Clinical application of basic anesthesia combined with local anesthesia in preoperative localization of multiple pulmonary nodules: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIAO Siyang , SUN Yungang , ZHANG Qiang ,  SHAO Feng

Department of Thoracic Surgery, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, P. R. China;

Corresponding author：

SHAO Feng, Email: doctorshao1982@sina.com

Keywords：

Mobile CT; multiple pulmonary nodules; basic anesthesia; locating

DOI：

10.7507/1007-4848.202405033

Video：

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Objective To evaluate the safety and efficacy of basic anesthesia combined with local anesthesia in the preoperative localization of multiple pulmonary nodules. Methods The clinical data of patients who underwent preoperative localization for multiple pulmonary nodules resection under single-port thoracoscopy in Nanjing Brain Hospital from July 2023 to September 2023 were extracted. They were divided into a group A and a group B according to the localization method. The patiens in the group A were localized under local anesthesia, and the patients in the group B were localized with basic anesthesia combined with local anesthesia. The basic clinical characteristics, localization success rate, incidence of localization complications, localization time, and pain score of the two groups were compared and analyzed. Results Finally, we included 200 patients with 100 patients in each group. There were 49 males and 51 females at age of 25-77 (50.94±14.29) years in the group A. There are 45 males and 55 females at age of 24-78 (48.25±14.04) years in the group B.The incidence of localization complications (4% vs. 13%, P=0.04), localization time [(19.90±8.66) min vs. (15.23±5.98) min, P<0.01], and pain score[ (2.01±2.09) vs. (3.29±2.54), P<0.01] in the group B were significantly lower than those in the group A, and the differences were statistically significant. The localization success rate of the group B was significantly higher than that of the group A (98% vs. 92%, P=0.04), and the difference was statistically significant.Conclusion Basic anesthesia combined with local anesthesia for preoperative localization of multiple pulmonary nodules under mobile CT has the advantages of short localization time, fewer localization complications, high safety, high success rate, and high patient comfort, and has certain clinical promotion value.

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11.	Shi LB, Zhang ML, Liu XX, et al. Application of dexmedetomidine based anesthesia combined with local anesthesia in breast reservation operation for stageⅠ breast cancer. Med Philos B, 2016, 37(2): 33-35.
12.	Wu XM, Xue ZG, Ma H, et al. Expert consensus on clinical application of dexmedetomidine (2018). J Clin Anesthesiol, 2018, 34(8): 820-823.
13.	Xu SS, Wang DQ, Yu YQ, et al. Clinical application of oxycodone compounded with dexmedetomidine in painless fiber bronchoscopy. Pharm J Chin People's Liberation Army, 2018, 34(1): 85-86, 97.
14.	Zhang LN, Xiong XP, Li P, et al. Comparison of anesthetic effects between dexmedetomidine or midazolam combined with oxycodone in the endobronchial ultrasound-guided transbronchial needle aspiration. J Clin Anesthesiol, 2020, 36(3): 262-265.
15.	Tian Y, An J, Zou Z, et al. Computed tomography-guided microcoil localization of pulmonary nodules: Effects of multiple punctures. Thorac Cardiovasc Surg, 2023, 71(7): 566-572.
16.	古琳, 丁锋, 陈开林, 等. 肺外周结节HOOKWIRE 穿刺定位后脱落原因分析及应用体会. 临床外科杂志, 2024, 32(1): 58-61.Gu L, Ding F, Chen KL, et al. Analysis of cause and application of detachment after hookwire puncture positioning of peripheral lung nodules. J Clin Surg, 2024, 32(1): 58-61.
17.	Zhao ZR, Lau RW, Ng CS. Hybrid theatre and alternative localization techniques in conventional and single-port video-assisted thoracoscopic surgery. J Thorac Dis, 2016, 8: S319-S327.
18.	Yang SM, Ko WC, et al. Image-guided thoracoscopic surgery with dye localization in a hybrid operating room. J Thorac Dis, 2016, 8: S681-S689.
19.	Chao YK, Pan KT, et al. A comparison of efficacy and safety of preoperative versus intraoperative computed tomography-guided thoracoscopic lung resection. J Thorac Cardiovasc Surg, 2018, 156: 1974-1830.
20.	Wang B, Zeng Y, Zhao Z, et al. A safe and novel method for video-assisted thoracic surgery preoperative localization of small pulmonary nodules by using ZT medical glue (2-octyl cyanoacrylate). Surg Oncol, 2020, 33: 164-169.

