Die nicht intubierte videoassistierte thorakoskopische Chirurgie (NiVATS) gewinnt
zunehmend an Bedeutung. Unter den richtigen Voraussetzungen ermöglicht sie auch Patienten
mit relevantem
Risiko für eine Allgemeinanästhesie eine sichere operative Versorgung intrathorakaler
Pathologien. Der Beitrag stellt die potenziellen Vor- und Nachteile vor und beschreibt
das Vorgehen in
der Praxis.
Abstract
Non-intubated thoracic surgery is currently gaining popularity. In select patients
and in experienced centres, non-intubated approaches may enable patients to safely
undergo thoracic
surgical procedures, who would otherwise be considered at high risk from general anaesthesia.
While non-intubated techniques have been widely adopted for minor surgical procedures,
its role
in major thoracic surgery is a topic of controversial debate.
This article discusses disadvantages of intubated anaesthetic approaches and advantages
of non-intubated thoracic surgery as well as the anaesthetic management. This includes
surgical and
anaesthetic criteria for patient selection, suitable regional anaesthetic techniques,
concepts for sedation and maintenance of airway patency as well as the management
of perioperative
complications.
Non-intubated thoracic surgery has the potential to reduce postoperative morbidity
and hospital length of stay. Successful non-intubated management depends on a standardised
and
well-trained interdisciplinary approach, especially regarding patient selection and
perioperative complications.
Schlüsselwörter
Thoraxanästhesie - nichtintubierte VATS - Atemwegsmanagement - Spontanatmung - Regionalanästhesie
Keywords
thoracic anaesthesia - non-intubated - airway management - spontaneous breathing -
regional anaesthesia
