Video-assisted thoracic surgery utilizing local anesthesia and sedation

• Published in: European journal of cardio-thoracic surgery Vol. 30; no. 3; pp. 529 - 532
• Main Author: Katlic, Mark R.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science B.V 01.09.2006; Elsevier Science
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia; Anesthesia, Local - methods; Biological and medical sciences; Biopsy; Biopsy - methods; Cardiology. Vascular system; Drainage - methods; Empyema, Pleural - surgery; Female; Hemothorax - surgery; Humans; Lung - surgery; Lung Diseases - surgery; Male; Medical sciences; Middle Aged; Pleura - surgery; Pleural Diseases - surgery; Pleural effusion; Pleural Effusion - surgery; Pleural Effusion, Malignant - surgery; Pneumology; Respiratory system : syndromes and miscellaneous diseases; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Thoracic Surgery, Video-Assisted - methods; Thoracoscopy; Treatment Outcome; Video-assisted thoracic surgery (VATS); Pleural effusion; Anesthesia; Video-assisted thoracic surgery (VATS); Biopsy; Thoracoscopy; Endoscopic surgery; Respiratory disease; Thorax; Sedation; Phlebology; Video recording; Treatment; Local anesthesia; Pleurisy; Pleural disease; Endoscopy; Circulatory system; Cardiology
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2006.06.019

Objective: Video-assisted thoracic surgery (VATS) is usually performed with general anesthesia and double-lumen endotracheal intubation, but minor procedures have been carried out with patients spontaneously breathing and with epidural or regional analgesia. We have broadened our indications for VATS utilizing purely local anesthesia and sedation. Methods: The medical records of all patients undergoing VATS under local anesthesia and sedation at Geisinger Wyoming Valley Medical Center between 7/1/02 and 6/1/06 were reviewed. All procedures were performed in the operating room with patients in full lateral position; no patient had endotracheal intubation or epidural or nerve block analgesia. Results: One hundred and fifteen patients, ranging in age from 21 to 88 years and in size from 40 to 172 kg, underwent 126 video-assisted thoracic operations: pleural biopsy/effusion drainage with or without talc 81, drainage of empyema 21, lung biopsy 18, evacuate hemothorax 3, pericardial window 2, biopsy chest wall mass 1. No patient required intubation or conversion to thoracotomy. Three patients who underwent lung biopsy died of their underlying disease (cytomegalovirus and pneumocystis, primary amyloidosis, metastatic cancer to contra-lateral lung) on postoperative days 18, 14, and 4, respectively. One patient developed transient renal insufficiency attributed to ketorolac. Conclusion: VATS utilizing local anesthesia and sedation is well tolerated, safe, and valuable for an increasing number of indications.