Article Text
PDF
Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant
Background and Aims In the case we presented,the VATS operation, which was a multiple interruption intubation attempt and had difficult airways, using epidural anesthesia. We provided the necessary sedation during the surgery with dexmedetomidine infusion.
Methods A 53years old female patient;body weight 80kg,height 160cm, ASA2, presented with Augmentin allergy, hypothyroidism, pulmonary nodules in the mediastinal+parenchymal tissues.The patient had a history of previous surgeries, multiple cesarean and a failed attempt at ventilation during VATS surgery one month ago, necessitating extubation due to suspected bronchospasm.Elective left VATS+Bx operation was planned, opting for awakeVATS due to previous difficulty with intubation.AwakeVATS operation under epidural anesthesia with dexmedetomidine iv infusion was planned. The patient received 1mg dormicum and 50mcg fentanyl for sedation, and was placed in the lateral decubitus position. An epidural catheter was inserted at the T5-T6 level. For induction 8cc 0.5% bupivacaine+2cc fentanyl+1cc NAC+4cc saline were administered through the catheter.In order to ensure patient compliance throughout the operation,0.3 mg/kg dexmedetomidine infusion was started.Maintenance included a mixture of 0.125% bupivacaine+2cc fentanyl at a rate of 7ml/kg/hr. N.Vagus was performed by surgeons to suppress the cough reflex.
Results During the operation, the patient was oriented to hold her breath while parenchymal biopsy was performed, ensuring reliable saturation levels. The procedure lasted for 4 hours and was successfully concluded.Transferred to the cardiothoracic ICU postoperatively.
Conclusions Recent studies have reported that non-intubated VATS operations can be feasible and safe for patients with compromised airways. Patient selection, surgical planning, and preparation are critical stages that require meticulous collaboration between experienced surgical and anesthesia teams
Patient position during surgery
Perimediastinal lesion excision during awake VATS