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Background and Aims Over the last 20 years,video assisted thoracic surgery(VATS) become the treatment of choice in multiple chest related illnesses.Usually,VATS requires general anaesthesia with the selective intubation.However,for patients with severe health conditions,or an increased risk of complications from anesthesia,general anesthesia might not be a suitable option.In these cases,VATS can be performed using local anesthesia,allowing the patient to remain awake and without the need for a breathing tube.Compared to traditional VATS with general anesthesia,Awake VATS (AVATS) boasts demonstrably shorter surgery times,less complication and hospital stays

Methods A 68-year-old male patient with known comorbidities of hypertension,and laryngeal cancer was taken into operation for VATS left upper lobectomy.In addition to simple monitoring methods,the patient was monitored for intra-arterial blood pressure measurement and an epidural catheter was inserted in a sitting position at the 5-6th thoracic level,accompanied by sedation.As a result of loss of resistance at 5 cm,the catheter was advanced 8 cm in the epidural space.The procedure was completed without complications.For the epidural dose,0.5%bupivacaine,0.5%fentanyl and 0.9% saline were used

Results The patient,who was asked to remain absolutely motionless in life-threatening critical locations,was switched to general anesthesia despite effective analgesia due to the change in respiratory depth.In addition to the epidural dose,the patient was given an induction dose of hypnotics and muscle relaxants

Conclusions AVATS performed using any method is feasible and effective in patients who are incompatible with general anesthesia due to serious comorbidities and respiratory failure.However,switching to general anesthesia should not be avoided due to requirements such as patient safety and surgical indications