Atelectasis, Complication of Ventilation Therapy, Tumor of Lung Parenchyma
Conditions
Keywords
Nonintubated video-assisted thoracic surgery (VATS)
Brief summary
A safe and effective surgical environment is important for nonintubated thoracoscopic surgery. The investigators hypothesize that mini-dose succinylcholine can induce ultra-short period of apnea, by which the ventilatory responses to open pneumothorax were abolished and may facilitate rapid and satisfying collapse of the operated lung during nonintubated thoracoscopic surgery.
Detailed description
Background: Nonintubated thoracoscopic surgery is the frontier of modern minimal invasive thoracic surgery. A safe and effective surgical environment is established via an iatrogenic open pneumothorax producing the operated lung fully collapsed. However, the initial respiratory response to open pneumothorax is both tachypnea and carbon dioxide rebreathing, which would jeopardize the quality of collapse of the operated lung and delay the performance of intrathoracic vagal block. Intravenous opioid is effective to attenuate ventilatory responses but herein with risk of persistent respiratory depression. Methods: The investigators hypothesize that mini-dose succinylcholine 0.15 mg/kg can induce ultra-short period of apnea, by which the ventilatory responses to open pneumothorax were abolished and may facilitate rapid and satisfying collapse of the operated lung during nonintubated thoracoscopic surgery. In a prospective, randomized, double-blind study design, 30 patients will be allocated to receive either succinylcholine (n=15) or placebo (n=15) in the beginning of open pneumothorax. The effectiveness of succinylcholine will be measured by the surgeon's evaluation of the quality of lung collapse, while the safety will be evaluated by determination of arterial blood gases within 20 minutes of one-lung spontaneous breathing. Expected results: Mini-dose succinylcholine can facilitate early lung collapse without jeopardizing the ventilatory function during nonintubated thoracoscopic surgery with one-lung spontaneous breathing, which may make nonintubated thoracoscopic surgery easier and safer.
Interventions
DRUGSuccinylcholine
Giving mini-dose succinylcholine to facilitate lung collapse during nonintubated VATS.
DRUGPlacebo
Giving placebo (normal saline) to facilitate lung collapse during nonintubated VATS.
Sponsors
National Taiwan University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults patients with lung tumors and elective for unilateral thoracoscopic surgery.
Exclusion criteria
* Over weighted, body mass index \> 26 kg/m2. * Previous thoracic surgery on the attempted operative side. * Hypoventilation syndrome requiring positive pressure ventilatory support or oxygen at home. * Relevant systemic disease, including heart failure, liver failure, renal failure with an American Society of Anesthesiologists (ASA) class above 3. * Difficult airway management. * Pregnancy. * Contraindications for succinylcholine, including family history of suspicious malignant hyperthermia, hyperkalemia, or other neuromuscular diseases.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Quality of lung collapse | 20 minutes | Quality of lung collapse will be quantified by the surgeon as score 1-3. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Arterial blood gas analysis | 20 minutes | Arterial partial pressure of carbon dioxide (PaCO2) and oxgen (PaO2) levels after succinylcholine and placebo during one-lung ventilation |
Countries
Taiwan
Contacts
Primary ContactMing-Hui Hung, MD, MSc
Outcome results
None listed