title: Awake nonresectional lung volume reduction surgery.
abstract: OBJECTIVE
  To assess the feasibility, safety, and early results of awake lung volume reduction surgery (LVRS) performed under thoracic epidural anesthesia by a new nonresectional technique.
  
  
  BACKGROUND
  So far, resectional LVRS under general anesthesia and one-lung ventilation is the more frequently used technique, but procedure-related morbidity has been considerable.
  
  
  METHODS
  The study cohort included 12 patients undergoing unilateral awake LVRS. Evaluated parameters included technical feasibility and anesthesia satisfaction scored into 4 grades (from 1 = poor to 4 = excellent), global operating room time, and arterial carbon dioxide tension (PaCO2). In addition, 6-month changes in outcome measures, including forced expiratory volume in 1 second (FEV1), residual volume (RV), 6-minute walking test (SMWT), and dyspnea index were recorded. Perioperative and 6-month results were comparable with those of a control group undergoing unilateral resectional LVRS.
  
  
  RESULTS
  Technical feasibility was excellent to satisfactory in 11 patients. One patient required conversion to one-lung ventilation. Differences between the awake and control group included global operating room time (90 +/- 17 minutes versus 145 +/- 19 minutes, P < 0.00001); PaCO2 24 hours after surgery (45 +/- 6 mm Hg versus 49 +/- 6 mm Hg, P = 0.02); and hospital stay (7.8 +/- 5 days versus 11.7 +/- 4 days, P = 0.02). Significant (P < 0.002) improvements occurred at 6 months in FEV1 (0.31 +/- 0.17 L), RV (-1.41 +/- 0.7 L), SMWT (73 +/- 25 m), and dyspnea index (-1.3 +/- 0.5) and were comparable with those of the control group.
  
  
  CONCLUSIONS
  In this study, awake nonresectional LVRS proved feasible and safe. This new modality was associated with a faster recovery and satisfactory 6-month outcome, which did not differ from that of resectional LVRS.
authors.affiliation: Division of Thoracic Surgery, Multidisciplinary Pulmonary Program, Tor Vergata School of Medicine, Policlinico Tor Vergata, Rome, Italy.
authors.forename: Tommaso Claudio
authors.initials: TC
authors.lastname: Mineo
authors.forename: Eugenio
authors.initials: E
authors.lastname: Pompeo
authors.forename: Davide
authors.initials: D
authors.lastname: Mineo
authors.forename: Frederico
authors.initials: F
authors.lastname: Tacconi
authors.forename: Mario
authors.initials: M
authors.lastname: Marino
authors.forename: Alessandro Fabrizio
authors.initials: AF
authors.lastname: Sabato
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011013:Pneumonectomy / Q000379:methods*; D011656:Pulmonary Emphysema / Q000601:surgery; D013906:Thoracoscopy; D016896:Treatment Outcome