Spontaneous ventilation combined with double-lumen tube intubation in thoracic surgery

Objective: We present the combination of spontaneous ventilation and double-lumen tube intubation in thoracic surgery.

Methods: At the beginning of the procedures, the patients with a body mass index of ≤ 30 were relaxed for a short time, and a double-lumen tube was inserted. After the utility incision or thoracotomy, the vagus nerve was blocked (in right side in the upper mediastinum; in left side in the aorto-pulmonary window) with 3-5 ml of 0.5% bupivacaine. The patients had a bispectral index of 40-60. After the short relaxation period, the patients were ventilating spontaneously without any cough during the manipulation.

Results: Between March 10 and September 18. 2020, 26 spontaneous ventilation combined with intubation surgeries were performed: 19 uniportal video-assisted thoracic surgery (15 lobectomies, 1 segmentectomy, and 3 wedge resections) and 7 open (5 lobectomies and 1 sleeve segmentectomy, 1 wedge resection). The mean mechanical and spontaneous one-lung ventilation time was 25.5 (15-115) and 73.3 (45-100) minutes, respectively. In 2 cases conversion to relaxation were necessary (2/26; 7.7%). The mean maximal carbon dioxide pressure was 52.3 (38-66) Hgmm and the mean lowest oxygen saturation was 93.8 (86-99) %. Breathing frequency ranged between 10-25/minute. The mean surgical times was 83.3 (55-130) minutes.

Conclusions: Spontaneous ventilation combined with intubation in video-assisted thoracic surgery or open resections is a safe method in selected patients. It can reduce the mechanical one-lung ventilation period with 76.6% and give safe airway for spontaneous ventilation thoracic procedures.