Anesthesiological management of thoracoscopic operations on lungs and mediastinum

The objective of the review: analysis of innovations in the conceptual justification and methodological support of anesthetic protection of thoracic surgical interventions.

Results: optimization of methods of anesthetic protection should be aimed at solving both surgical requirements such as creating conditions for surgical comfort and at the same time, ensuring the maximum achievable level of protection efficiency and patient safety. When solving the problems of patient protection in thoracic surgery in general and thoracoscopic surgery in particular, the special attention is paid to ensuring effective gas exchange and optimal anesthesia methods corresponding to them within the framework of the multi-component concept. It is important to consider that weaning from mechanical ventilation and the careful collapse of the operated lung are absolute indications for thoracoscopic surgery. This approach is used due to the need to provide space in the pleural cavity for instrumental manipulations during surgery.

1. Vetshev P.S., Аblitsov А.Yu., Sanadze А.G. et al. Robot-assisted and thoracoscopic surgery in the treatment of patients with tumors of the thymus gland. Meditsinskiy Vestnik Yuga Rossii, 2018, vol. 9, no. 2, pp. 15-25. (In Russ.)

2. Zhikharev V.А., Porkhanov V.А., Koryachkin V.А. et al. Video assisted thoracoscopic thymectomy in myasthenia. A new approach. Messenger of Anesthesiology and Resuscitation, 2018, vol. 15, no. 3, pp. 14-19. (In Russ.

3. Kassil V. L., Vyzhigina M. А., Eremenko А. А. et al. Ventilyatsiya lyogkikh v anesteziologii i intensivnoy terapii. [Mechanical ventilation in anesthesiology and intensive therapy]. Moscow, GEOTAR-Media Publ., 2016, pp. 66-74.

4. Kassil V.L., Vyzhigina M.А., Khapiy Kh. Kh. Mekhanicheskaya ventilyatsiya lyogkikh v anesteziologii i intensivnoy terapii. [Mechanical ventilation in anesthesiology and intensive therapy]. Moscow, MEDpress-Inform Publ., 2009, pp. 34-45.

5. Kudlay D.A. Immunometabolicheskiye aspekty patogeneza politravmy. Diss. dokt. med. nauk. [Immunometabolic aspects of polytrauma pathogenesis. Doct. Diss.]. Novosibirsk State Medical University, Novosibirsk, 2007.

6. Kurilova O.А. Sochetannoye ispolzovaniye vnutrivennoy i vysokoy epiduralnoy anestezii pri torakalnykh operatsiyakh. Diss. kand. med. nauk. [Combined use of intravenous and high epidural anesthesia in thoracic surgery. Cand. Diss.]. 14.01.20, I.M. Sechenov First Moscow State Medical University, Moscow, 2011, 125 p.

7. Nikishov V.N., Sigal E.I., Potanin V.P. et al. The use of thoracoscopic access in thymus surgery. Meditsinskiy Almanakh, 2010, vol. 3, no. 12, pp. 63-66. (In Russ.)

8. Ovcharenko N.M. Optimizatsiya anesteziologicheskogo posobiya pri videotorakoskopicheskikh operatsiyakh u detey. Diss. kand. med. nauk. [Optimization of anesthetic management during video-assiated thoracoscopic surgery in children. Cand. Diss.]. 14.01.20; Pirogov Medical University, Moscow, 2011, 73 p.

9. Abo-Zeid M.A., Elgamal M.M., Hewidy A.A. et al. Ultrasound-guided multilevel paravertebral block versus local anesthesia for medical thoracoscopy. Saudi J. Anaesth., 2017, vol. 11, no. 4, pp. 442‒448.

10. Agnoletti V., Gurioli C., Piraccini E. et al. Efficacy and safety of thoracic paravertebral block for medical thoracoscopy. British J. Anaesth., 2011, vol. 106, no. 6, pp. 916‒917.

11. Ahmed N., Chung R. Role of early thoracoscopy for management of penetrating wounds of the chest. Аm. Surgeon, 2010, vol. 76, no. 11, pp. 1236‒1239.

12. AlGhamdi Z.M., Lynhiavu L., Moon Y.K. et al. Comparison of non-intubated versus intubated video-assisted thoracoscopic lobectomy for lung cancer. J. Thoracic Dis., 2018, vol. 10, no. 7, pp. 4236‒4243.

13. Ambrogi M.C., Zirafa C.C., Davini F. et al. Transcollation (R) technique in the thoracoscopic treatment of primary spontaneous pneumothorax. Interact. Cardiovasc. Thoracic Surgery, 2015, vol. 20, no. 4, pp. 445‒448.

