Anesthesia for Non-intubated Thoracic Surgery

  • Peter Slinger


Initial attempts at anesthesia for thoracic surgery in the late 1800s were all made with non-intubated patients breathing air-ether spontaneously through a mask. The lung collapse and pendelluft effect (see Chap.  1) when the surgeon opened the chest led to hypoxemia, hypercapnia, and hemodynamic instability [1]. The first major advance in thoracic anesthesia came in the first decade of 1900 when Sauerbruch developed the negative pressure chamber for thoracic anesthesia (see Fig. 25.1) [2]. Non-intubated patients continued to breathe air-ether spontaneously, but the negative pressure in the chamber (which excluded the patients head) prevented the lung in the open hemithorax from collapsing. However, this technique did not deal well with the problem of secretions. This was a major drawback since most of the chest surgery in the early part of the past century was for infectious causes.


Anesthesia Non-intubated Thoracic Surgery VATS Chest wall Sedation 

Supplementary material


  1. 1.
    Mushin W, Rendell-baker L. The origins of Thoracic Anesthesia: Wood Library of Anesthesiology. Chicago, IL. 1953.Google Scholar
  2. 2.
    Sauerbruch F. Investigations concerning ventilation during lung surgery. Mitt Grenzgeb Med Chir. 1904;13:399.Google Scholar
  3. 3.
    Shields H. Spinal anesthesia for thoracic surgery. Anesth Analg. 1935;14:193.Google Scholar
  4. 4.
    Williams A, Kay J. Thoracic epidural anesthesia for thoracoscopy, rib resection and thoracotomy. Anesthesiology. 2000;92:1482–4.CrossRefGoogle Scholar
  5. 5.
    Sunaga H, Blasberg J, Heerdt P. Anesthesia for non-intubated video-assisted thoracic surgery. Curr Opin Anaesthesiol. 2017;30:1–6.PubMedGoogle Scholar
  6. 6.
    Katlic M, Facktor M. Video-assisted thoracic surgery utilizing local anesthesia and sedation: 384 consecutive cases. Ann Thorac Surg. 2010;90:240–5.CrossRefGoogle Scholar
  7. 7.
    Deng H-Y, Zhu Z-J, et al. Non-intubated video-assisted thoracoscopic surgery under loco-regional anesthesia for thoracic surgery: a meta-analysis. Interact Cardiovasc Thorac Surg. 2016;23:31–40.CrossRefGoogle Scholar
  8. 8.
    Lu Y-F, Hung M-H, Hsu H-H, et al. Non-intubated thoracoscopic segmentectomy for second primary lung cancer in a patient with previous contra-lateral lobectomy and emphysematous bullae. J Cardiothorac Vasc Anesth. 2016;30:1639–40.CrossRefGoogle Scholar
  9. 9.
    Iwata Y, Hamai Y, Koyama T. Anesthetic management of non-intubated video-assisted thoracoscopic surgery using epidural anesthesia and dexmedetomidine in three patients with severe respiratory dysfunction. J Anesth. 2016;30:324–7.CrossRefGoogle Scholar
  10. 10.
    Chen K, Chen Y, Hung M, et al. Nonintubated thoracoscopic surgery for lung cancer using epidural anesthesia and intercostal blockade. J Thorac Dis. 2012;4:347–51.PubMedPubMedCentralGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of AnesthesiaToronto General HospitalTorontoCanada

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