Effect of non-intubated anesthesia video-assisted thoracoscopic surgery on postoperative diaphragm function and pulmonary complications in patients undergoing lung surgery: a randomized clinical trial

BACKGROUND: Postoperative diaphragmatic dysfunction (PDD) and pulmonary complications (PPCs) are common complications in patients undergoing video-assisted thoracoscopic (VATS) lung surgery. There is increasing evidence for the safety and advantages of nonintubated anesthesia in VATS lung surgery. It remains, however, to be demonstrated whether nonintubated anesthesia in these patients improved PDD and PPCs. METHODS: Between 9 October 2022 and 26 November 2023, 160 patients scheduled for VATS lung surgery were enrolled and randomly allocated to nonintubated anesthesia (NIVATS) group or intubated anesthesia (IVATS) group. The primary outcome was the incidence of PDD at 24 h postoperatively, defined as a diaphragmatic excursion less than 10 mm evaluated by ultrasound. The occurrence of PPCs was assessed up to 7 days after surgery. RESULTS: The incidence of PDD at 24 h postoperatively was significantly lower in the NIVATS group [28 of 80, (35.0%)] than in the IVATS group [46 of 80 (57.5%); relative risk (95% confidence interval), 0.61 (0.43-0.87); P < 0.001]. The rate of PPCs within 7 days after surgery was significantly lower in the NIVATS group [14 of 80 (17.5%)] than in the IVATS group [27 of 80 (33.8%); relative risk (95% confidence interval), 0.52 (0.29-0.91); P = 0.019]. CONCLUSIONS: Nonintubated anesthesia reduced the incidence of PDD and PPCs for patients undergoing VATS lung surgery. These findings indicated that NIVATS offers more benefits and may be a superior option compared to IVATS for selected patients.