Thesis supervisor: Zsolt Szabó
Location of studies (in Hungarian): MODI Abbreviation of location of studies: MODI
Description of the research topic:
During chest surgery, the lungs collapse after the chest opening causes countless physiological changes. Hypoxic vasoconstriction (HPV) that develops after lung collapse fundamentally changes the flow and resistance conditions in the lungs. Vasoconstriction diverts blood flow from non-
ventilated areas to well-ventilated areas, thereby improving oxygenation. The development of HPV is biphasic, the first phase begins immediately after the onset of hypoxia and lasts approximately 20-30 minutes, while the second phase starts after 40 minutes and plateaus after 2 hours [1].
Those assumptions based on the mentioned physiological processes, do not seem unfounded
a) the lack of muscle relaxation, b) the intact functioning of the diaphragm and c) the lower or
negative breathing pressure occurring in the dependent lung during NITS surgery, individually or together, might cause lower ventilation/perfusion mismatch (V/Q) comparing during OLV’s[2,3].
However, in the last decade, a novel anesthetic procedure appeared, the non-intubated thoracoscopic surgery (NITS), during which operations are performed on the patient using a combination of intravenous anesthesia and regional anesthesia techniques, while maintaining spontaneous breathing [4,5 ]. Based on the recently published reports, it seems that NITS can become an equal alternative to traditional anesthetic techniques, since no significant difference was found, neither in surgical and anesthetic applicability, nor in outcome [3,4,5]. Moreover, some authors observed a shorter hospital stay, shorter chest drainage time, fewer respiratory complications, lower stress hormone and T-lymphocyte levels, i.e. a less intense inflammatory response, in the NITS group [3-7].
Although numerous publications have been published on the intrapulmonary shunt that can be measured during OLV, there are no data on the evolution of the V/Q ratio during NITS, nor have there been any comparative studies between OLV and NITS in this area. However, these
would be necessary, on the one hand, to better understand the physiological changes that take place during surgery, and on the other hand, the results can also help in choosing of treatment strategy for intraoperative hypoxia.The aim of our investigation is to calculate the
intraoperative V/Q based on blood samples taken from the pulmonary artery and the radial artery during lung operations performed with NITS and OLV techniques. 1. Talbot NP, Balanos GM, Dorrington KL, Robbins PA. Two temporal components within the human pulmonary vascular response to approximately 2 h of isocapnic hypoxia. J Appl Physiol. 005;98:1125–39.
2. Kao MC, Lan CH, Huang CJ. Anesthesia for awake video-assisted thoracic surgery. Acta Anaesthesiol Taiwan 2012;50:126–30.
3 Diego Gonzalez-Rivas, Cesar Bonomec, Eva Fieirab, Humberto Aymerich, Ricardo Fernandeza,Maria Delgadob,Lucia Mendezb and Mercedes de la Torre:Non-intubated video-assisted thoracoscopic lung resections:the future of thoracic surgery? European Journal of Cardio-Thoracic Surgery 49 (2016) 721–731,19 April 2015
4. Ke-Cheng Chen, Ya-Jung Cheng et al.: Nonintubated thoracoscopic surgery using regional anesthesia and vagal block and targeted sedation J Thorac Dis. 2014 Jan; 6(1): 31–36.
5. Jen-Ting Yang, Ming-Hui Hung et al: Anesthetic consideration for nonintubated VATS J Thorac Dis. 2014 Jan; 6(1): 10–13. doi: 10.3978/j.issn.2072-1439.2014.01.03
6. Bei Wang, Shengjin Ge: Nonintubated anesthesia for thoracic surgery J Thorac Dis. 2014 Dec; 6(12): 1868–1874. doi: 10.3978/j.issn.2072-1439.2014.11.39
7. Eugenio Pompeo, Roberto Sorge, Andrej Akopov, Miguel Congregado, Tomasz Grodzki:Non-intubated thoracic surgery: A survey from the European Society of Thoracic Surgeons for the ESTS Non-intubated Thoracic Surgery Working Group Ann Transl Med. 2015 Mar; 3(3): 37. doi: 10.3978/j.issn.2305-5839.2015.01.34
8. Federico Tacconi, Eugenio Pompeo : Non-intubated video-assisted thoracic surgery: where does evidence stand? J Thorac Dis. 2016 Apr; 8(Suppl 4): S364–S375. doi: 10.21037/jtd.2016.04.39
9. Tacconi F, Pompeo E, Sellitri F, Mineo TC. Surgical stress hormones response is reduced after awake videothoracoscopy. Interact CardioVasc Thorac Surg 2010;10:666–71.
10. Mineo TC1, Sellitri F2,3, Vanni G4, Gallina FT5, Ambrogi V: Immunological and Inflammatory Impact of Non-Intubated Lung Metastasectomy. Int J Mol Sci. 2017 Jul 7;18(7). pii: E1466. doi: 10.3390/ijms18071466.
Required language skills: angol Number of students who can be accepted: 3
Deadline for application: 2024-12-31
2024. IV. 17. ODT ülés Az ODT következő ülésére 2024. június 14-én, pénteken 10.00 órakor kerül sor a Semmelweis Egyetem Szenátusi termében (Bp. Üllői út 26. I. emelet).
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