Spontaneous ventilation anaesthesia: total intravenous anaesthesia with local anaesthesia or thoracic epidural anaesthesia for thoracoscopic bullectomy.
OBJECTIVE
At present, few data exist regarding the comparisons of perioperative outcomes and recurrence of spontaneous ventilation (SV) video-assisted thoracic surgery (VATS) bullectomy using total intravenous anaesthesia (TIVA) with local anaesthesia (LA) or thoracic epidural anaesthesia (TEA). We evaluated the feasibility and safety of TIVA with LA in the management of primary spontaneous pneumothorax (PSP).


METHODS
We conducted a single-institution retrospective analysis of patients undergoing VATS bullectomy between July 2011 and May 2015; 240 patients were included for analysis. Preoperative, intraoperative and postoperative variables of patients undergoing VATS bullectomy using TIVA-TEA (n = 140) were compared with those using TIVA-LA (n = 100).


RESULTS
Baseline demographics were similar between groups. No patients in either group required conversion to thoracotomy. Three patients (TIVA-TEA: 2; TIVA-LA: 1) required conversion to intubated general anaesthesia. Both groups had comparable surgical duration, estimated blood loss, peak EtCO2and lowest intraoperative SpO2level. Postoperatively, thoracic drainage volume, duration of chest tube drainage and hospitalization cost did not differ between groups. The incidence of postoperative complications between groups was not significant (2% for TIVA-TEA vs 2% for TIVA-LA, P = 1.00). Pneumothorax recurrence rate was 3% in TIVA-TEA cases (n = 4) and 2% in TIVA-LA cases (n = 2).


CONCLUSIONS
SV-VATS bullectomy using TIVA with LA or TEA is technically feasible and safe. Both groups have comparable short-term outcomes and recurrence rates; TIVA-LA seems a valid alternative to TIVA-TEA for the surgical management of PSP under SV.
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.|Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.|National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Zhihua
Z
Guo
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.|Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.|National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Weiqiang
W
Yin
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.|Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.|National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Wei
W
Wang
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.|Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.|National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Jianrong
J
Zhang
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.|Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.|National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Xin
X
Zhang
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.|Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.|National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Guilin
G
Peng
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.|Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.|National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Xin
X
Xu
Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Zhaomin
Z
Huang
Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Lixia
L
Liang
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.|Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.|National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Hanzhang
H
Chen
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China drjianxing.he@gmail.com.|Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.|National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Jianxing
J
He
D000293:Adolescent; D000328:Adult; D000765:Anesthesia, Conduction / Q000379:methods*; D000767:Anesthesia, Epidural / Q000379:methods; D000771:Anesthesia, Intravenous / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011030:Pneumothorax / Q000601:surgery*; D012008:Recurrence; D012119:Respiration; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
Local anaesthesia; Lung bullectomy; Spontaneous ventilation; Thoracic epidural anaesthesia; Thoracoscopy; Total intravenous anaesthesia