Non-intubated anesthesia in patients undergoing video-assisted thoracoscopic surgery: A systematic review and meta-analysis


Autoři: Mei-gang Yu aff001;  Ren Jing aff001;  Yi-jie Mo aff003;  Fei Lin aff001;  Xue-ke Du aff001;  Wan-yun Ge aff001;  Hui-jun Dai aff001;  Zhao-kun Hu aff001;  Sui-sui Zhang aff001;  Ling-hui Pan aff001
Působiště autorů: Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China aff001;  The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China aff002;  Department of Anesthesiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224737

Souhrn

Introduction

Non-intubated anesthesia (NIA) has been proposed for video-assisted thoracoscopic surgery (VATS), although how the benefit-to-risk of NIA compares to that of intubated general anesthesia (IGA) for certain types of patients remains unclear. Therefore, the aim of the present meta-analysis was to understand whether NIA or IGA may be more beneficial for patients undergoing VATS.

Methods

A systematic search of Cochrane Library, Pubmed and Embase databases from 1968 to April 2019 was performed using predefined criteria. Studies comparing the effects of NIA or IGA for adult VATS patients were considered. The primary outcome measure was hospital stay. Pooled data were meta-analyzed using a random-effects model to determine the standard mean difference (SMD) with 95% confidence intervals (CI).

Results and discussion

Twenty-eight studies with 2929 patients were included. The median age of participants was 56.8 years (range 21.9–76.4) and 1802 (61.5%) were male. Compared to IGA, NIA was associated with shorter hospital stay (SMD -0.57 days, 95%CI -0.78 to -0.36), lower estimated cost for hospitalization (SMD -2.83 US, 95% CI -4.33 to -1.34), shorter chest tube duration (SMD -0.32 days, 95% CI -0.47 to -0.17), and shorter postoperative fasting time (SMD, -2.76 days; 95% CI -2.98 to -2.54). NIA patients showed higher levels of total lymphocytes and natural killer cells and higher T helper/T suppressor cell ratio, but lower levels of interleukin (IL)-6, IL-8 and C-reactive protein (CRP). Moreover, NIA patients showed lower levels of fibrinogen, cortisol, procalcitonin and epinephrine.

Conclusions

NIA enhances the recovery from VATS through attenuation of stress and inflammatory responses and stimulation of cellular immune function.

Klíčová slova:

Anesthesia – Cellular stress responses – General anesthesia – Hospitals – Immune response – Inflammation – Surgical and invasive medical procedures


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Článek vyšel v časopise

PLOS One


2019 Číslo 11