Video-assisted thoracoscopic surgery (VATS) with nonintubated spontaneous breathing general anesthesia using laryngeal mask (LMA)

Introduction: VATS has been an important minimally invasive tool in the hands of experienced surgeons.On a natural progress, anaesthetic support has evolved and become equally less invasive. Objective: To investigate the efficacy and safety of non intubated spontaneous breathing general anaesthesia via LMA in VATS procedures. Materials and Methods: Retrospective study of 23 patients that underwent VATS with spontaneous breathing general anesthesia with LMA without using muscle relaxants(March 2013-January 2015). Results: Thirteen males and 10 females were studied with a mean age of 65.22years (range 35-87).We used LMA Proseal in 20/23 patients and LMA Fastrach in 3/23. ASA grades were I(14/23) and II(9/23). VATS procedures included pleural&lung biopsies(8/23), pulmonary nodule excisions(5/23), pericardial window(3/23), multiloculated empyema debridement(4/23), pneumothorax(3/23). Mean operative time was 40 minutes.Mean values of lower oxygen saturation and peak end-tidal carbon dioxide tension were 95% and 50mmHg, respectively.No mask displacement/conversion to endotracheal anesthesia occured,and one patient required conversion to mini thoracotomy.The level of technical feasibility was excellent(9/23) and good(14/23) cases. Mortality and morbidity rates were zero. Mean postoperative stay:2.6 days. Conclusions: VATS procedures are safe and efficient under nonintubated spontaneous breathing anesthesia with LMA. The latter allows a confident manipulation of lung parenchyma preventing cough, pain, or panic attack described for awake epidural anesthesia, and avoids the risks of tracheal intubation and mechanical ventilation.