title: Thoracoscopic surgery under epidural anesthesia for intractable secondary spontaneous pneumothorax.
abstract: OBJECTIVE
  Surgical intervention might be required in secondary spontaneous pneumothorax (SSP) with prolonged air leak; however, operation under general anesthesia (GA) could be critical in compromised patients. In this study, we performed video-assisted thoracic surgery (VATS) under epidural anesthesia (EA) in compromised patients with SSP and evaluated its feasibility.
  
  
  METHODS
  Of 212 patients who underwent VATS for SSP, 179 patients had surgery under GA and 33 under EA from 2006 to 2014. All medical records were retrospectively reviewed for operative time, pre- and postoperative chest tube drainage, postoperative complications, and hospital death. To evaluate the efficacy of VATS under EA, these factors were compared between EA and GA groups.
  
  
  RESULTS
  The mean operative time and the mean duration of postoperative drainage, respectively was 106.2±45.3 minutes and 6.15±10.51 days in GA, and 102.6±43.1 minutes and 6.10±7.20 days in EA. Of 18 cases with recurrence and 13 cases with complications, only one recurrence and one complication developed in EA.
  
  
  CONCLUSIONS
  In case with patients having intractable SSP with compromised pulmonary function, VATS under EA could be an effective and safe option to approach the appropriate goals of air leak control and less recurrence of pneumothorax.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution, Busan, Republic of Korea.
authors.forename: Hyo Yeong
authors.initials: HY
authors.lastname: Ahn
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution, Busan, Republic of Korea. Electronic address: domini@pnu.edu.
authors.forename: Yeong Dae
authors.initials: YD
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution, Busan, Republic of Korea.
authors.forename: Jeong Su
authors.initials: JS
authors.lastname: Cho
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution, Busan, Republic of Korea.
authors.forename: Hoseok
authors.initials: H
authors.lastname: I
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution, Busan, Republic of Korea.
authors.forename: Jonggeun
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Anesthesia and Pain Medicine, Pusan National University Hospital, Medical Research Institution, Busan, Republic of Korea.
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Kwon
mesh_terms: D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome
keywords: anesthesia; pneumothorax; thoracoscopy; video-assisted thoracic surgery