14. Aragon J., Perez I., Gonzalez-Rivas D. Video-assisted thoracoscopic lobectomy versus stereotactic radiotherapy for stage I lung cancer. J. Thorac. Dis., 2015, vol. 7, no. 7, pp. 1074‒1075.

15. Bassi A., Milani W.R., El Dib R., Matos D. Intravenous versus inhalation anaesthesia for one-lung ventilation. Cochrane Database of Systematic Reviews, 2008, no. 2, doi: 10.1002/14651858.CD006313.pub2 Available: https://pubmed.ncbi.nlm.nih.gov/18425945/

16. Bayman E.O., Parekh K.R., Keech J. et al. A Prospective Study of Chronic Pain after Thoracic Surgery. Anesthesiology, 2017, vol. 126, no. 5, pp. 938‒951.

17. Bendixen M., Jorgensen O.D., Kronborg C. et al. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncology, 2016, vol. 17, no. 6, pp. 836‒844.

18. Bickler P.E., Feiner J.R., Lipnick M.S. et al. Effects of acute, profound hypoxia on healthy humans: implications for safety of tests evaluating pulse oximetry or tissue oximetry performance. Anesthesia & Analgesia, 2017, vol. 124, no. 1, pp. 146‒153.

19. Bravo Iniguez C.E., Armstrong K.W., Cooper Z. et al. Thirty-day mortality after lobectomy in elderly patients eligible for lung cancer screening. Ann. Thoracic Surgery, 2016, vol. 101, no. 2, pp. 541‒546.

20. Campos J.H., Feider A. Hypoxia during one-lung ventilation ‒ A review and update. J. Cardiothor. Vascular Anest., 2018, vol. 32, no. 5, pp. 2330‒2338.

21. Davies R.G., Myles P.S., Graham J.M. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy‒a systematic review and meta-analysis of randomized trials. BJA: British J. Anaesth., 2006, vol. 96, no. 4, pp. 418‒426.

22. De Backer D., Bakker J., Cecconi M. et al. Alternatives to the Swan-Ganz catheter. Intens. Care Med., 2018, vol. 44, no. 6, pp. 730‒741.

23. Desai H., Natt B., Kim S. et al. Decreased in-hospital mortality after lobectomy using video-assisted thoracoscopic surgery compared with open thoracotomy. Ann. Am. Thoracic Society, 2017, vol. 14, no. 2, pp. 262‒266.

24. Fernandez F.G., Kosinski A.S., Burfeind W. et al. The Society of Thoracic Surgeons Lung Cancer Resection Risk Model: higher quality data and superior outcomes. Ann. Thoracic Surgery, 2016, vol. 102, no. 2, pp. 370‒377.

25. Forero M., Adhikary S.D., Lopez H. et al. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg. Anesth. Pain Med., 2016, vol. 41, no. 5, pp. 621‒627.

26. Gao W., Liu D., Li D. et al. Effects of hypercapnia on T cells in lung ischemia/reperfusion injury after lung transplantation. Experim. Biology Med., 2014, vol. 239, no. 12, pp. 1597‒1605.

27. Gonzalez-Rivas D., Bonome C., Fieira E. et al. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur. J. Cardio-Thoracic Surgery, 2016, vol. 49, no. 3, pp. 721‒731.

28. Gonzalez-Rivas D., Fernandez R., de la Torre M. et al. Uniportal video-assisted thoracoscopic left upper lobectomy under spontaneous ventilation. Journal of Thoracic Disease, 2015, vol. 7, no. 3, pp. 494‒495.

29. Gonzalez-Rivas D., Paradela M., Fernandez R. et al. Uniportal video-assisted thoracoscopic lobectomy: two years of experience. Ann. Thoracic Surgery, 2013, vol. 95, no. 2, pp. 426‒432.

30. Huang J., Li J., Qiu Y. et al. Thoracoscopic double sleeve lobectomy in 13 patients: a series report from multi-centers. J. Thoracic Disease, 2015, vol. 7, no. 5, pp. 834,

31. Irons J.F., Miles L.F., Joshi K.R. et al. Intubated versus nonintubated general anesthesia for video-assisted thoracoscopic surgery-a case-control study. J. Cardiothor. Vascular Anesth., 2017, vol. 31, no. 2, pp. 411‒417.

32. Katlic M.R. Video-assisted thoracic surgery utilizing local anesthesia and sedation: how i teach it. Ann. Thoracic Surgery, 2017, vol. 104, no. 3, pp. 727‒730.

