Video –assisted thoracoscopic surgery (VATS) has become common and globally accepted surgical approach for a variety of thoracis diseases. Conventionally, it is performed under tracheal intubation with double lumen tube or bronchial blocker to achieve single lung ventilation. Nonintubated video-assisted thoracoscopic surgery (VATS) has been reported to be safe and feasible for patients with various thoracic diseases, including those who have respiratory dysfunction. VATS without tracheal intubation is safe in a series of VATS procedures, including management of pneumothorax, wedge resection of pulmonary tumors, excision of mediastinal tumors, lung volume reduction surgery, segmentectomy and lobectomy. Patiens undergoing nonintubated VATS are anesthetized using regional anesthesia in a spontaneously single lung breathing status after iatrogenic open pneumothorax. Therefore, we need to minimize the patients physical and psyichological discomfort by using sedation or intrathoracic vagal blockade on the surgical side, if analgesia and sedation are inadequate, conversion to intubated general anesthesia may be required. The early outcomes of nonintubated VATS include faster postoperative recovery and less complication rate comparing with its counterpart of intubated general anesthesia.

Key words: Nonintubated video-assisted thoracoscopic  surgery (VATS), regional anesthesia, lung cancer, analgesia and sedation

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