CO2 during single incisional thoracoscopic bleb resection with two-lung ventilation

Dong Kyu Lee, Heezoo Kim, Hyun Koo Kim, Dong Ik Chung, Kook Nam Han, Young Ho Choi

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    4 Citations (Scopus)

    Abstract

    Background: CO2 insufflation could provide a better surgical field during single-incision thoracoscopic surgery (SITS) with small tidal two-lung ventilation (ST-TLV). Here we compared the surgical field and physiological effects of ST-TLV with and without CO2 during SITS. Methods: Patients underwent scheduled SITS bullectomy. Surgery under ST-TLV general anesthesia performed without CO2 (group NC) or with CO2 insufflation (group C). The surgical field was graded at thoracoscope introduction and at bulla resection as follows: good (more than half of the 1st rib visible; bleb easily grasped with the stapler), fair (less than half of the 1st rib visible; some manipulation needed to grasp the bleb with the stapler), or poor (1st rib non-visible; bleb ungraspable). Vital signs, arterial blood gas analysis (ABGA), and mechanical ventilation parameters, postoperative chest tube indwelling duration, length of hospital stays, and complications were recorded. Results: A total of 80 patients were ultimately included. The surgical field at thoracoscope introduction was better in group C (P=0.022). However, at bleb resection, the surgical fields did not differ (P=0.172). The operation time was significantly longer in group C (P=0.019) and anesthesia recovery time was not different (P=0.369). During the CO2 insufflation, the airway pressure was higher in group C (P=0.009). Mean PaCO2 was significantly higher (P=0.012) and mean PaO2 was significantly lower (P=0.024) in group C, but both values were within the physiologically normal range. Postoperative chest tube indwelling duration and length of hospital stays were not statistically different (P=0.234 and 0.085 respectively). Postoperative complication frequencies were similar (12.5% for group NC, 10.0% for group C, P=0.723). Conclusions: SITS with CO2 insufflation during ST-TLV did not produce a superior surgical field except at the beginning of surgery. CO2 insufflation required more time and resulted in higher mean PaCO2 and peak airway pressure.

    Original languageEnglish
    Pages (from-to)5057-5065
    Number of pages9
    JournalJournal of Thoracic Disease
    Volume10
    Issue number8
    DOIs
    Publication statusPublished - 2018

    Bibliographical note

    Funding Information:
    Funding: This work was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI17C0654).

    Publisher Copyright:
    © Journal of Thoracic Disease. All rights reserved.

    Keywords

    • Carbon dioxide
    • Feasibility studies
    • Minimally invasive surgical procedures
    • Pneumothorax
    • Video-assisted thoracoscopic surgery (VATS)

    ASJC Scopus subject areas

    • Pulmonary and Respiratory Medicine

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