title: Four-step local anesthesia and sedation for thoracoscopic diagnosis and management of pleural diseases.
abstract: OBJECTIVE
  Most thoracic surgeons perform thoracoscopy under general anesthesia using a double-lumen endotracheal tube. We describe our own technique for performing thoracoscopy under local anesthesia and sedation.
  
  
  METHODS
  Forty-five patients underwent the procedure under local anesthesia and sedation (mean age, 64 years; age range, 40 to 92 years). A known history of cancer was present in 12 patients. American Society of Anesthesiology score was I in 1 patient, II in 16 patients, III in 22 patients, IV in 5 patients, and V in 1 patient. Premedication was comprised of droperidol, 5 mg, and atropine, 0.5 mg, administered 20 min before the scheduled operating room time. Sedation was maintained by diazepam injection, 3 mg. Four-step local anesthesia in the planned intercostal space using 10 mL of ropivacaine, 7.5 mg/mL, was performed.
  
  
  RESULTS
  Mean operative time was 45.7 min (range, 20 to 90 min); mean time of anesthesia was 71.3 min (range, 30 to 150 min). Among patients with pleural effusion, 23 effusions were simple and 16 effusions were complex. Talc was administrated in 28 patients. Complications were intraoperative bleeding (one patient), hyperpyrexia (eight patients), and atrial fibrillation (two patients). The mean time for removal of the chest drain was 5.6 days (range, 2 to 13 days). Postoperative hospital stay was 6.4 days (range, 2 to 14 days). No hospital mortality occurred. Follow-up is complete in all patients (mean, 92.8 days; range, 31 to 270 days).
  
  
  CONCLUSIONS
  Four-step local anesthesia and sedation is a simple and effective method of performing a video-assisted thoracic procedure to diagnose and treat simple thoracic pathologies.
authors.affiliation: Section of General Thoracic Surgery, Department of Surgery, University of Catania, Catania, Italy. mmiglior@mbox.unict.it
authors.forename: Marcello
authors.initials: M
authors.lastname: Migliore
authors.forename: Riccardo
authors.initials: R
authors.lastname: Giuliano
authors.forename: Tarek
authors.initials: T
authors.lastname: Aziz
authors.forename: Rasheed A
authors.initials: RA
authors.lastname: Saad
authors.forename: Francesco
authors.initials: F
authors.lastname: Sgalambro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D010995:Pleural Diseases / Q000175:diagnosis* / Q000628:therapy*; D013906:Thoracoscopy