title: Thoracoscopic operation for secondary pneumothorax under local and epidural anesthesia in high-risk patients.
abstract: BACKGROUND
  Video-assisted thoracic operations usually require single-lung ventilation under general anesthesia. However, for high-risk patients with other underlying pulmonary diseases, one has to consider risks of general anesthesia itself.
  
  
  METHODS
  Four high-risk patients (4 men; mean age, 73 years) with intractable secondary pneumothorax and other underlying pulmonary diseases were treated by video-assisted thoracic operations under local and epidural anesthesia. Absorbable polyglycolic acid sheets and fibrin glue were used to control the air leakage.
  
  
  RESULTS
  The mean duration of the procedure was 108 minutes. Pain and cough reflex were well controlled, and spontaneous breathing and hemodynamics were well maintained during the operation. The mean duration of the postoperative chest drainage was 5 days. No significant postoperative complication was encountered. No pneumothorax had recurred at a mean follow-up of 16 months.
  
  
  CONCLUSIONS
  Video-assisted thoracic operations can be performed safely under local and epidural anesthesia for the treatment of intractable secondary pneumothorax in high-risk patients. The air leakage can be controlled with the use of polyglycolic acid sheets and fibrin glue without bullectomy.
authors.affiliation: Department of Surgery II, Okayama University School of Medicine, Okayama-city, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Mukaida
authors.forename: A
authors.initials: A
authors.lastname: Andou
authors.forename: H
authors.initials: H
authors.lastname: Date
authors.forename: M
authors.initials: M
authors.lastname: Aoe
authors.forename: N
authors.initials: N
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000772:Anesthesia, Local; D015505:Chest Tubes; D000075202:Contraindications; D003371:Cough / Q000503:physiopathology / Q000517:prevention & control; D004724:Endoscopy; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007430:Intraoperative Care; D008171:Lung Diseases / Q000150:complications / Q000503:physiopathology; D008297:Male; D010146:Pain / Q000503:physiopathology / Q000517:prevention & control; D011030:Pneumothorax / Q000601:surgery*; D011100:Polyglycolic Acid / Q000737:chemistry; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012008:Recurrence; D012121:Respiration, Artificial / Q000379:methods; D012307:Risk Factors; D013526:Surgical Mesh; D013906:Thoracoscopy; D013997:Time Factors; D014014:Tissue Adhesives / Q000627:therapeutic use; D014741:Video Recording
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D011100:Polyglycolic Acid