Thoracoscopy under local anesthesia for patients with a high cardiopulmonary risk index

Amac: Bu calismada, yuksek kardiyopulmoner risk indeksine sahip olan hastalarin tani ve tedavisinde lokal anestezi ve sedasyon ile uygulanan torakoskopinin etkinligi arastirildi. Ca­lis­ma­pla­ni:­Ocak 2007 ve Ocak 2010 tarihleri arasinda Pamukkale Universitesi Tip Fakultesi Gogus Cerrahisi Anabilim Dali’nda yuksek kardiyopulmoner riske sahip olan ve lokal anestezi ve sedasyon ile torakoskopi uygulanan 32 hasta (22 erkek, 10 kadin; ort. yas 63.6 yil; dagilim 36-89 yil) calismaya dahil edildi. Risk degerlendirmesi kardiyopulmoner risk indeksi ile yapildi. Tum islemler ameliyathanede gerceklestirildi. Bul gu lar: Hastalarin kardiyopulmoner risk indeks puani 7-37 (ortalama 13.6) arasinda degisiyor idi. Hicbir hastaya genel anestezi, endotrakeal entubasyon veya epidural ya da interkostal blokaj uygulanmadi. Hastalarin 15’ine talk kullanilarak yapilan ploredez ile birlikte ya da tek basina plevral biyopsi/efuzyon drenaji, altisina ampiyem drenaji ve debridmani, dordune mediastinal lenf nodu biyopsisi uygulandi. Buna ilaveten uc hastaya sekonder pnomotoraks nedeni ile parsiyel plorektomi, birine mediastinal kitle nedeni ile biyopsi, birine ise hematom cikarilmasi uygulandi. Ayrica bir hastaya yabanci cisim cikarilmasi ve bir digerine multipl akciger nodullerinin tanisi icin kama rezeksiyon endikasyonu ile torakoskopi uygulandi. Hastalarin hicbirinde torakotomi gerekmedi. Morbidite uc hastada (%9) gozlendi, fakat hicbir hastada mortalite gorulmedi. So­nuc:­ Torakoskopi, lokal anestezi ve sedasyon esliginde, genel durumu kotu hastalarda bile guvenli ve etkilidir. Anah tar soz cuk ler: Lokal anestezi; medikal torakoskopi; plevral efuzyon; video yardimli torakoskopi. Background:­ In this study, we aimed to investigate the efficacy of thoracoscopy performed under local anesthesia and sedation for the diagnosis and treatment of patients with a high cardiopulmonary risk index. Methods: Between January 2007 and October 2010, 32 patients (22 males, 10 females; mean age 63.6 years; range 36 to 89 years) with a high cardiopulmonary risk index who underwent thoracoscopy under local anesthesia and sedation at Pamukkale University, School of Medicine, Department of Thoracic Surgery were included. Risk assessment was performed using the cardiopulmonary risk index. All procedures were performed in the operating room. Results:­ The cardiopulmonary risk index points of the patients ranged from 7 to 37 (mean 13.6). None of the patients underwent general anesthesia, indotracheal intubation, or epidural or intercostal blockage. Pleural biopsy/effusion drainage, either with or without talc pleurodesis, was performed in fifteen patients, six had drainage and debridement of empyema, and four had a biopsy of a mediastinal lymph node. In addition, three patients had a partial pleurectomy for secondary pneumothorax, one underwent a biopsy of a mediastinal mass, and one had a hematoma removed. Furthermore, a foreign body was extracted from one patient, and a wedge resection for the diagnosis of multiple lung nodules was performed on another. None of the patients required a thoracotomy. Morbidity was observed in three patients (9%), but no mortality was seen. Conclusion:­ Thoracoscopy performed under local anesthesia and sedation is a safe and effective, even for patients in poor general condition.