Evaluation of the Awake Thoracic Epidural in Vedio-Assissted Thoracoscopic Surgery Regarding Maintainance of Pre-Operative and Post-Operative Haemodynamics and Pulmonary Homeostasis

Background: This study evaluated the ability to maintain normal intra-operative and post-operative haemodynamics and pulmonary homeostasis in awake thoracic surgery under Thoracic Epidural Anesthesia (TEA) vs. a traditional thoracic surgery under General Aneasthesia (GA).Methods: Thirty patients scheduled for thoracic surgery were randomly assigned to receive either sole TEA at any level between T4-T6 with sedation (awake group [AG], n=15) or receive GA with One Lung Ventilation (OLV) and thoracic epidural analgesia (Control Group [CG], n=15). Evaluated variables included perioperative arterial oxygen tension to fraction of inspired oxygen (PaO2/FiO2), arterial carbon dioxide tension (PaCO2), Heart Rate (HR) and Mean Arterial Pressure (MAP). Anesthesia, and total operating room times were recorded.Results: The study groups were comparable as regards technical feasibility, anesthesia satisfaction, PaO2/FiO2 and PaCO2. The operating room workflow was better in the AG group when compared with the CG [anesthesia time, 14 (3) vs. 33 (6) min, p 0.001; global operating room time 59 (15) vs 89 (2 1) min, p 0.001, respectively; time to Aldrete score 8, 21 (13) min in CG]. The ICU stay was 18 (5.3) h in the AG vs 29 (11) h in the CG, p=0.002). The anesthetic costs were significantly reduced in the AG (L.E. 213 (33) vs. L.E. 709 (25) in CG, p 0.001).Conclusions: Awake thoracic surgery under TEA in highly selected patients and procedures is safe, satisfactory, and technically feasible, with less cost, shorter global operating room time than the same procedures performed under GA.