Effects of Nonintubated Versus Intubated General Anesthesia on Recovery After Thoracoscopic Lung Resection

Lung cancer is the leading cause of cancer death in Taiwan and worldwide. With the advancement of thoracoscopic technique, thoracoscopic surgery has emerged as a reasonable option for the management of early-stage non-small cell lung cancer (NSCLC). Additionally, current lung cancer screening policy recruits increasing number of candidates requiring thoracoscopic lung resections because of lung nodules/tumors. Traditionally, intubated general anesthesia with one-lung ventilation using a double-lumen endotracheal tube or an endobronchial blocker has been considered mandatory in thoracoscopic surgery. However, adverse effects of intubated general anesthesia are not negligible. Recently, a nonintubated thoracoscopic technique has developed to reduce the adverse effects of intubated general anesthesia with encouraging results. Nonetheless, the role of nonintubated technique in thoracoscopic lung resection surgery in quality of postoperative recovery in not clear. As an enhanced recovery is the major goal of modern minimally invasive surgery, the investigators hypothesize that nonintubated thoracoscopic technique can facilitate and improve the recovery quality after surgery. To this end, the investigators will recruit 300 patients in subgroups including patients undergoing segmentectomy/lobectomy, wedge resection and geriatric patients in this two-year project. Patients will be randomly allocated in nonintubated and intubated groups and quality of recovery of all patients will be evaluated according the protocol of Postoperative Quality of Recovery Scale. In the meantime, the preoperative and postoperative cytokines will be compared between the groups as well as patients with different recovery scales.

Sex

All

Minimum age

20 Years

Inclusion Criteria:

* Age: older than 20 years old;
* Tumor size less than 6 cm;
* Eligible for unilateral thoracoscopic surgery;
* Preoperative lung function FEV1 \> 60%.

Exclusion Criteria:

* Neurological deficits, including previous stroke, dementia etc.;
* Previous thoracic surgery;
* Suspect invasion of tumor into chest wall, diaphragm, or main bronchus;
* Suspect severe pleural or diaphragmatic adhesions;
* Significant comorbidities with high ASA classification (ASA \> 3), including history of heart failure, liver failure and renal failure;
* Severe obstructive sleep apnea requiring continuous positive airway pressure support or oxygen supplement;
* Difficult airway management;
* Pregnant women.