Awake nonresectional lung volume reduction surgery.
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.
Mineo
Tommaso Claudio
TC
Division of Thoracic Surgery, Multidisciplinary Pulmonary Program, Tor Vergata School of Medicine, Policlinico Tor Vergata, Rome, Italy.
Pompeo
Eugenio
E
Mineo
Davide
D
Tacconi
Frederico
F
Marino
Mario
M
Sabato
Alessandro Fabrizio
AF
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