Awake Video-assisted Thoracic Surgery with Thoracic Epidural Anesthesia in a Patient with Chronic Obstructive Pulmonary Disease

Abstract

Video-assisted thoracic surgery is the gold standard for minimally invasive surgery and can eliminate the need for general anesthesia in high-risk patients. In patients with significant respiratory dysfunction, such as chronic obstructive pulmonary disease, the choice of anesthesia technique is critical for surgical outcomes. This case report examines the application of thoracic epidural anesthesia during awake video-assisted thoracic surgery in a patient with advanced-stage chronic obstructive pulmonary disease. Thoracic epidural anesthesia offers significant advantages, including effective pain management, reduced opioid consumption, and improved postoperative respiratory function. Furthermore, it contributes to the reduction of postoperative complications and acceleration of recovery by minimizing the risks associated with tracheal intubation and mechanical ventilation. This case demonstrates that thoracic epidural anesthesia is safe and effective for video-assisted thoracic surgery with stable hemodynamic and respiratory parameters.

Keywords

• Awake Surgery
• Thoracic Epidural Anesthesia
• Video-Assisted Thoracic Surgery
• Chronic Obstructive Pulmonary Disease.

Kronik Obstrüktif Akciğer Hastalığı Olan Bir Hastada Torasik Epidural Anestezi ile Uyanık Video Yardımlı Torasik Cerrahi

Abstract

Video yardımlı torasik cerrahi, minimal invaziv cerrahinin altın standardı olup, risk grubundaki hastalarda genel anestezi ihtiyacını ortadan kaldırma potansiyeline sahiptir. Kronik obstrüktif akciğer hastalığı gibi ciddi solunum fonksiyon bozukluğu olan hastalarda, anestezi yöntemi seçimi cerrahi sonuçlar için kritik öneme sahiptir. Bu vaka raporunda, ileri evre kronik obstrüktif akciğer hastalığı olan hastada uyanık video yardımlı torasik cerrahi sırasında torasik epidural anestezinin uygulanması incelenmiştir. Torakal epidural anestezi, etkili ağrı yönetimi, opioid kullanımının azaltılması ve postoperatif solunum fonksiyonlarının iyileştirilmesi gibi önemli avantajlar sunmaktadır. Ayrıca, trakeal entübasyon ve mekanik ventilasyona bağlı riskleri en aza indirerek postoperatif komplikasyonların azalmasına ve iyileşme sürecinin hızlanmasına katkı sağlamaktadır. Bu vaka, stabil hemodinamik ve solunum parametreleri ile birlikte torakal epidural anestezinin video yardımlı torasik cerrahide güvenli ve etkili olduğunu göstermektedir.

Keywords

• Uyanık Cerrahi
• Torasik Epidural Anestezi
• Video Yardımlı Torasik Cerrahi
• Kronik Obstrüktif Akciğer Hastalığı.

References

1. Al-Abdullatief M, Wahood A, Al-Shirawi N, et al. Awake anaesthesia for major thoracic surgical procedures: an observational study. Eur J Cardiothorac Surg. 2007;32(2):346-350. doi:10.1016/j. ejcts.2007.04.029
2. Belzarena SD. Comparative study between thoracic epidural block and general anesthesia for oncologic mastectomy. Rev Bras Anestesiol. 2008;58(6):561-568. doi:10.1590/s0034-70942008000600001
3. Fabo, C., Oszlanyi, A., Barta, Z. V., Nemeth, T., Lantos, J., Vaida, S. N., & Szabo, Z. (2022). Anesthesiology of the spontaneous ventilation in thoracic surgery: A narrative review. AME Surgical Journal, 2, 1 https://doi.org/10.21037/asj-21-2
4. Groeben H. (2006). Epidural anesthesia and pulmonary function. Journal of anesthesia, 20(4), 290–299. https://doi.org/10.1007/s00540- 006-0425-6
5. Jørgensen, H., Wetterslev, J., Møiniche, S., & Dahl, J. B. (2000). Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database of Systematic Reviews, 2000(4), CD001893. https://doi.org/1002/14651858.CD001893
6. Kao, M. C., Tsai, S. K., Tsou, M. Y., Lee, H. K., Guo, W. Y., & Hu, J. S. (2004). Paraplegia after delayed detection of inadvertent spinal cord injury during thoracic epidural catheterization in an anesthetized elderly patient. Anesthesia & Analgesia, 99(2), 580-583. https://doi.org/10.1213/01.ANE.0000130391.62612.3E
7. Liu, J., Cui, F., Li, S., Chen, H., Shao, W., Liang, L., Yin, W., Lin, Y., & He, J. (2015). Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: A randomized control study. Surgical Innovation, 22(2), 123-130. https://doi.org/10.1177/1553350614531662
8. Loick, H. M., Schmidt, C., Van Aken, H., Junker, R., Erren, M., Berendes, E., Rolf, N., Meissner, A., Schmid, C., Scheld, H. H., & Möllhoff, T. (1999). High thoracic epidural anesthesia, but not clonidine, attenuates the perioperative stress response via sympatholysis and reduces the release of troponin T in patients undergoing coronary artery bypass grafting. Anesthesia & Analgesia, 88(4), 701-709. https://doi.org/10.1097/00000539-199904000-00001

9. Moen, V., Dahlgren, N., & Irestedt, L. (2004). Severe neurological complications after central neuraxial blockades in Sweden 1990-1999. Anesthesiology, 101(4), 950–959. https://doi.org/10.1097/00000542- 200410000-00021
10. Pompeo, E., Tacconi, F., Mineo, D., & Mineo, T. C. (2007). The role of awake video-assisted thoracoscopic surgery in spontaneous pneumothorax. Journal of Thoracic and Cardiovascular Surgery, 133(3), 786-790. https://doi.org/10.1016/j.jtcvs.2006.11.001
11. Pöpping, D. M., Elia, N., Marret, E., Remy, C., & Tramèr, M. R. (2008). Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: A meta-analysis. Archives of Surgery, 143(10), 990-99 https://doi.org/10.1001/archsurg. 143.10.990
12. Rocco, G., Martucci, N., La Manna, C., Jones, D. R., De Luca, G., La Rocca, A., Cuomo, A., & Accardo, R. (2013). Ten-year experience on 644 patients undergoing single-port (uniportal) video-assisted thoracoscopic surgery. Annals of Thoracic Surgery, 96(2), 434- 438. https://doi.org/10.1016/j.athoracsur.2013.04.044
13. Yang, M., Wang, D., Xu, X., Yu, X., Xu, H., Zeng, Z., & Dai, J. (2024). Application of OFA-based ERAS for video-assisted thoracoscopic surgery in elderly patients with airway stenosis: A case report. Medicine, 103(16), e37662. https://doi.org/10.1097/ MD.0000000000037662.