Kikuchi Yuki, Orihara Masaki, Mieda Rie, Saito Shigeru
Department of Anesthesiology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya-shi, Tochigi, 321-0974, Japan.
Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebash-shi, Gunma, 371-8511, Japan.
JA Clin Rep. 2019 Sep 3;5(1):57. doi: 10.1186/s40981-019-0278-2.
Video-assisted thoracoscopic surgery (VATS) is usually performed under general anesthesia with a double-lumen tube. Recently, VATS without tracheal intubation in a patient with severe respiratory dysfunction has been reported. A case of nonintubated (also known as awake or tubeless) VATS using adaptive servo ventilation (ASV), a form of noninvasive positive pressure ventilation providing varying amounts of ventilator support, is presented. This is the first report of nonintubated VATS using ASV.
A 60-year-old woman was scheduled for VATS bullectomy for the treatment of pneumothorax. She had severe respiratory dysfunction and had been receiving ASV therapy because of type 2 respiratory failure. Thus, nonintubated VATS using ASV, epidural anesthesia, and dexmedetomidine were selected. When surgical pneumothorax was created by incision of the pleura, her respiratory status remained stable. In addition, lung collapse was easily induced at operation. The leaking bulla was easy to identify, and bullectomy was performed. During surgery, she continued spontaneous breathing and did not complain of pain or discomfort. She was transferred to the intensive care unit with ASV and discharged on postoperative day 12 with no respiratory complications.
It is necessary to maintain a stable respiratory status, as well as adequate analgesia and sedation, during nonintubated VATS in patients with severe respiratory dysfunction. When total lung collapse is not necessary for the surgical procedure, use of ASV would be an effective strategy.
电视辅助胸腔镜手术（VATS）通常在全身麻醉下使用双腔管进行。最近，有报道称在一名患有严重呼吸功能障碍的患者中进行了非气管插管的VATS。本文介绍了一例使用适应性伺服通气（ASV）的非插管（也称为清醒或无管）VATS病例，ASV是一种无创正压通气形式，可提供不同程度的呼吸机支持。这是首例使用ASV的非插管VATS报告。
一名60岁女性计划接受VATS肺大疱切除术以治疗气胸。她有严重的呼吸功能障碍，因Ⅱ型呼吸衰竭一直在接受ASV治疗。因此，选择了使用ASV、硬膜外麻醉和右美托咪定的非插管VATS。当通过切开胸膜造成手术性气胸时，她的呼吸状态保持稳定。此外，术中很容易诱导肺萎陷。漏气的肺大疱易于识别，并进行了肺大疱切除术。手术过程中，她持续自主呼吸，未诉疼痛或不适。她在ASV支持下被转入重症监护病房，并于术后第12天出院，无呼吸并发症。
在患有严重呼吸功能障碍的患者进行非插管VATS期间，维持稳定的呼吸状态以及充分的镇痛和镇静是必要的。当手术过程不需要全肺萎陷时，使用ASV将是一种有效的策略。
