| Objective:Video-assisted thoracoscopic surgery(VATS)is gradually replacing traditional thoracotomy because of its advantages of less surgical trauma,less postoperative pain and less impact on lung function.However,due to the limited surgical space in thoracoscopy,the exposure of the surgical field during one-lung ventilation(OLV)becomes very important,and the key to anesthetic management is the rapid and adequate collapse of the lung tissue on the non-ventilated side to reduce blood flow to the non-ventilated lung and increase perfusion to the ventilated lung.The aim of this study was to explore the effect of three different strategies on the effectiveness and safety of lung collapse with the aid of closed vacuum suction.The three strategies were the non-ventilated side tracheal intubation clamped technique,the disconnection technique and the initiation of one-lung ventilation when the surgeon made the skin incision.Methods:The 96 patients who met the inclusion and exclusion criteria for elective thoracoscopic right upper lung resection were randomly divided into three groups(n=32)after induction of general anesthesia and left-sided double-lumen tracheal intubation.Group A(tracheal intubation clamped technique)had the non-ventilated side of the tracheal intubation clamped in the lateral position and unclamped after pleural opening,followed by one-lung ventilation.Group B(disconnection technique)had paused breathing for 2 min immediately when the surgeon made the skin incision,followed by one-lung ventilation.Group C(conventional technique)underwent one-lung ventilation immediately when the surgeon made the skin incision.All groups underwent closed vacuum suction for 1minute after pleural opening.The primary outcome was the time from pleural opening to lung collapse score(LCS)of 8(satisfactory lung collapse).The secondary outcomes were LCS at immediate pleural opening,1 min,5 min,10 min and 20 min after pleural opening.Arterial partial pressure of oxygen was recorded 10 min after double lung ventilation in lateral position,10 min,20 min and 30 min after one-lung ventilation.Visual analogue scale(VAS)for satisfaction of surgeon was scored,and the duration of one-lung ventilation and surgery,and the occurrence of intraoperative hypoxemia were recorded.Results:The time to achieve satisfactory lung collapse was 20.37 ± 4.44 min,14.45 ± 3.19 min,and 23.50 ± 3.91 min in groups A,B,and C,respectively(P < 0.001),with the shortest time to achieve satisfactory lung collapse in group B.The LCS in group B was higher than that in groups A and C at all time points.At 10 min after one-lung ventilation,the arterial partial pressure of oxygen was higher in group B compared with groups A and C(P=0.001).Compared with groups A and C,there was a shorter duration of one-lung ventilation(P=0.005)and a shorter surgery time(P=0.003).At the end of the procedure,the median satisfaction scores were 7,8 and 7 in groups A,B and C,respectively(P< 0.01),with the highest score in group B.There was no statistical difference in the incidence of hypoxemia during one-lung ventilation in all groups.Conclusions:With the assistance of closed vacuum suction,both non-ventilated side tracheal intubation clamped technique and disconnection technique shortened the time to satisfactory lung collapse compared with the initiation of one-lung ventilation when the surgeon made the skin incision,and the disconnection technique resulted in a faster achievement of satisfactory lung collapse than tracheal intubation clamped technique.The disconnection technique resulted in higher arterial partial pressure of oxygen at 10 min of one-lung ventilation,higher satisfaction of surgeon,and shorter one-lung ventilation time and surgery time,with no significant difference in the incidence of intraoperative hypoxemia. |
PDF Full Text Request