| BackgroundPectus excavatum(PE)is the most common congenital chest wall deformity,which comprises approximately 90%of all chest wall deformities.The optimal treatment for PE is surgical correction.And the NUSS procedure under endotracheal intubated general anesthesia is the main treatment for PE at home and abroad now.The non-endotracheal intubated anesthetic has been verified to be less invasive and with less postoperative complicatinos,and therefore being used in thoracic surgery increasingly.Objective(1)To determine the safety and feasibility of thoracoscopic Nuss procedureunder non-endotracheal intubated anesthesia with laryngeal mask airway(LMA);(2)To compare the early outcomes of thoracoscopic Nuss procedure between under LMA for non-endotracheal intubated anesthesia and under endotracheal intubatied general anesthesia.MethodsBetween July 2015 and December 2015,30 selected patients with PE were planned to undergo thoracoscopic Nuss procedure using LMA for non-endotracheal intubated anesthesia.The clinical data were collected and analyzed to evaluate the safety and feasibility of this technique.Between October 2015 and September 2016,64 selected patients with PE were randomly allocated into two groups(LMA or ETT).In the LMA group,patients were planned to undergo a thoracoscopic Nuss procedure using LMA for non-endotracheal intubated anesthesia.While in the ETT group,patients were planned to undergo a thoracoscopic Nuss procedure using endotracheal tube for endotracheal intubated anesthesia.The clinical data were collected and analyzed to compare the early outcomes of thoracoscopic Nuss procedure between under LMA for non-endotracheal intubated anesthesia and under endotracheal intubatied anesthesia.ResultsAll of the 30 patients were successfully corrected with NUSS procedure and without requiring conversion to an open surgery.The operative length was 79.96±45.37 minutes,the blood loss was 8.13±9.30 ml,and the postoperative hospital stay was 4.13±1.30 days.The intraoperative hemodynamics were remained stable throughout the procedure in all cases.Two patients experienced postoperative nausea and one reported a sore throat.The mean postoperative pain score was 3.5±1.1 at the first day,and alleviated gradually.Neither gastro-esophageal reflux nor in-hospital mortality occurred.There were no significant differences between the LMA group and the ETT group at the all aspects of the age,sex,Haller index,the smooth level of anesthesia and surgery,numbers of inserted bars,operative length,blood loss,postoperative complications,hospital stays,corrective outcomes,intraoperative hemodynamics and high-sensitive C-reactive protein,and the postoperative pain scores.All patients were successfully corrected with NUSS procedure and without requiring conversion to an open surgery.Neither gastro-esophageal reflux nor in-hospital mortality occurred in the two groups.No displacement of the airway devices happened either in the two groups.ConclusionThe NUSS procedure can be safely and effectively carried out under the non-endotracheal intubated anesthesia with LMA.The NUSS procedure can be safely and effectively carried out either under the non-endotracheal intubated anesthesia with LMA or under the endotracheal intubated anesthesia with ETT.The surgical team,which include surgeons and anesthetists,can choose either of the two options depending on their experience and the specific conditions of the patiants. |
