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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 12  |  Issue : 8  |  Page : 277-280

Single-lumen tracheal ventilation for minimally invasive esophagectomy in patients with esophageal cancer


Department of Anesthesiology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China

Date of Web Publication22-Feb-2017

Correspondence Address:
Xi Hua Lu
Department of Anesthesiology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.200757

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 > Abstract 

Objective: The aim of this study was to observe the efficacy and safety of single-lumen tracheal ventilation for esophageal cancer surgery.
Methods: Thirty-eight patients with esophageal carcinoma who prepared for minimally invasive esophagectomy were included in this study. All of the included 38 patients were received single-lumen tracheal ventilation. The arterial blood gas index was monitored through the operation procedure and recorded at four-time points: before induction (T0), at the end of chest operation (T1), at the end of the abdominal operation (T2), and 30 min after extubation (T3). The heart rate (HR) and blood pressure (BP) were also monitored and recorded during the period of PetCO2 >50 mmHg. The agitation incidence rate was also recorded in awakening period.
Results: All the included 38 patients were successfully completed the operation without conversing to open thoracotomy or open laparotomy. The artificial pneumothorax time, artificial pneumoperitoneum time, and operation time were 136.6 ± 26.2 min, 104.4 ± 21.3 min, and 306.7 ± 42.0 min, respectively. The patients' BP and HR was slight elevated but within the normal range (HR <100 breaths/min and BP <140/90 mmHg) when the PetCO2 >50 mmHg. Arterial blood gas results showed that PaCO2 significantly increased in time point of T1, T2, and T3 compared to T0 (P < 0.05); PaO2 significantly increased in time point of T1 and T2 compared to T0 (P < 0.05); HR significantly increased during the operation procedure of the time points T1 (P < 0.05). Of the included 38 patients, 8 were observed preoperative blood gas PaO2 <80 mmHg and the patients had decreased PaO2 in the time point T3 compared to other 30 normal preoperative PaO2 patients. Electrocardiogram monitoring showed that all patients do not appear arrhythmia and myocardial ischemia in the process of surgery. Two of 38 patients were found of mild agitated during waking period.
Conclusion: Single-lumen tracheal ventilation for esophageal cancer surgery is safe and can provide acceptable anesthesia effect.

Keywords: Anesthesia effect, blood gas analysis, esophageal cancer, single-lumen tracheal ventilation


How to cite this article:
Bai Y, Zhou Y, Lu XH. Single-lumen tracheal ventilation for minimally invasive esophagectomy in patients with esophageal cancer. J Can Res Ther 2016;12:277-80

How to cite this URL:
Bai Y, Zhou Y, Lu XH. Single-lumen tracheal ventilation for minimally invasive esophagectomy in patients with esophageal cancer. J Can Res Ther [serial online] 2016 [cited 2017 Nov 23];12:277-80. Available from: http://www.cancerjournal.net/text.asp?2016/12/8/277/200757


 > Introduction Top


Under the current technology, minimally invasive esophagectomy is widely used clinically.[1] The operation of thoracoscopic surgery can be used with double-lumen endobronchial intubation for single-lung ventilation or single-lumen tracheal ventilation airway management style. We know that double-lumen cannula diameter is large with high hardness which can damage the glottis and pharyngeal tissue and further lead to hoarse voice and throat pain.[2] Moreover, the successful intubation rate is relatively low. However, for single-lumen endotracheal tube, the successful intubation is high with easy positioning.[3] The single-lumen tracheal ventilation for esophageal cancer surgery was rarely reported.[4] In this prospective, single-arm clinical study, we have discussed the efficacy and safety of single-lumen tracheal ventilation for esophageal cancer surgery.


 > Methods Top


Patients selection

Thirty-eight patients with esophageal carcinoma underwent minimally invasive esophagectomy (chest abdominal operations are completed under the artificial pneumothorax) were recruited in Henan Cancer Hospital from February to July 2016. Of the included 38 patients, there are 25 male and 13 female patients with the average age of 61.2 ± 7.3 (range: 46–73) years and average weight of 61.4 ± 6.1 (50–80) kg. The patients' inclusion criteria were (1) patients with diagnosis of esophageal cancer with pathology or cytology confirmation, (2) prepared for thoracoscopic surgery, (3) patients and their families signed informed consent, and (4) without operation contraindication after evaluation; exclusion criteria were (1) patients prepared for open thoracic surgery, (2) with remote metastasis lesions such as brain metastases, and (3) with operation contraindication such as heart failure and blood coagulation dysfunction.

