Clinical Effects Between Tubelss Anesthesia And Double-Lumen Endotracheal Intubation Anesthesia In Video-Assisted Thoracic Surgery

Objective:This trial aims to evaluate the feasibility of the tubeless anesthesia strategy in video-assisted thoracic surgery and the actual advantages and disadvantages of tubeless anesthesia for surgical patients by comparing the tubeless anesthesia and double-lumen endotracheal intubation anesthesia.Methods:Select patients in our hospital from January 2020 to January 2021who underwent thoracoscopic sympathectomy,thoracoscopic lobectomy,and thoracoscopic bullae wedge resection.The patients were divided into two groups using the computer-generated number table method:Tubeless anesthesia group（T group）and double-lumen endotracheal intubation anesthesia group（C group）.T group adopts Tubeless anesthesia strategy including thoracic paravertebral nerve block,laryngeal mask placement to maintain spontaneous breathing,incision local anesthetic infiltration,intrathoracic vagus nerve and phrenic nerve block combined intravenous anesthesia;C group double-lumen tracheal intubation single lung machine ventilation,incision local anesthetic infiltration compound intravenous anesthesia.Preoperative,intraoperative,and postoperative arterial blood gas analysis results include Pa CO₂,Pa O₂;operation time,intraoperative blood loss,PACU stay time,opioid consumption,the number of analgesia pump compressions,postoperative feeding time,postoperative activity time,the incidence of postoperative complications,the length of hospitalization,and the cost of hospitalization were collected.Results:A total of 70 patients were enrolled in this study,35 in each of the T group and C group.The highest value of Pa CO₂ in group T was significantly higher than that of group C（P<0.05）and the lowest value of Pa O₂ was significantly lower than that of group C（P<0.05）.However,there was no difference between the postoperative value of Pa CO₂ and the normal value（P>0.05）,and there was no significant difference in the incidence of Pa O₂<80mm Hg between patients in group T and C（P>0.05）.There was no significant difference in operation time and intraoperative blood loss between group T and group C（P>0.05）.PACU stay time,opioid consumption,the number of analgesia pump compressions,postoperative feeding time,postoperative activity time,the incidence of postoperative complications,the length of hospitalization,and the cost of hospitalization in group T are less than those of group C,and the difference is statistically significant（P<0.05）.In group T,one case was converted to tracheal intubation.Conclusion:Although patients in the Tubeless anesthesia group are prone to hypercapnia and low oxygen partial pressure during surgery,hypercapnia is permissible,and low arterial oxygen partial pressure has no practical clinical significance.Tubeless anesthesia is feasible in thoracoscopic surgery.At the same time,Tubeless anesthesia strategy has obvious advantages in postoperative recovery of patients,speeding up the recovery of patients after surgery,and reducing the total length of hospitalization and total cost of patients.