To describe the reproducible surgical and anesthesia techniques of lung volume reduction surgery (LVRS) under non-intubation. In addition, the advantages of modified non-intubated unilateral LVRS are also introduced in this article.
The perioperative complications and unsatisfied mortality of the typical LVRS under general anesthesia hinder the popularity of the surgery. In recent years, the concept of non-intubation has been introduced to LVRS. However, the reports and researches in this field are not so common.
We searched current literature related to LVRS and non-intubated LVRS of recent 20 years in PubMed and compared different resection ranges and methods of LVRS under non-intubation.
Our group reviewed the current papers in this field and found that the poor lung quality (and cardiac function in some cases) of the target patient is not the absolute contradiction to adopting the non-intubation anesthesia technique in LVRS. On the contrary, the non-intubated LVRS may be even safer and bring more benefits than the traditional operation method among selected patients. Furthermore, the modified non-intubated unilateral LVRS can reduce perioperative complications by comparing to the traditional bilateral LVRS. The LVRS on the opposite side is unnecessary if no significant progression is found by regular follow-up. In summary, the surgical team can make an attempt to non-intubation in LVRS after thorough evaluation.