Feasibility, safety and effectiveness of videothoracoscopy with local anesthesia and sedation without tracheal intubation

Alexandre de Oliveira, João Aléssio Juliano Perfeito, Manoel João Batista Castello Girão, Mike Shyu


Background: Videothoracoscopy (VT) is the procedure that achieves the greatest diagnostic yield in thoracic surgery. General anesthesia is the standard practice, in cases of debilitated patients, the proposal arose to perform VT under local anesthesia and sedation. This study evaluates the feasibility, safety and effectiveness of VT under local anesthesia and sedation.
Methods: A prospective study, whereas 48 patients underwent a VT under local anesthesia and sedation. Patients were previously sedated. After this, oxygen saturation (O2 Sat), blood pressure (BP) and heart rate (HR) where registered. Then, fentanyl was administered, and this moment was standardized as time “0”. Intercostal block was performed at the insertion point of the trocars. Vital signs were measured every three minutes and registered, until the end of the procedure. Sedation level assessed every nine minutes and applied to the Ramsay Sedation Scale (RSS). Changes in vital signs during the course of the surgery were compared to time “0”.
Results: No patients had any memory of discomfort or pain from the operation, no tracheal intubation or postoperative in the ICU was required. VT achieved its diagnostic or therapeutic purposes in all cases.
Conclusions: VT under local anesthesia and sedation is feasible and safe. Procedure was successfully performed on all analyzed patients. The process achieved its goal in all the patients, attaining the diagnosis or treatment of illness that led to the indication for VT, making it the best option in the selected patients.