Awake Thoracic Epidural Anaesthesia Versus General Anesthesia for Video Assisted Thoracoscopic Surgery

Comparative Study Between Awake Thoracic Epidural Anaesthesia and General Anesthesia for Video Assisted Thoracoscopic Surgery

Thoracic procedures are routinely performed under general anesthesia (GA), with one lung ventilation (OLV)by double lumen tube or (GA) in spontaneously breathing patient by TIVA or LMA are usually combined with thoracic epidural analgesia.

However, GA whether mechanically ventilated or spontaneously breathing may have adverse effects including peri-intubation hypoxia, trauma to the upper airway, mechanical ventilation-induced injuries, impaired cardiac performance, neuromuscular problems in OLV and increased risk of pneumonia, and release of proinflammatory mediators in generally.

Recently, awake thoracic epidural anesthesia (ATEA) has been used alone in thoracic procedures The results achieved in early studies have been encouraging. ATEA may eventually provide an alternative method to GA for thoracic procedures that would not only eliminate the need for GA but also facilitate both surgical reconstruction and eventually patient recovery.

Recent studies suggested better clinical outcomes with ATEA, including less intraoperative bleeding, a better control of postoperative pain, early mobilization and short hospital stay, oral intake tolerance, reduction of surgical stress response, reduction of intraoperative cardiac events, improvement of myocardial flow determinants and left ventricular function, and a reduction of complications including pulmonary, thrombotic and infectious events.

Inclusion Criteria:

• Age range between 18 and 60 years.
• ASA score equal to or less than III.
• The absence of severe emphysema or clinical signs of active infectious disease.
• The procedure is predicted to be completed within two hours.

Exclusion Criteria:

• Patients with expected difficult airway management
• Haemodynamically unstable patients
• Obesity (body mass index >30)
• Inexperienced and poorly cooperative surgical team
• Coagulopathy (international normalized ratio >1.5)
• Persistent cough or high airway secretion
• Neurological disorders: risk of seizure, unable to cooperate, intracranial mass or brain oedema
• Extensive pleural adhesions or previous pulmonary resections
• Hypoxaemia (PaO2 <60) or hypercarbia (PCO2 >50)
• Any contraindications for use of regional anesthesia technique