Anesthesia for awake video-assisted thoracic surgery

Ming Chang Kao, Cing Hung Lan, Chun Jen Huang

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Awake video-assisted thoracic surgery (VATS) has been increasingly employed in a variety of procedures involving pleura, lungs, and mediastinum. Adequate anesthesia and analgesia obtained from thoracic epidural anesthetic (TEA) allow VATS to be performed in awake patients. The potential general anesthesia-related adverse effects, such as intubation-related trauma, pneumonia, ventilator-associated lung injury, effects of neuromuscular blocking agents, and postoperative nausea and vomiting, can thus be avoided. Moreover, TEA holds the benefits of reducing pulmonary and cardiac morbidities and mortalities after noncardiac surgery. Patients who undergo awake VATS may also benefit from the efficient contraction of the dependent hemidiaphragm and preserved hypoxic pulmonary vasoconstriction during surgically-induced pneumothorax. Preliminary results from early case series have indicated certain benefits, including greater patient satisfaction, less nursing care, less sore throat, earlier resumption of oral intake, lower rate of morbidity, reduced perioperative pain, reduced cost, and shorter hospital stay. However, anesthesia for awake VATS presents a particular challenge to anesthesiologists and requires extra vigilance. Potential hazards include paradoxical respiration and mediastinum shift after surgery induced pneumothorax, which may cause progressive hypoxia, hypercapnia and hypotension. Anesthesiologists should be acquainted with the procedure to be performed, be knowledgeable on the physiological changes, be aware of the potential problems, and have good judgment on suitable timing for conversion of regional anesthesia to intubation general anesthesia in enforced circumstance.

Original languageEnglish
Pages (from-to)126-130
Number of pages5
JournalActa Anaesthesiologica Taiwanica
Volume50
Issue number3
DOIs
Publication statusPublished - 2012
Externally publishedYes

Fingerprint

Video-Assisted Thoracic Surgery
Anesthesia
Mediastinum
Pneumothorax
Intubation
Lung
General Anesthesia
Anesthetics
Thorax
Neuromuscular Blocking Agents
Morbidity
Anesthesia and Analgesia
Ventilator-Associated Pneumonia
Postoperative Nausea and Vomiting
Conduction Anesthesia
Pharyngitis
Hypercapnia
Pleura
Lung Injury
Nursing Care

Keywords

  • Anesthesia, epidural
  • Hypercapnia
  • Hypoxemia
  • Pulmonary ventilation: one-lung
  • Thoracic surgery, video-assisted

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Anesthesia for awake video-assisted thoracic surgery. / Kao, Ming Chang; Lan, Cing Hung; Huang, Chun Jen.

In: Acta Anaesthesiologica Taiwanica, Vol. 50, No. 3, 2012, p. 126-130.

Research output: Contribution to journalArticle

Kao, Ming Chang ; Lan, Cing Hung ; Huang, Chun Jen. / Anesthesia for awake video-assisted thoracic surgery. In: Acta Anaesthesiologica Taiwanica. 2012 ; Vol. 50, No. 3. pp. 126-130.
@article{684b34fec9014290915a92329ad319f9,
title = "Anesthesia for awake video-assisted thoracic surgery",
abstract = "Awake video-assisted thoracic surgery (VATS) has been increasingly employed in a variety of procedures involving pleura, lungs, and mediastinum. Adequate anesthesia and analgesia obtained from thoracic epidural anesthetic (TEA) allow VATS to be performed in awake patients. The potential general anesthesia-related adverse effects, such as intubation-related trauma, pneumonia, ventilator-associated lung injury, effects of neuromuscular blocking agents, and postoperative nausea and vomiting, can thus be avoided. Moreover, TEA holds the benefits of reducing pulmonary and cardiac morbidities and mortalities after noncardiac surgery. Patients who undergo awake VATS may also benefit from the efficient contraction of the dependent hemidiaphragm and preserved hypoxic pulmonary vasoconstriction during surgically-induced pneumothorax. Preliminary results from early case series have indicated certain benefits, including greater patient satisfaction, less nursing care, less sore throat, earlier resumption of oral intake, lower rate of morbidity, reduced perioperative pain, reduced cost, and shorter hospital stay. However, anesthesia for awake VATS presents a particular challenge to anesthesiologists and requires extra vigilance. Potential hazards include paradoxical respiration and mediastinum shift after surgery induced pneumothorax, which may cause progressive hypoxia, hypercapnia and hypotension. Anesthesiologists should be acquainted with the procedure to be performed, be knowledgeable on the physiological changes, be aware of the potential problems, and have good judgment on suitable timing for conversion of regional anesthesia to intubation general anesthesia in enforced circumstance.",
keywords = "Anesthesia, epidural, Hypercapnia, Hypoxemia, Pulmonary ventilation: one-lung, Thoracic surgery, video-assisted",
author = "Kao, {Ming Chang} and Lan, {Cing Hung} and Huang, {Chun Jen}",
year = "2012",
doi = "10.1016/j.aat.2012.08.007",
language = "English",
volume = "50",
pages = "126--130",
journal = "Asian Journal of Anesthesiology",
issn = "2468-824X",
publisher = "Elsevier Taiwan LLC",
number = "3",

