Department of Surgery, University of Szeged, Semmelweis u. 8. 6725, Szeged, Hungary.
Department of Anesthesiology, University of Szeged, Szeged, Hungary.
Gen Thorac Cardiovasc Surg. 2021 Jun;69(6):976-982. doi: 10.1007/s11748-020-01572-3. Epub 2021 Jan 12.
We present the combination of spontaneous ventilation and double-lumen tube intubation in thoracic surgery.
At the beginning of the procedures, the patients with a body mass index of ≤ 30 were relaxed for a short time, and a double-lumen tube was inserted. After the utility incision or thoracotomy, the vagus nerve was blocked (in right side in the upper mediastinum; in left side in the aorto-pulmonary window) with 3-5 ml of 0.5% bupivacaine. The patients had a bispectral index of 40-60. After the short relaxation period, the patients were ventilating spontaneously without any cough during the manipulation.
Between March 10 and September 18. 2020, 26 spontaneous ventilation combined with intubation surgeries were performed: 19 uniportal video-assisted thoracic surgery (15 lobectomies, 1 segmentectomy, and 3 wedge resections) and 7 open (5 lobectomies and 1 sleeve segmentectomy, 1 wedge resection). The mean mechanical and spontaneous one-lung ventilation time was 25.5 (15-115) and 73.3 (45-100) minutes, respectively. In 2 cases conversion to relaxation were necessary (2/26; 7.7%). The mean maximal carbon dioxide pressure was 52.3 (38-66) Hgmm and the mean lowest oxygen saturation was 93.8 (86-99) %. Breathing frequency ranged between 10-25/minute. The mean surgical times was 83.3 (55-130) minutes.
Spontaneous ventilation combined with intubation in video-assisted thoracic surgery or open resections is a safe method in selected patients. It can reduce the mechanical one-lung ventilation period with 76.6% and give safe airway for spontaneous ventilation thoracic procedures.
介绍在胸外科手术中自发性通气与双腔管插管相结合的方法。
在手术开始时，体重指数≤30 的患者会短暂放松，然后插入双腔管。在进行小切口或开胸术之后，在迷走神经（上纵隔右侧，主肺动脉窗左侧）处注入 3-5ml 0.5%布比卡因进行阻滞。患者的脑电双频指数（bispectral index，BIS）为 40-60。短暂放松期过后，患者在操作过程中可自主呼吸且无咳嗽。
2020 年 3 月 10 日至 9 月 18 日期间，共完成了 26 例自发性通气联合插管手术：19 例单孔电视辅助胸腔镜手术（15 例肺叶切除术、1 例肺段切除术和 3 例楔形切除术）和 7 例开胸手术（5 例肺叶切除术和 1 例袖状肺段切除术，1 例楔形切除术）。机械通气和自主通气的平均时间分别为 25.5（15-115）分钟和 73.3（45-100）分钟。有 2 例（2/26；7.7%）需要转换为放松。最大二氧化碳压力平均为 52.3（38-66）mmHg，最低氧饱和度平均为 93.8（86-99）%。呼吸频率在 10-25 次/分钟之间。平均手术时间为 83.3（55-130）分钟。
在选择的患者中，电视辅助胸腔镜手术或开胸手术中自发性通气与插管相结合是一种安全的方法。它可以将机械通气时间减少 76.6%，并为自发性通气胸科手术提供安全的气道。