Anesthetic techniques

Before 6–8 h of surgery, patients were forbidden of eating and drinking. After entering the operation room, patients were given electrocardiograph (ECG) monitoring to monitor the heart rate (HR), respiratory rate, and blood pressure (BP). The patients were given internal jugular vein puncture for intravenous infusion channel and radial artery catheter for invasive BP monitor. General anesthesia was induced with propofol (2 mg/kg), sufentanil (0.4 µg/kg), and cisatracurium (2 mg/kg) to facilitate intubation. A 7–7.5 single-lumen endotracheal tube was inserted through the mouth, distance of incisors depth of 21–23 cm. Patients were intubated soon after they lost consciousness and given inhaled sevoflurane or propofol intravenous for maintaining anesthesia.[5] 0.4 µg/kg intravenous sufentanil, intermittent intravenous cisatracurium, and sufentanil were given to maintain muscle relaxant and analgesia before incision. Patients were ventilated at a tidal volume of 5 ml/kg and respiratory rate of 16 breaths per minute (bpm). The inspiratory-to-expiratory rate was fixed at 1:1.5 during artificial pneumothorax and artificial pneumoperitoneum process. The artificial CO2 pressure was 12 mmHg. The capacity control model of ventilation was used in the operation procedure.

Observation indexes

The arterial blood gas indices such as HR, PaO2, PaCO2, and SpO2 were recorded before induction (T0), at the end of the chest operation (T1), at the end of the abdominal operation (T2), and 30 min after extubation (T3) time points. Moreover, the anesthesia complications such as arrhythmia, myocardial ischemia, and agitation were also recorded during the operation.

Statistical analysis

All the data were analyzed using Stata11.0 software (Stata Corporation, College Station, TX, USA). The measurement data were expressed by x̄ ± s and analyzed by Student's t-test. P <0.05 was considered statistically significant.


 > Results Top


Operation time

All the included 38 patients were successfully completed the operation without conversing to open thoracotomy or open laparotomy procedure. The artificial pneumothorax time, artificial pneumoperitoneum time, and operation time were 136.6 ± 26.2 min, 104.4 ± 21.3 min, and 306.7 ± 42.0 min, respectively.

Arterial blood gas analysis

The patients' BP and HR were slightly elevated but within the normal range (HR <100 bpm, BP <140/90 mmHg) when the PetCO2 >50 mmHg. Arterial blood gas results showed that PaCO2 significantly increased in time point of T1, T2, and T3 compared to T0 (P < 0.05); PaO2 significantly increased in time point of T1 and T2 compared to T0 (P < 0.05); HR significantly increased during the operation procedure of the time points T1 (P < 0.05) [Table 1]. Of the included 38 patients, 8 were observed preoperative blood gas PaO2 <80 mmHg and the patients had decreased PaO2 in the time point T3 compared to other 30 normal preoperative PaO2 patients [Figure 1].
Table 1: The arterial blood gas analysis for the included 38 patients

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Figure 1: The arterial blood gas analysis for the eight cases with abnormal preoperative PaO2

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Anesthesia complications

ECG monitoring showed that all patients did not appear arrhythmia and myocardial ischemia in the process of operation. Two of 38 patients were found of mild agitated during waking period.


 > Discussion Top


Esophageal cancer is one of the most diagnosed cancer worldwide. And because of its poor prognosis, it is the sixth most common cause of cancer-related death.[6],[7] It caused about 400,000 deaths in 2012, accounting for about 5% of all cancer deaths (about 456,000 new cases were diagnosed, representing about 3% of all cancers).[8] For early-stage patients, the operation is recommended and the prognosis is relatively well.[9] However, for advanced-stage patients or metastasis disease, the systematic chemoradiation is generally applied.[10]

In recent years, with the development of surgery technique, the minimally invasive thoracic surgery has been significant improved.[11],[12],[13] In our hospital, most of the patients with esophageal cancer were treated with video-assisted thoracic surgery for esophagectomy. The prognosis and long-term survival was relatively well.[1]

In the present study, we discussed the efficacy and safety of single-lumen tracheal ventilation for video-assisted esophageal cancer surgery. We prospectively included 38 esophageal cancer patients who were prepared for video-assisted esophagectomy. The 38 cases were received single-lumen tracheal ventilation. All the 38 cases have successfully completed the operation without conversing to open thoracotomy or open laparotomy procedure. The video-assisted esophagectomy through single-lumen tracheal ventilation was relatively safe. The artificial pneumothorax time, artificial pneumoperitoneum time, and operation time were 136.6 ± 26.2 min, 104.4 ± 21.3 min, and 306.7 ± 42.0 min, respectively. The operation time was a little bit longer compared to traditional open thoracic surgery for esophagectomy. During the operation, patients' BP and HR was slightly elevated but within the normal range (HR <100 bpm, BP <140/90 mmHg) when the PetCO2 >50 mmHg. This means that the hemodynamics of the patients were not seriously affected. Moreover, the arterial blood gas results showed that PaCO2, PaO2, and SpO2 significantly increased in time point of T1, T2, and T3 compared to T0 (P < 0.05); HR significantly increased during the operation procedure of the time points T1 and T2 (P < 0.05). Of the included 38 patients, 8 cases were observed preoperative blood gas PaO2 <80 mmHg and the patients has decreased PaO2 in the time point T3 compared to other 30 normal preoperative PaO2 patients. The above results indicated that the single-lumen tracheal ventilation can provide enough oxygen saturation during the operation. ECG monitor showed that all patients do not appear arrhythmia and myocardial ischemia in the process of surgery, which demonstrated that single-lumen tracheal ventilation was safe with less complications.

