Feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules.
BACKGROUND
General anesthesia with single-lung ventilation is considered mandatory for thoracoscopic pulmonary resection. We assessed in a randomized study the feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules.


METHODS
Between March 2001 and February 2003, 60 patients were randomized into two 30-patients arms: a general anesthesia arm entailing double-lumen intubation and thoracic epidural anesthesia (control group); and an awake arm entailing sole thoracic epidural anesthesia at T4-T5 (awake group). Anesthesia time; operative time; global operating room time; patient satisfaction with the anesthesia and technical feasibility scored into 4 grades (from 1 = poor to 4 = excellent); visual analog pain score (VAS), nursing care (number of patient calls per day), 24 hours changes in arterial oxygenation (DeltaPaO2), and hospital stay were assessed.


RESULTS
There was no mortality. There was no difference in technical feasibility between the groups although 2 patients in the awake group required conversion to thoracotomy due to severe adhesions. Other 2 patients in each group required conversion due to unexpected lung cancer requiring lobectomy. Comparisons of awake versus control group results showed that in the awake group, anesthesia satisfaction score was greater (4 vs 3, p = 0.04), whereas DeltaPaO2 (-3 mm Hg vs -6.5 mm Hg, p = 0.002); nursing care (2.5 calls per day vs 4 calls per day, p = 0.0001), and hospital stay (2 days vs 3 days, p = 0.02) were significantly reduced.


CONCLUSIONS
In our study, awake thoracoscopic resection of solitary pulmonary nodules proved safely feasible. It resulted in better patient satisfaction, less nursing care and shorter in-hospital stay than procedures performed under general anesthesia.
Pompeo
Eugenio
E
Division of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy. pompeo@med.uniroma2.it
Mineo
Davide
D
Rogliani
Paola
P
Sabato
Alessandro F
AF
Mineo
Tommaso C
TC
D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control; D017060:Patient Satisfaction; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000453:epidemiology / Q000451:nursing; D012121:Respiration, Artificial; D003074:Solitary Pulmonary Nodule / Q000473:pathology / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods / Q000451:nursing / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014851:Wakefulness