Non-intubated video-assisted thoracoscopic McKeown oesophagectomy using i-gel™ and continuous pressure support ventilation: A case report.

Abstract

Abstract: Non-intubated video-assisted thoracoscopic surgery (NIVATS) minimises airway trauma and ventilator-induced lung injury, yet its application in complex, multi-phase McKeown oesophagectomy is seldom reported. A 32-year-old female (40 kg, 140 cm and body mass index: 20.4 kg/m 2 ) presented for McKeown minimally invasive oesophagectomy following neoadjuvant chemoradiotherapy. We employed a 'less invasive anaesthesia' strategy combining T9-T10 thoracic epidural analgesia with Bispectral Index-guided target-controlled propofol infusion. Continuous pressure support ventilation (16 cmH 2 O above a positive end-expiratory pressure of 5 cmH 2 O) with preserved spontaneous breathing was maintained via a size 3 i-gel™ throughout surgery; neuromuscular blockade and controlled mechanical ventilation were not used at any stage. Surgical exposure was optimised via right-sided capnothorax. The resulting permissive hypercapnia was haemodynamically well-tolerated. Recovery was uneventful, and the airway device was removed after protective airway reflexes had returned. She was discharged from the hospital on post-operative day 6 without any complications. NIVATS for McKeown oesophagectomy may be feasible in carefully selected patients.