoscopic surgery-tips and tricks from anesthesiological aspects: A mini review. Front Surg, 2022, 8(11): 818456.
12. Slinger P. Pro: Low tidal volume is indicated during one-lung ventilation. Anesth Analg, 2006, 103(2): 268-270.
13. Liu J, Cui F, He J. Non-intubated video-assisted thoracoscopic surgery anatomical resections: A new perspective for treatment of lung cancer. Ann Transl Med, 2015, 3(8): 102.
14. Xu JY, Li YJ, Ning XG, et al. SV-VATS exhibits dual intraoperative and postoperative advantages. Ann Transl Med, 2021, 9(12): 790.
15. Hung MH, Chan KC, Liu YJ, et al. Nonintubated thoracoscopic lobectomy for lung cancer using epidural anesthesia and intercostal blockade: A retrospective cohort study of 238 cases. Medicine (Baltimore), 2015, 94(13): e727.
16. 蔡开灿, 王向东, 叶靖, 等. 喉罩全麻与气管插管全麻胸腔镜手术治疗肺大疱的临床对照研究. 南方医科大学学报, 2013, 33(5): 756-760.
17. 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.
18. Pistelli F, Bottai M, Carrozzi L, et al. Changes in obesity status and lung function decline in a general population sample. Respir Med, 2008, 102(5): 674-680.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effects of non-endotracheal intubation versus endotracheal intubation in thoracic surgery

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