Non-intubated Thoracoscopic Surgery to Minimize Contamination From Airway Secretions During the COVID-19 Pandemic

Man-Ling Wang; Ming-Hui Hung; Hsao-Hsun Hsu; Ya-Jung Cheng; Jin-Shing Chen

doi:10.3389/fsurg.2022.818824

Non-intubated Thoracoscopic Surgery to Minimize Contamination From Airway Secretions During the COVID-19 Pandemic

Front Surg. 2022 Feb 18:9:818824. doi: 10.3389/fsurg.2022.818824. eCollection 2022.

Authors

Man-Ling Wang^{1

2}, Ming-Hui Hung^{1

2}, Hsao-Hsun Hsu³, Ya-Jung Cheng^{1

4}, Jin-Shing Chen^{3

5}

Affiliations

¹ Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
² Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
³ Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
⁴ Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan.
⁵ Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.

Abstract

Background: General anesthesia and tracheal intubation potentially pose a high risk to health care workers (HCWs) managing surgical patients during the coronavirus disease 2019 (COVID-19) pandemic. Non-intubated anesthesia is a rational way of managing patients undergoing thoracoscopic surgery that avoids tracheal intubation and minimizes the aerosols generated during airway instrumentation. The purpose of this study was to determine whether non-intubated anesthesia in combination with a face mask is safe and feasible in patients undergoing thoracoscopic surgery.

Methods: A total of 18 patients who underwent non-intubated thoracoscopic surgery with a face mask during the perioperative period between March 9, 2020 and April 6, 2020 were included. The main outcomes were anesthetic management and postoperative results.

Results: The 18 patients had a mean age of 64 years and a body mass index of 22.9 kg/m². All patients wore a mask during induction of anesthesia and throughout surgery. Three patients underwent lobectomy, four segmentectomy, ten wedge resection, and one underwent anterior mediastinal tumor resection. No patient developed cough or vomiting during the perioperative period. All patients were transferred to the postoperative recovery unit within 15 min of the end of surgery (average 7.2 min). No patient required conversion to tracheal intubation or conversion to thoracotomy.

Conclusion: Non-intubated anesthesia with a mask was safe and feasible in patients undergoing thoracoscopic surgery. Avoidance of intubated general anesthesia and use of a lung separation device may reduce the risk to HCWs of contamination by airway secretions, thereby conserving personal protective equipment, especially during the COVID-19 pandemic.

Keywords: coronavirus disease (COVID-19); non-intubated thoracic surgery; personal protective equipment (PPE); thoracic surgery; video-assisted thoracic surgery.