Application and Comparison of Different Anesthetic Ventilation Methods in Minimally Invasive Thoracic Surgery Training

doi:10.12300/j.issn.1674-5817.2023.135

Abstract

Abstract:

Objective To compare the effectiveness and safety of one-lung ventilation and small tidal volume two-lung ventilation anesthesia methods in the training of minimally invasive thoracic surgery on experimental pigs. Methods Forty experimental pigs undergoing robotic thoracic surgery were randomly divided into two groups: two-lung ventilation group (n=20) and one-lung ventilation group (n=20). The two-lung ventilation group underwent single-lumen tracheal intubation, utilizing a small tidal volume with a fast respiratory rate combined with carbon dioxide pneumothorax for anesthesia ventilation during the operation. The one-lung ventilation group received one-lung ventilation using a double-lumen bronchial catheter placed under fiberoptic bronchoscopic guidance. The anesthesia implementation indexes from the two groups were compared, including the values of vital signs such as operative heart rate (HR), noninvasive mean blood pressure (MAP), end-tidal carbon dioxide (ETCO₂), and oxygen saturation (SpO₂), as well as the assessment of surgical training performance. Results The intubation success rate for animals in both groups was 100%, with no intraoperative deaths. The intubation completion time was significantly shorter in the two-lung ventilation group compared to the one-lung ventilation group (P < 0.001). Within each group, SpO₂ levels were significantly higher in the two-lung ventilation group at 30 minutes after the start of thoracic surgery (T₁) and at surgery completion (T₃) compared to 60 minutes after the start of surgery (T₂) (P<0.05). ETCO₂, HR, and MAP were significantly higher at T₂ and T₃ compared to T₁(P<0.05). In the one-lung ventilation group, SpO₂ levels were significantly higher at T₁ and T₃ compared to T₂ (P<0.05), while ETCO₂ levels gradually increasing over time (P<0.05). In the between-group comparisons at the same time points, SpO₂ levels of the two-lung ventilation group were significantly higher than those of the one-lung ventilation group at all time points (T₁, T₂, T₃) (P<0.05). Conclusion Both one-lung ventilation and two-lung ventilation anesthesia methods are effective and safe for use in surgical training, with controllable effects on intraoperative animal vital signs and minimal impact on surgical operation training, meeting the needs of robotic thoracic surgery training. One-lung ventilation provides a better experience during pneumonectomy procedures, while small tidal volume two-lung ventilation is easier to implement and does not require additional equipment purchase, making it a feasible supplemental anesthesia option for thoracoscopic surgery on experimental pigs.

Key words: Experimental pig, Anesthesia, Thoracoscopy surgery, Airway management, Surgical robot training

CLC Number:

R-332

Yishu LIU, Shanmin ZHAO, Liping CAI. Application and Comparison of Different Anesthetic Ventilation Methods in Minimally Invasive Thoracic Surgery Training[J]. Laboratory Animal and Comparative Medicine, 2024, 44(1): 97-104.

Figures/Tables 5

Table 1 Comparison of anesthesia implementation indexes between two groups of animals （）

指标

Indexes

双肺通气组 (n=20)

Two-lung ventilation group

单肺通气组 (n=20)

One-lung ventilation

group

t值

P值

动物体质量/kg

Animal body weight/kg

插管用时/min

Intubation time/min

插管成功率/%

Intubation success rate/%

100±0

Figure 1 Comparison of vital signs indices between two groups of animalsNote：A-D， the numerical values of blood oxygen saturation （SpO2）， end-expiratory carbon dioxide （ETCO2）， heart rate （HR）， and mean blood pressure （MAP） at 15 minutes （T1）， 30 minutes （T2） after the establishment of artificial pneumothorax， and completion of surgery （T3）. TLV represents the two-lung ventilation group (n=20), while OLV represents the one-lung ventilation group (n=20). Compared with T1, *P<0.05; Compared with T2, #P<0.05； Compared with the TLV group, &P<0.05.

Figure 2 Comparison of surgical training assessment between the two groups of animal surgeriesNote：A-C， the number of robotic arm collisions (times), surgical time (min), and blood loss (mL) during the surgical procedure. TLV represents the two-lung ventilation group (n=20), while OLV represents the one-lung ventilation group (n=20). nsP>0.05, vs TLV group.

Figure 3 Comparison of the thoracoscopic surgical field between the two groups of animalsNote：Figure A shows the view under thoracoscopy of the two-lung ventilation group， with the white arrow indicating the lung lobe under low tidal volume ventilation mode. Figure B shows the view under thoracoscopy of the one-lung ventilation group， with the white arrow indicating the collapsed lung lobe.

Figure 4 Anesthesia strategies and methods for experimental pigs in specialized training for robotic thoracic surgery

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