33. Kiss G., Claret A., Desbordes J. et al. Thoracic epidural anaesthesia for awake thoracic surgery in severely dyspnoeic patients excluded from general anaesthesia. Interact. Cardiovasc. Thoracic Surgery, 2014, vol. 19, no. 5, pp. 816‒823.

34. Lee S.H., Kim N., Lee C.Y. et al. Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery: A randomised double-blinded trial. Eur. J. Anaesth., 2016, vol. 33, no. 4, pp. 275‒282.

35. Lirio F., Galvez C., Bolufer S. et al. Tubeless major pulmonary resections. J. Thoracic Disease, 2018, vol. 10, no. 22, pp. 2664‒2670.

36. Lohser J., Slinger P. Lung injury after one-lung ventilation: a review of the pathophysiologic mechanisms affecting the ventilated and the collapsed lung. Anesthesia & Analgesia, 2015, vol. 121, no. 2, pp. 302‒318.

37. Lu Y., Dai W., Zong Z. et al. Bronchial blocker versus left double-lumen endotracheal tube for one-lung ventilation in right video-assisted thoracoscopic surgery. J. Cardioth. Vascular Anesthesia, 2018, vol. 32, no. 1, pp. 297‒301.

38. Mier J.M., Chavarin A., Izquierdo-Vidal C. et al.A prospective study comparing three-port video-assisted thoracoscopy with the single-incision laparoscopic surgery (SILS) port and instruments for the video thoracoscopic approach: a pilot study. Surgical Endoscopy, 2013, vol. 27, no. 7, pp. 2557‒2560.

39. Migliore M., Giuliano R., Aziz T. et al. Four-step local anesthesia and sedation for thoracoscopic diagnosis and management of pleural diseases. Chest, 2002, vol. 121, no. 6, pp. 2032‒2035.

40. Mineo T.C. Epidural anesthesia in awake thoracic surgery. Eur. J. Cardio-Thoracic Surgery, 2007, vol. 32, no. 1, pp. 13‒19.

41. Ning Y., Wang Y., Tao X. et al. Single-port endoscopic thoracic sympathectomy with monitored anesthesia care: a more promising procedure for palmar hyperhidrosis. World J. Surgery, 2015, vol. 39, no. 9, pp. 2269‒2273.

42. Nwogu C.E., D’Cunha J., Pang H. et al. VATS lobectomy has better perioperative outcomes than open lobectomy: CALGB 31001, an ancillary analysis of CALGB 140202 (Alliance). Ann. Thoracic Surgery, 2015, vol. 99, no. 2, pp. 399‒405.

43. Paul S., Jalbert J., Isaacs A.J. et al. Comparative effectiveness of robotic-assisted vs thoracoscopic lobectomy. Chest, 2014, vol. 146, no. 6, pp. 1505‒1512.

44. Piccioni F., Langer M., Fumagalli L. et al. Thoracic paravertebral anaesthesia for awake video‐assisted thoracoscopic surgery daily. Anaesthesia, 2010, vol. 65, no. 12, pp. 1221‒1224.

45. Piccioni F., Ragazzi R. Anesthesia and analgesia: how does the role of anesthetists changes in the ERAS program for VATS lobectomy. J. Visualized Surgery, 2018, vol. 4, pp. 9.

46. Rocco G., Martucci N., La Manna C. et al. Ten-year experience on 644 patients undergoing single-port (uniportal) video-assisted thoracoscopic surgery. Ann. Thoracic Surgery, 2013, vol. 96, no. 2, pp. 434‒438.

47. Salati M., Brunelli A., Xiume F. et al.Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax: clinical and economic analysis in comparison to the traditional approach. Interact. Cardiovasc. Thoracic Surgery, 2008, vol. 7, no. 1, pp. 63‒66.

48. Tamura M., Shimizu Y., Hashizume Y. Pain following thoracoscopic surgery: retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery. J. Cardiothoracic Surgery, 2013, vol. 8, no. 1, pp. 153.

49. Thompson T., Keogh E., French C.C. et al. Anxiety sensitivity and pain: generalisability across noxious stimuli. Pain, 2008, vol. 134, no. 1-2, pp. 187‒196.

50. Umari M., Falini S., Segat M., et al. Anesthesia and fast-track in video-assisted thoracic surgery (VATS): from evidence to practice. J. Thoracic Disease, 2018, vol. 10, no. 4, pp. 542‒554.

51. Zhao Z.R., Lau R.W.H., Ng C.S.H. Anaesthesiology for uniportal VATS: double lumen, single lumen and tubeless. J. Visualized Surgery, 2017, vol. 3, pp. 108.