Non-intubation General Anesthesia In Thoracoscopic Surgery

Background and Objective: Compared with endotracheal intubation,the outstanding advantage of LM is the elimination of mechanical invasion to the trachea and larynx.Laryngeal and trachea are not only channels for gas conversion,but also have functions such as pronunciation,vocal cord movement,prevention of foreign body intrusion,and maintenance of functional residual capacity.Tracheal ciliary movement has airway self-purification function.Tracheal intubation can temporarily impede these functions.The patient is also reluctant to accept.The physicality of the tracheal tube and its cuff can hinder tracheal cilia movement and impede drainage.The sputum is easy to store around the catheter tip and inside the catheter.Intraoperative compression of the tracheal mucosa due to cuffs and catheters.Postoperative can also cause temporary tracheal mucociliary dyskinesia.Sputum stays in the trachea.Patients with thoracic surgery often have difficulty in coughing due to advanced age and incision pain,decreased physical strength and other reasons.Unfavorable dysentery,followed by complications such as atelectasis and pulmonary infection.Not conducive to postoperative management.Tracheal intubation can also cause laryngeal edema,vocal cord injury,recurrent laryngeal nerve palsy and other functional disorders.In this study,we reviewed the non-intubated general anesthesia thoracoscopic surgery in our hospital for the past 5 years,and analyzed the clinical indicators of the intraoperative conditions,postoperative recovery,etc.to evaluate the feasibility and safety of this technique.Methods: A total of 31 non-intubated patients underwent thoracoscopic surgery in our hospital from June 2012 to June 2017 were selected as the observation group.At the same time,the same group of surgeons and anesthesiologists were selected to perform tracheal intubation anesthesia for thoracoscopic surgery.31 cases were used as control group.The evaluation index was divided into two parts: intraoperative and postoperative.Intraoperative evaluation indicators included surgical field exposure scores,anesthetic effect scores,intraoperative blood loss(ml),surgery,and anesthesia.Postoperative evaluation indicators included questioning when the patient started eating,when he started to work,and when he was hospitalized.WBC,NEU% changes before and after surgery,with or without gastrointestinal symptoms,sore throat,hoarseness,postoperative eating time,postoperative complications,postoperative thoracic fluid drainage,postoperative chest tube indwelling time were compared and analyzed.Results: Compared with the control group,the experimental group had obvious advantages in postoperative fasting time,postoperative thoracic fluid drainage,and postoperative hospital stay(P<0.05).The postoperative recovery was significantly faster than that of the control group;the intraoperative blood loss and operation time The postoperative complications and the number of lymph node dissections were not significantly different from those in the control group(P>0.05).Conclusion: Patients with selected thoracic surgical diseases are safe and feasible under thoracoscopic lung cancer surgery with spontaneous respiratory anesthesia,and they also have certain advantages in accelerating recovery.