Anesthesia Management, Inflammatory Response and Recovery After Non-intubated VATS Pericardial Window

Effect of Different Anesthesia Management Approaches on Inflammatory Response and Enhanced Postoperative Recovery Outcomes in Non Intubated Video-assisted Thoracoscopic Surgery: A Single-centre Retrospective Cohort Study

Non-intubated video-assisted thoracoscopic surgery (NIVATS) is performed under spontaneous ventilation and avoids tracheal intubation and one-lung mechanical ventilation. It is increasingly used for the surgical management of pericardial effusion, where a pericardial window is created thoracoscopically. Because NIVATS avoids airway instrumentation and positive-pressure ventilation, it has been proposed to blunt the perioperative inflammatory and stress response and to support enhanced recovery after surgery targets. Within NIVATS, anaesthetic management is not uniform. In routine institutional practice, some patients are managed with procedural sedation plus systemic opioid analgesia, while others receive procedural sedation plus a thoracic regional analgesia technique. Whether this difference in analgesic strategy translates into a measurable difference in the systemic inflammatory response or in early recovery outcomes has not been established. This single-centre retrospective cohort study will review the records of adult patients who underwent NIVATS pericardial window creation for pericardial effusion at a tertiary hospital.

This single-centre retrospective cohort study will review the records of adult patients who underwent NIVATS pericardial window creation for pericardial effusion at a tertiary cardiovascular training and research hospital. Patients will be classified into two predefined groups according to the anaesthesia management module documented in their perioperative records. The primary outcome is the change in the neutrophil-to-lymphocyte ratio (NLR) from before surgery to the morning of postoperative day 1. Secondary outcomes address ERAS-related endpoints, including discharge within postoperative day 1, intensive care admission, hospital length of stay, analgesic and antiemetic requirements, and postoperative complications. The ability of each anaesthesia management module to sustain the planned non-intubated technique through to the end of surgery is also assessed. No intervention is assigned by the investigators. All data are obtained from existing clinical records, and no additional test, procedure, or contact with patients is involved.

Inclusion Criteria:

• Adults aged 18 to 80 years
• Underwent non-intubated video-assisted thoracoscopic surgery with spontaneous ventilation for creation of a pericardial window for pericardial effusion at the study centre
• American Society of Anesthesiologists (ASA) physical status I to IV
• Available preoperative complete blood count within 24 hours before surgery and routine morning complete blood count on postoperative day 1
• Anaesthesia management module classifiable as Group A or Group B from the perioperative records

Exclusion Criteria:

• Age under 18 years or over 80 years
• Pregnancy
• Documented poor general condition or haemodynamic instability before surgery
• Requirement for inotropic or vasopressor support before surgery
• Intensive care unit stay exceeding 24 hours before surgery
• Missing preoperative or postoperative day 1 complete blood count
• Haematological malignancy, active systemic infection, or ongoing corticosteroid or immunosuppressive therapy at the time of surgery
• Anaesthesia management not classifiable into either predefined module