Awake Nonresectional Lung Volume Reduction Surgery
Objective: To assess the feasibility, safety, and early results of awake lung volume reduction surgery (LVRS) performed under thoracic epidural anesthesia by a new nonresectional technique.
Summary Background Data: So far, resectional LVRS under general anesthesia and one-lung ventilation is the more frequently used technique, but procedure-related morbidity has been considerable.
Methods: The study cohort included 12 patients undergoing unilateral awake LVRS. Evaluated parameters included technical feasibility and anesthesia satisfaction scored into 4 grades (from 1-poor to 4 -excellent), global operating room time, and arterial carbon dioxide tension (PaCO2). In addition, 6-month changes in outcome measures, including forced expiratory volume in 1 second (FEV1), residual volume (RV), 6-minute walking test (SMWT), and dyspnea index were recorded. Perioperative and 6-month results were comparable with those of a control group undergoing unilateral resectional LVRS.
Results: Technical feasibility was excellent to satisfactory in 11 patients. One patient required conversion to one-lung ventilation. Differences between the awake and control group included global operating room time (90±17 minutes versus 145±19 minutes,P＜0.00001); PaCO224 hours after surgery (45±6 mm Hg versus49±6 mm Hg, P＝0.02); and hospital stay (7.8±5 days versus11.7±4 days, P＝0.02). Significant (P＜0.002) improvements occurred at 6 months in FEV1 (0.31±0.17 L), RV (-1.41±0.7L), SMWT (73±25 m), and dyspnea index (-1.3±0.5) and were comparable with those of the control group.
Conclusions: In this study, awake nonresectional LVRS proved feasible and safe. This new modality was associated with a faster recovery and satisfactory 6-month outcome, which did not differ from that of resectional LVRS.
作者: 丁香园通讯员
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