Previous article Table of Contents  Next article

EDITORIAL
Year : 2017  |  Volume : 11  |  Issue : 3  |  Page : 265-266

Anesthesia for video-assisted thoracic surgery: An algorithm


Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Correspondence Address:
Abdelazeem Eldawlatly
Department of Anesthesia, College of Medicine, King Saud University, Riyadh
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.SJA_282_17

Rights and Permissions
Date of Web Publication29-Jun-2017
 


How to cite this article:
Alqatari A, Eldawlatly A. Anesthesia for video-assisted thoracic surgery: An algorithm. Saudi J Anaesth 2017;11:265-6

How to cite this URL:
Alqatari A, Eldawlatly A. Anesthesia for video-assisted thoracic surgery: An algorithm. Saudi J Anaesth [serial online] 2017 [cited 2017 Nov 23];11:265-6. Available from: http://www.saudija.org/text.asp?2017/11/3/265/209160



Video-assisted thoracic surgery (VATS) is widely used nowadays for the surgical treatment of lung and pleural diseases. Anesthesia has also been evolved in recent years to meet the surgical demands and to be an essential arm of the enhanced recovery after surgery (ERAS) guidelines. Recently, we organized a conference on enhanced recovery after anesthesia (ERAA), whereby to the first time we have introduced the term ERAA instead of ERAS though both are synonym.[1] One session of the conference was on enhanced recovery after thoracic anesthesia with talks on nonintubated (NI) VATS or in other words tubeless VATS.[2] In our setting, we are practicing NI-VATS in selected cooperative patients undergoing lung/pleural biopsies. Due to the wide dimension of various anesthetic techniques in lung and pleural surgeries, we sought to develop an algorithm on anesthesia for VATS [Figure 1]. We classified the algorithm into two different methods, namely, intubated VATS (I-VATS) (tubed) and NI-VATS (tubeless). Then, we classified I-VATS techniques into those patients who require lung isolation and who do not. For those without lung isolation, the most favorable anesthetic technique is the use of a single-lumen tracheal tube and capnothorax with CO2 insufflation pressure <10 cm H2O. That technique we have described validated some time ago for patients undergoing thoracoscopic sympathectomy for the treatment of palmar hyperhidrosis.[3],[4],[5] In case lung isolation is required, we have described the tools which could be used and we divided them into the double-lumen tube (DLT) and bronchial blocker (BB). DLT was further classified into two types according to the material used for their manufacture into polyvinyl chloride and silicone types. The silbroncho DLT is the prototype of the silicone material.[6] The silbroncho tube has important features that it does not irritate the tracheobronchial mucosa; furthermore, it is not affected by the patient temperature and it has a soft-reinforced bronchial end which does not kink or causes any trauma to the tracheobronchial mucosa. The BB is divided into dependent and independent blockers. Univent tube or torque-controlled blocker is the prototype of dependent BBs. The independent BBs are wire-guided endobronchial blocker (Arndt), tip deflecting BB (Cohen), Fuji BB, and bifurcated tip BB (EZ).[7] Anesthesia for NI-VATS could be achieved with sedation and laryngeal mask airway or periportal local anesthetic infiltration or intercostal nerve block or interpleural local anesthetic instillation or paravertebral block. Furthermore, anesthesia for NI-VATS could be achieved using thoracic epidural analgesia or total intravenous anesthesia using a combination of propofol and remifentanil or dexmedetomidine. This algorithm is comprehensive and incorporated all commonly used tools for I-VATS and NI-VATS. We believe that it could be an appropriate teaching module for anesthesia in VATS.
Figure 1: Algorithm

Click here to view




 
  References Top

1.
Eldawlatly A. Is enhanced recovery after anesthesia a synonym to enhanced recovery after surgery? Saudi J Anaesth 2016;10:119-20.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Navarro-Martínez J, Gálvez C, Rivera-Cogollos MJ, Galiana-Ivars M, Bolufer S, Martínez-Adsuar F. Intraoperative crisis resource management during a non-intubated video-assisted thoracoscopic surgery. Ann Transl Med 2015;3:111.  Back to cited text no. 2
    
3.
El-Dawlatly AA. Impedance cardiography: Noninvasive measurement of hemodynamics and thoracic fluid content during endoscopic thoracic sympathectomy. Surg Laparosc Endosc Percutan Tech 2005;15:328-31.  Back to cited text no. 3
    
4.
El-Dawlatly AA, Al-Dohayan A, Abdel-Meguid ME, Turkistani A, Alotaiby WM, Abdelaziz EM. Variations in dynamic lung compliance during endoscopic thoracic sympathectomy with CO2 insufflation. Clin Auton Res 2003;13 Suppl 1:I94-7.  Back to cited text no. 4
    
5.
El-Dawlatly A, Al-Dohayan A, Riyad W, Thalaj A, Delvi B, Al-Saud S. Thoracoscopic sympathectomy: Endobronchial anesthesia vs. endotracheal anesthesia with intrathoracic CO2 insufflation. J Anesth 2002;16:13-6.  Back to cited text no. 5
    
6.
Jeon J, Lee K, Ahn G, Lee J, Hwang W. Comparison of postoperative sore throat and hoarseness between two types of double-lumen endobronchial tubes: A randomized controlled trial. J Cardiothorac Vasc Anesth 2015;29:121-5.  Back to cited text no. 6
    
7.
Neustein SM. Pro: Bronchial blockers should be used routinely for providing one-lung ventilation. J Cardiothorac Vasc Anesth 2015;29:234-6.  Back to cited text no. 7
    


    Figures

  [Figure 1]



 

Top
 
Previous article    Next article
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  IN THIS Article
   References
   Article Figures

 Article Access Statistics
    Viewed795    
    Printed14    
    Emailed0    
    PDF Downloaded105    
    Comments [Add]    

Recommend this journal