Clinical Study Of Non-tracheal Intubation General Anesthesia With Spontaneous Breathing In Troacoscopic Radical Resection Of Lung Cancer

Background:With the continuous improvement of the concept and technology of anesthesia and the level of surgical risk management,the development of integrated minimally invasive surgery including anesthesia has become the requirement of the concept of rapid rehabilitation in thoracic surgery.Non-tracheal intubation anaesthesia with spontaneous breathing can avoid complications such as airway injury and ventilator-related lung injury caused by traditional tracheal intubation,facilitate early postoperative activity and eating,shorten postoperative hospital stay,and promote patient recovery.This is in line with the requirements of the overall minimally invasive and rapid rehabilitation concept of thoracic surgery.However,this technique still lacks a large sample of prospective clinical trials to prove its safety and effectiveness at present.Objective:Through the preliminary exploration of thoracoscopic radical resection of lung cancer(non-small cell lung cancer)under the condition of preserving spontaneous breathing and non-intubation general anaesthesia,we can evaluate the safety and feasibility of this anaesthetic technique in thoracoscopic radical resection of lung cancer and its superiority for patients' rapid rehabilitation after operation.Methods:In this study,patients who underwent thoracoscopic radical resection of lung cancer were admitted to the Department of Cardiothoracic surgery,Huzhou Hospital of Zhejiang University from June 2018 to June 2019.In a prospective randomized controlled study,100 subjects were randomly divided into non-intubation group(n = 50)and intubation group(n = 50).The non-intubation group was treated with self-breathing non-intubation general anesthesia for thoracoscopic radical resection of lung cancer with no muscle relaxant used and with spontaneous breathing retained during laryngeal mask insertion.The intubation group was treated with endotracheal intubation general anesthesia and muscle relaxant.One-lung mechanical ventilation was performed by inserting double-lumen bronchus.According to the pathology,location and size of the tumor,thoracic surgeons underwent thoracoscopic wedge pneumonectomy or lobectomy plus lymph node dissection.The relevant information and data of the two groups of patients in this study were collected and analyzed respectively.Result:Because the rapid intraoperative pathological results of 18 patients indicated benign,3 patients had extensive pleural adhesion and 1 patient lost follow-up after surgery,78 patients were finally included in the analysis: 38 in the non-intubation group and 40 in the intubation group.There was experimental comparability in the two groups as no significant difference in basic condition and operation mode between the two groups.There was no significant difference in intraoperative anesthetic effect score,blood loss,lowest pulse oxygen saturation and operation duration between the two groups(P > 0.05).Compared with the intubation group,the operative field exposure score and the maximum end-expiratory carbon dioxide partial pressure in the experimental group increased,and the changes of blood pressure and heart rate decreased before and after intubation / laryngeal mask.Meanwhile,the time of extubation,the time of getting out of the room,getting out of bed,the time of eating and hospitalization after operation were shortened,the medical expenses were reduced,and the incidence of throat discomfort was decreased(P < 0.05).There was no significant difference in the percentage of leukocytes and neutrophils between the two groups(P >0.05)and C reactive protein in the experimental group was lower than that in the laryngeal mask group(P < 0.05).Conclusion:Preserving spontaneous breathing non-intubation general anesthesia for thoracoscopic radical resection of lung cancer is safe and feasible,and there are certain advantages in speeding up postoperative recovery and reducing medical costs.