The results also showed that PetCO2 gradually increased after 20 min of thoracoscopic operation. PetCO2 is higher as the ventilation time extending, and it tends to be stable within 60 minutes after operation. For cases of PetCO2 up to 80 mmHg, pH is significantly lower at T1, and PaCO2 increases obviously, indicating that small tidal volume fast frequency double-lung ventilation with CO2 pneumothorax can lead to acute hypercapnia. During this period, hemodynamics was relatively stable, and the BP and HR increased but within normal range.

Although high carbonic acid hematic disease will appear during artificial pneumothorax and pneumoperitoneum, PetCO2 and PaCO2 can obviously reduce in half an hour by normal tidal volume ventilation. Intraoperative hemodynamic index can be adjusted to normal range in short period of postoperation and will not affect the patients' regained consciousness. For patients under preoperative PaO2 <80 mmHg (71.5 ± 4 mmHg), the whole process of anesthesia is safe. Therefore, in patients of normal heart and lung function, single-lumen tracheal ventilation is safe under the condition of a certain operation time range. However, the sample size was relatively small with only 38 patients included in this study. Moreover, there was no control group. Hence, well-designed, multicenter, prospective, randomized controlled studies were still needed to further evaluate the efficacy and safety of single-lumen tracheal ventilation for esophageal cancer surgery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

1.
Liu BX, Li Y, Qin JJ. Comparison of thoraco-laparoscopic and open three-field subtotal esophageetomy for esophageal cancer. Chin J Gastrointest Surg 2012;15:938-42.  Back to cited text no. 1
    
2.
Reeb J, Falcoz PE, Santelmo N, Massard G. Double lumen bi-cava cannula for veno-venous extracorporeal membrane oxygenation as bridge to lung transplantation in non-intubated patient. Interact Cardiovasc Thorac Surg 2012;14:125-7.  Back to cited text no. 2
    
3.
Zhang R, Liu S, Sun H, Liu X, Wang Z, Qin J, et al. The application of single-lumen endotracheal tube anaesthesia with artificial pneumothorax in thoracolaparoscopic oesophagectomy. Interact Cardiovasc Thorac Surg 2014;19:308-10.  Back to cited text no. 3
    
4.
Gatell JA, Barst SM, Desiderio DP, Kolker AC, Scher CS. A new technique for replacing an endobronchial double-lumen tube with an endotracheal single-lumen tube. Anesthesiology 1990;73:340-1.  Back to cited text no. 4
    
5.
Wong RY, Fung ST, Jawan B, Chen HJ, Lee JH. Use of a single lumen endotracheal tube and continuous CO2 insufflation in transthoracic endoscopic sympathectomy. Acta Anaesthesiol Sin 1995;33:21-6.  Back to cited text no. 5
    
6.
Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014;64:9-29.  Back to cited text no. 6
    
7.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015;65:5-29.  Back to cited text no. 7
    
8.
Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012;62:10-29.  Back to cited text no. 8
    
9.
Worrell S, De Meester SR. Endoscopic resection and ablation for early-stage esophageal cancer. Thorac Surg Clin 2016;26:173-6.  Back to cited text no. 9
    
10.
Behrens A, Ell C, Lordick F. Perioperative and palliative chemotherapy for esophageal cancer. Viszeralmedizin 2015;31:341-6.  Back to cited text no. 10
    
11.
Sato S, Nagai E, Hazama H, Taki Y, Takahashi M, Kyoden Y, et al. Video-assisted thoracoscopic esophagectomy in the left lateral decubitus position in an esophageal cancer patient with pectus excavatum. Asian J Endosc Surg 2015;8:333-6.  Back to cited text no. 11
    
12.
Wang QY, Tan LJ, Feng MX, Zhang XY, Zhang L, Jiang NQ, et al. Video-assisted mediastinoscopic resection compared with video-assisted thoracoscopic surgery in patients with esophageal cancer. J Thorac Dis 2014;6:663-7.  Back to cited text no. 12
    
13.
Kubo N, Ohira M, Lee T, Sakurai K, Toyokawa T, Tanaka H, et al. Successful resection of esophageal cancer with right aortic arch by video-assisted thoracoscopic surgery: A case report. Anticancer Res 2013;33:1635-40.  Back to cited text no. 13
    


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