}

TY - JOUR

T1 - Anesthesia for awake video-assisted thoracic surgery

AU - Kao, Ming Chang

AU - Lan, Cing Hung

AU - Huang, Chun Jen

PY - 2012

Y1 - 2012

N2 - Awake video-assisted thoracic surgery (VATS) has been increasingly employed in a variety of procedures involving pleura, lungs, and mediastinum. Adequate anesthesia and analgesia obtained from thoracic epidural anesthetic (TEA) allow VATS to be performed in awake patients. The potential general anesthesia-related adverse effects, such as intubation-related trauma, pneumonia, ventilator-associated lung injury, effects of neuromuscular blocking agents, and postoperative nausea and vomiting, can thus be avoided. Moreover, TEA holds the benefits of reducing pulmonary and cardiac morbidities and mortalities after noncardiac surgery. Patients who undergo awake VATS may also benefit from the efficient contraction of the dependent hemidiaphragm and preserved hypoxic pulmonary vasoconstriction during surgically-induced pneumothorax. Preliminary results from early case series have indicated certain benefits, including greater patient satisfaction, less nursing care, less sore throat, earlier resumption of oral intake, lower rate of morbidity, reduced perioperative pain, reduced cost, and shorter hospital stay. However, anesthesia for awake VATS presents a particular challenge to anesthesiologists and requires extra vigilance. Potential hazards include paradoxical respiration and mediastinum shift after surgery induced pneumothorax, which may cause progressive hypoxia, hypercapnia and hypotension. Anesthesiologists should be acquainted with the procedure to be performed, be knowledgeable on the physiological changes, be aware of the potential problems, and have good judgment on suitable timing for conversion of regional anesthesia to intubation general anesthesia in enforced circumstance.

AB - Awake video-assisted thoracic surgery (VATS) has been increasingly employed in a variety of procedures involving pleura, lungs, and mediastinum. Adequate anesthesia and analgesia obtained from thoracic epidural anesthetic (TEA) allow VATS to be performed in awake patients. The potential general anesthesia-related adverse effects, such as intubation-related trauma, pneumonia, ventilator-associated lung injury, effects of neuromuscular blocking agents, and postoperative nausea and vomiting, can thus be avoided. Moreover, TEA holds the benefits of reducing pulmonary and cardiac morbidities and mortalities after noncardiac surgery. Patients who undergo awake VATS may also benefit from the efficient contraction of the dependent hemidiaphragm and preserved hypoxic pulmonary vasoconstriction during surgically-induced pneumothorax. Preliminary results from early case series have indicated certain benefits, including greater patient satisfaction, less nursing care, less sore throat, earlier resumption of oral intake, lower rate of morbidity, reduced perioperative pain, reduced cost, and shorter hospital stay. However, anesthesia for awake VATS presents a particular challenge to anesthesiologists and requires extra vigilance. Potential hazards include paradoxical respiration and mediastinum shift after surgery induced pneumothorax, which may cause progressive hypoxia, hypercapnia and hypotension. Anesthesiologists should be acquainted with the procedure to be performed, be knowledgeable on the physiological changes, be aware of the potential problems, and have good judgment on suitable timing for conversion of regional anesthesia to intubation general anesthesia in enforced circumstance.

KW - Anesthesia, epidural

KW - Hypercapnia

KW - Hypoxemia

KW - Pulmonary ventilation: one-lung

KW - Thoracic surgery, video-assisted

UR - http://www.scopus.com/inward/record.url?scp=84871445302&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84871445302&partnerID=8YFLogxK

U2 - 10.1016/j.aat.2012.08.007

DO - 10.1016/j.aat.2012.08.007

M3 - Article

VL - 50

SP - 126

EP - 130

JO - Asian Journal of Anesthesiology

JF - Asian Journal of Anesthesiology

SN - 2468-824X

IS - 3

ER -