DOI: 10.36347/sjmcr.2019.v07i03.026

Pages: 258-262

Background: Video-assisted thoracoscopic surgery (VATs) is becoming more common because of its effectiveness and less invasiveness. With this change, the anesthetic practice is also needed to be modified. We report cases in which patients maintained spontaneous breathing without intubation through monitored anesthesia care (MAC) during VATs. Methods: We performed MAC on 18 patients undergoing VATs for primary pneumothorax without intubation. With standard monitoring, MAC was performed by using midazolam (0.1 mg/kg), remifentanil (0.03-0.1 µg/kg/min), propofol (0.5 mg/kg before incision, additional 20 mg as needed) and oxygen (5 L/min) via nasal prong with capnogram. ABGA was performed immediately after bullectomy or the patient's saturation dropped to less than 90%. Results: The duration of anesthesia and operation time were 60.0 (55.0, 63.8) min and 35.0 (30.0, 37.3) min. Doses of midazolam, propofol and remifentanil were 5.0 (5.0, 10.0) mg, 90.0 (70.0, 120.0) mg and 0.2 (0.2, 0.3) mg, respectively. PaO2 and PaCO2 during the operation were 108.8 (81.6, 190.2) mmHg and 57.9 (52.9, 62.8) mmHg. MAC provided adequate sedation and analgesia for VATs except for one case converted to general anesthesia for severe adhesions. Flumazenil was used in 7 patients (38.8%) in the anesthesia recovery phase. Conclusions: MAC can be a good alternative to general anesthesia in patients undergoing VATs for the treatment of primary pneumothorax.