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Abstract
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Background and Aims Video-Assisted Thoracic Surgery (VATS), a minimally invasive surgery usually performed under general anesthesia. Like in Laparoscopic and breast surgeries, Thoracic segmental spinal anesthesia may be a viable option as a regional anesthesia approach in VATs. The use of this technique as an alternative to general anesthesia is much simpler compared to other regional anesthesia techniques.
Methods A 51-year old ASA II male was schedule for VATS biopsy and deloculation. The patient was informed of the anesthesia technique and provided informed consent. Thoracic segmental spinal anesthesia was done by slowly injecting a mixture of Bupivacaine 0.5% Isobaric 5mg, Fentanyl 20 mcg, Ketamine 10mg, and Dexmedetomidine 5 mcg intrathecally at the level of T6-7 interspace using a gauge 25 spinal needle via paramedian approach. No recorded paresthesia or any problems during the puncture or injection of anesthetic were encountered.
Results After confirming the desired block height of T1-9 surgery was started. Lidocaine bolus followed by a low-dose infusion was started to reduce the coughing reflex or reflexive bronchoconstriction during lung manipulation. The procedure commenced without any complications. Patient remained comfortable, easily arousable, and responsive during the whole operation. The surgery lasted for 1 hour and 45 minutes, with no complaints of pain and discomfort from the patient.
Conclusions Awake VATS presents a particular challenge to the anesthesiologist and requires extra vigilance. Current preliminary data support the feasibility and safety of awake VATs under regional anesthesia, especially by thoracic segmental spinal. Nevertheless, large scale studies are needed before the overall risk and benefits can be concluded.
Thoracic segmental puncture at T6-7 interspace
Surgical Team
surgeon performing awake vats