Four-step local anesthesia and sedation for thoracoscopic diagnosis and management of pleural diseases

Study objectives: Most thoracic surgeons perform thoracoscopy under general anesthesia using a double-lumen endotracheal tube. We describe our own technique for performing thoracoscopy under local anesthesia and sedation. Design, setting, patients: Forty-five patients underwent the procedure under local anesthesia and sedation (mean age, 64 years; age range, 40 to 92 years). A known history of cancer was present in 12 patients. American Society of Anesthesiology score was I in 1 patient, II in 16 patients, III in 22 patients, IV in 5 patients, and V in 1 patient. Premedication was comprised of droperidol, 5 mg, and atropine, 0.5 mg, administered 20 min before the scheduled operating room time. Sedation was maintained by diazepam injection, 3 mg. Four-step local anesthesia in the planned intercostal space using 10 mL of ropivacaine, 7.5 mg/mL, was performed. Results: Mean operative time was 45.7 min (range, 20 to 90 min); mean time of anesthesia was 71.3 min (range, 30 to 150 min). Among patients with pleural effusion, 23 effusions were simple and 16 effusions were complex. Talc was administrated in 28 patients. Complications were intraoperative bleeding (one patient), hyperpyrexia (eight patients), and atrial fibrillation (two patients). The mean time for removal of the chest drain was 5.6 days (range, 2 to 13 days). Postoperative hospital stay was 6.4 days (range, 2 to 14 days). No hospital mortality occurred. Follow-up is complete in all patients (mean, 92.8 days; range, 31 to 270 days). Conclusion: Four-step local anesthesia and sedation is a simple and effective method of performing a video-assisted thoracic procedure to diagnose and treat simple thoracic pathologies.