Kayama Satoru, Yamamoto Haruna, Sawamura Shigehito
Department of Anesthesiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan.
JA Clin Rep. 2018 Jun 18;4(1):48. doi: 10.1186/s40981-018-0183-0.
One-lung ventilation under general anesthesia is necessary for thoracic surgery, but this procedure is often difficult in surgery for patients with cardiopulmonary failure. Non-intubated video-assisted thoracic surgery (VATS) is performed under local anesthesia for patients with respiratory failure, but has not been performed for patients with circulatory failure. Here, we report management of two patients with cardiopulmonary failure who underwent non-intubated VATS with paravertebral block and infiltration anesthesia.
Case 1 was a 79-year-old male with dyspnea at rest due to left large pleural effusion and cardiac dysfunction who underwent thoracoscopic pleural biopsy with paravertebral block under spontaneous breathing. The patient was also receiving dialysis. Case 2 was a 53-year-old male who developed empyema due to large pleural effusion, resulting in a poor general condition and cardiac dysfunction, and underwent video-assisted empyema curettage only with infiltration anesthesia under spontaneous breathing. In both patients, intraoperative respiration and circulation remained stable with values similar to those present preoperatively, and there were no problems after surgery.
We safely anesthetized two patients with difficulty to general anesthesia by ensuring sufficient regional anesthesia during VATS under spontaneous breathing. These cases suggest that regional anesthesia for non-intubated VATS can contribute to maintain intra- and postoperative respiration and circulation in patients with cardiopulmonary failure.
全身麻醉下的单肺通气是胸外科手术所必需的，但对于心肺功能衰竭的患者，此操作在手术中往往具有难度。非插管电视辅助胸腔镜手术（VATS）是在局部麻醉下为呼吸衰竭患者进行的，但尚未应用于循环衰竭患者。在此，我们报告了两名心肺功能衰竭患者在椎旁阻滞和浸润麻醉下接受非插管VATS手术的管理情况。
病例1是一名79岁男性，因左侧大量胸腔积液和心脏功能不全而静息时呼吸困难，在自主呼吸下接受了椎旁阻滞下的胸腔镜胸膜活检。该患者同时正在接受透析治疗。病例2是一名53岁男性，因大量胸腔积液导致脓胸，全身状况较差且伴有心脏功能不全，仅在自主呼吸下接受浸润麻醉进行了电视辅助脓胸清创术。在这两名患者中，术中呼吸和循环均保持稳定，数值与术前相似，术后也未出现问题。
我们通过在自主呼吸下的VATS手术期间确保充分的区域麻醉，成功地为两名难以耐受全身麻醉的患者实施了麻醉。这些病例表明，非插管VATS的区域麻醉有助于维持心肺功能衰竭患者术中和术后的呼吸及循环。