1. Lin Z, Yang GM, Ye XB, et al. Clinical application of two types of Hook-Wire needle localization procedures for pulmonary small nodule biopsy. Technol Health Care, Published online April 12, 2024.
2. Romaszko AM, Doboszyńska A. Multiple primary lung cancer: A literature review. Adv Clin Exp Med, 2018, 27(5): 725-730.
3. Wu X, Chen D, Zhu R, et al. Progress in basic research and clinical treatment of multiple pulmonary nodules. Zhongguo Fei Ai Za Zhi, 2019, 22(3): 173-177.
4. Heuvelmans MA, Walter JE, Peters RB, et al. Relationship between nodule count and lung cancer probability in baseline CT lung cancer screening: The NELSON study. Lung Cancer, 2017, 113: 45-50.
5. Yao F, Yang H, Zhao H. Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules. J Thorac Dis, 2016, 8(3): 469-475.
6. Cantey EP, Walter JM, Corbridge T, et al. Complications of thoracentesis: Incidence, risk factors, and strategies for prevention. Curr Opin Pulm Med, 2016, 22(4): 378-385.
7. Olshansky B. Vagus nerve modulation of inflammation: Cardiovascular implications. Trends Cardiovasc Med, 2016, 26(1): 1-11.
8. Ai M, Xu J. Computed tomography-guided simultaneous coil localization of multiple pulmonary nodules before video-assisted thoracoscopic surgery. Wideochir Inne Tech Maloinwazyjne, 2022, 17(1): 245-251.
9. Goettel N, Bharadwaj S, Venkatraghavan L, et al. Dexmedetomidine vs. propofol-remifentanil conscious sedation for awake craniotomy: A prospective randomized controlled trial. Br J Anaesth, 2016, 116(6): 811-821.
10. He Y, Chen Y, Pan XJ, et al. Effect of lidocaine local anesthesia combined with low dose midazolam and sufentanil citrate intravenous anesthesia in electronic bronchoscopy. Chin Community Dr, 2017, 33(18): 41-42, 44.
11. Shi LB, Zhang ML, Liu XX, et al. Application of dexmedetomidine based anesthesia combined with local anesthesia in breast reservation operation for stageⅠ breast cancer. Med Philos B, 2016, 37(2): 33-35.
12. Wu XM, Xue ZG, Ma H, et al. Expert consensus on clinical application of dexmedetomidine (2018). J Clin Anesthesiol, 2018, 34(8): 820-823.
13. Xu SS, Wang DQ, Yu YQ, et al. Clinical application of oxycodone compounded with dexmedetomidine in painless fiber bronchoscopy. Pharm J Chin People's Liberation Army, 2018, 34(1): 85-86, 97.
14. Zhang LN, Xiong XP, Li P, et al. Comparison of anesthetic effects between dexmedetomidine or midazolam combined with oxycodone in the endobronchial ultrasound-guided transbronchial needle aspiration. J Clin Anesthesiol, 2020, 36(3): 262-265.
15. Tian Y, An J, Zou Z, et al. Computed tomography-guided microcoil localization of pulmonary nodules: Effects of multiple punctures. Thorac Cardiovasc Surg, 2023, 71(7): 566-572.
16. 古琳, 丁锋, 陈开林, 等. 肺外周结节HOOKWIRE 穿刺定位后脱落原因分析及应用体会. 临床外科杂志, 2024, 32(1): 58-61.Gu L, Ding F, Chen KL, et al. Analysis of cause and application of detachment after hookwire puncture positioning of peripheral lung nodules. J Clin Surg, 2024, 32(1): 58-61.
17. Zhao ZR, Lau RW, Ng CS. Hybrid theatre and alternative localization techniques in conventional and single-port video-assisted thoracoscopic surgery. J Thorac Dis, 2016, 8: S319-S327.
18. Yang SM, Ko WC, et al. Image-guided thoracoscopic surgery with dye localization in a hybrid operating room. J Thorac Dis, 2016, 8: S681-S689.
19. Chao YK, Pan KT, et al. A comparison of efficacy and safety of preoperative versus intraoperative computed tomography-guided thoracoscopic lung resection. J Thorac Cardiovasc Surg, 2018, 156: 1974-1830.
20. Wang B, Zeng Y, Zhao Z, et al. A safe and novel method for video-assisted thoracic surgery preoperative localization of small pulmonary nodules by using ZT medical glue (2-octyl cyanoacrylate). Surg Oncol, 2020, 33: 164-169.

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