A Comparative Study between Thoracic Epidural Anesthesia in Non-Intubated Video-Assisted Thoracoscopes and the Conventional General Anesthesia with One Lung Ventilation

Abstract

Epidural anesthesia and analgesia have proven to be beneficial amongst a wide range of clinical applications either as combined to general anesthesia (GA) or an alternative to it. For Thoracic Epidural Anesthesia (TEA), several dosing regimens can be used to stabilize hemodynamic swings and avoid respiratory impairment (in awake patients). The level and duration of epidural anesthesia depends on the injection site and the targeted segment to be blocked. Non-intubated Video-Assisted Thoracoscopic Surgery (nVATS), requires an increased anesthesiological effort, accurate patient selection and rigorous planning of airway management. TEA in nVATS patients provided a good preservation of pulmonary functions which are reflected in arterial blood gas values. Despite the diminished contractility of the left ventricle after TEA, there was no change in global ventricular performance, because of a concomitant reduction of afterload. Apart from the sympatholytic role of TEA, there is a decrease in circulating catecholamines levels due to block of the sympathetic adrenal medullary innervation. This is beneficial in patients with high basal sympathetic tone. This modestly blunts the stress-related hemodynamic response. The duration of postoperative ileus can be shortened by TEA because of the blockage of nociceptive afferent nerves and thoraco-lumbar sympathetic efferent fibers with preserved parasympathetic outflow, besides, enhanced recovery and early mobilization. In contrast to morphine, TEA does not appear to delay gastric emptying. In fact, it has been shown to increase gastric and intestinal activity.