Awake nonresectional lung volume reduction surgery

OBJECTIVE: To assess the feasibility, safety, and early results of awake lung volume reduction surgery (LVRS) performed under thoracic epidural anesthesia by a new nonresectional technique. SUMMARY BACKGROUND DATA: So far, resectional LVRS under general anesthesia and one-lung ventilation is the more frequently used technique, but procedure-related morbidity has been considerable. METHODS: The study cohort included 12 patients undergoing unilateral awake LVRS. Evaluated parameters included technical feasibility and anesthesia satisfaction scored into 4 grades (from 1 = poor to 4 = excellent), global operating room time, and arterial carbon dioxide tension (PaCO2). In addition, 6-month changes in outcome measures, including forced expiratory volume in 1 second (FEV1), residual volume (RV), 6-minute walking test (SMWT), and dyspnea index were recorded. Perioperative and 6-month results were comparable with those of a control group undergoing unilateral resectional LVRS. RESULTS: Technical feasibility was excellent to satisfactory in 11 patients. One patient required conversion to one-lung ventilation. Differences between the awake and control group included global operating room time (90 +/- 17 minutes versus 145 +/- 19 minutes, P < 0.00001); PaCO2 24 hours after surgery (45 +/- 6 mm Hg versus 49 +/- 6 mm Hg, P = 0.02); and hospital stay (7.8 +/- 5 days versus 11.7 +/- 4 days, P = 0.02). Significant (P < 0.002) improvements occurred at 6 months in FEV1 (0.31 +/- 0.17 L), RV (-1.41 +/- 0.7 L), SMWT (73 +/- 25 m), and dyspnea index (-1.3 +/- 0.5) and were comparable with those of the control group. CONCLUSIONS: In this study, awake nonresectional LVRS proved feasible and safe. This new modality was associated with a faster recovery and satisfactory 6-month outcome, which did not differ from that of resectional LVRS.