Defosse Jérôme Michel, Wappler Frank, Schieren Marc
Anasthesiol Intensivmed Notfallmed Schmerzther. 2022 Jun;57(6):405-416. doi: 10.1055/a-1497-9883. Epub 2022 Jun 21.
Non-intubated thoracic surgery is currently gaining popularity. In select patients and in experienced centres, non-intubated approaches may enable patients to safely undergo thoracic surgical procedures, who would otherwise be considered at high risk from general anaesthesia. While non-intubated techniques have been widely adopted for minor surgical procedures, its role in major thoracic surgery is a topic of controversial debate.This article discusses disadvantages of intubated anaesthetic approaches and advantages of non-intubated thoracic surgery as well as the anaesthetic management. This includes surgical and anaesthetic criteria for patient selection, suitable regional anaesthetic techniques, concepts for sedation and maintenance of airway patency as well as the management of perioperative complications.Non-intubated thoracic surgery has the potential to reduce postoperative morbidity and hospital length of stay. Successful non-intubated management depends on a standardised and well-trained interdisciplinary approach, especially regarding patient selection and perioperative complications.
非插管胸外科手术目前越来越受欢迎。在特定患者和经验丰富的中心，非插管方法可能使患者能够安全地接受胸外科手术，否则这些患者可能被认为因全身麻醉而处于高风险状态。虽然非插管技术已广泛应用于小型外科手术，但其在大型胸外科手术中的作用仍是一个有争议的话题。本文讨论了插管麻醉方法的缺点、非插管胸外科手术的优点以及麻醉管理。这包括患者选择的手术和麻醉标准、合适的区域麻醉技术、镇静和维持气道通畅的概念以及围手术期并发症的管理。非插管胸外科手术有可能降低术后发病率和缩短住院时间。成功的非插管管理取决于标准化且训练有素的多学科方法，特别是在患者选择和围手术期并发症方面。
