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A1766 - The Nuss Procedure Under Non-Endotracheal Intubated Anesthesia Compared with Conventional Anesthetic Option: A Randomized Control Study
Author Block: X. Du1, G. Chen2, J. Cui3, L. Xie2, X. Ben2, J. Tang2, D. Zhang2, X. Ye2, Z. Zhou2, D. Tian2, R. Shi2, S. Mao3, Y. Zheng3, J. Ma3, H. Zhou2; 1department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang, China, 2department of Thoracic Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China, 3department of Anesthesia, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Rationale: Previously, general anesthesia using an endotracheal tube with muscle relaxation was the standard for the Nuss procedure. However, endotracheal intubated anesthia is associated with many intubation-related adverse events. The purposes of this study were to evaluate the feasibility, safety, and advantages of the Nuss procedure under non-endotracheal intubated anesthesia, by comparing with conventional approaches. Methods: Between October 2015 and September 2016 in Guangdong General Hospital, 64 selected patients with pectus excavatum were randomly assigned into the laryngeal mask airway group and endotracheal tube group. In the laryngeal mask airway group, patients received the Nuss procedure under non-endotracheal intubated anesthesia with a laryngeal mask airway. While, in the endotracheal tube group, patients received it under endotracheal intubated anesthesia with a single lumen endotracheal tube. The clinical data was collected and analyzed. Results: The baselines of the demographic data of the two groups were comparable. All of the 64 patients were successfully corrected by the Nuss procedure without requiring conversion to an open surgery. Neither gastro-esophageal reflux nor in-hospital mortality occurred in either group. Three patients in the laryngeal mask airway group required conversion to an endotracheal tube. The differences of surgical and anesthetic feasibility between the two groups were both not significant (P>0.05). In the laryngeal mask airway group, the corrected outcomes were excellent in 29 patients and good in 3 patients. By contrast, in the endotracheal tube group, there were 30 patients with excellent outcomes and 2 with good (P=1.00). The hemodynamics throughout the surgery in both groups were similar and maintained stable. The differences of the high-sensitive C reactive protein levels and postoperative pain scores between the two groups were not significant, either. Conclusions: The Nuss procedure can be effectively and safely performed under either non-endotracheal intubated anesthesia with a laryngeal mask airway or endotracheal intubated anesthesia with an endotracheal tube, and could not be interfered by the two different anesthetic approaches. Both approaches can get the same corrected outcomes. The surgeon and anesthesiologist can choose either according to their own experience and the specific situation of the patient. Keywords: pectus excavatum; Nuss; Laryngeal mask airway; non-endotracheal tube; endotracheal tube