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Spontaneous ventilation combined with double-lumen tube intubation in thoracic surgery

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Abstract

Objective

We present the combination of spontaneous ventilation and double-lumen tube intubation in thoracic surgery.

Methods

At the beginning of the procedures, the patients with a body mass index of ≤ 30 were relaxed for a short time, and a double-lumen tube was inserted. After the utility incision or thoracotomy, the vagus nerve was blocked (in right side in the upper mediastinum; in left side in the aorto-pulmonary window) with 3–5 ml of 0.5% bupivacaine. The patients had a bispectral index of 40–60. After the short relaxation period, the patients were ventilating spontaneously without any cough during the manipulation.

Results

Between March 10 and September 18. 2020, 26 spontaneous ventilation combined with intubation surgeries were performed: 19 uniportal video-assisted thoracic surgery (15 lobectomies, 1 segmentectomy, and 3 wedge resections) and 7 open (5 lobectomies and 1 sleeve segmentectomy, 1 wedge resection). The mean mechanical and spontaneous one-lung ventilation time was 25.5 (15–115) and 73.3 (45–100) minutes, respectively. In 2 cases conversion to relaxation were necessary (2/26; 7.7%). The mean maximal carbon dioxide pressure was 52.3 (38–66) Hgmm and the mean lowest oxygen saturation was 93.8 (86–99) %. Breathing frequency ranged between 10–25/minute. The mean surgical times was 83.3 (55–130) minutes.

Conclusions

Spontaneous ventilation combined with intubation in video-assisted thoracic surgery or open resections is a safe method in selected patients. It can reduce the mechanical one-lung ventilation period with 76.6% and give safe airway for spontaneous ventilation thoracic procedures.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Author notes

  1. József Furák and Zsolt Szabó contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, University of Szeged, Semmelweis u. 8. 6725, Szeged, Hungary

    József Furák

  2. Department of Anesthesiology, University of Szeged, Szeged, Hungary

    Zsolt Szabó

Authors
  1. József Furák
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  2. Zsolt Szabó
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Correspondence to József Furák.

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The authors declare no conflicts of interest: FJ has no conflict of interest; SzZs has no conflict of interest.

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Furák, J., Szabó, Z. Spontaneous ventilation combined with double-lumen tube intubation in thoracic surgery. Gen Thorac Cardiovasc Surg 69, 976–982 (2021). https://doi.org/10.1007/s11748-020-01572-3

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  • DOI: https://doi.org/10.1007/s11748-020-01572-3

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