Nonintubated Anesthesia in Video-assisted Thoracoscopic Surgery

The standard anesthesia method in intubated patients during thoracoscopic surgery is one-lung ventilation (OLV). Accumulated experience in video-assisted thoracoscopic surgery (VATS) has remarkably advanced minimally invasive techniques in thoracic surgeries, a progress that has prompted anesthesiologists to pursue different and alternative methods. The desire to avoid possible general anesthesia side effects, such as intubation-related airway trauma, mechanical ventilation-induced lung damage, residual neuromuscular blockade, and postoperative nausea and vomiting, has led to the introduction of nonintubated anesthesia techniques as an alternative anesthesia method in thoracic surgery. Nonintubated techniques are established to preserve the patient’s spontaneous breathing during iatrogenic pneumothorax created by the surgeon during VATS and the atelectasis on the side to be operated on, providing sufficient surgical field of view and allowing successful completion of the surgery. Although this does not compete with continuing traditional thoracic anesthesia, in the future, nonintubated techniques will gain greater acceptance for VATS with appropriate patient selection and increased experience. This article reviews nonintubated anesthesia techniques used in VATS, including their advantages, disadvantages, appropriate patient selection, and complications.