Anesthetic Management in Non-Intubated VATS

Standard ASA monitoring was applied during the surgery. On arrival at the operating theater, patients were administered 5 mg of dexamethasone and 0.2 mg of glycopyrrolate. Spontaneous breathing was maintained throughout the non-intubated VATS procedure. Continuous dexmedetomidine infusion was administered to all patients at a rate of 0.5–0.7 μg/kg/h following 10 min of a loading dose of 1 μg/kg. Propofol administration was initiated with effective site concentrations of 3.0 μg/mL and titrated to 2.0–4.0 μg/mL. In initially awake patients, the dose was titrated to achieve a modified Ramsay sedation (MRS) score between 4 (appears asleep; purposeful responses to verbal commands louder than a usual conversation or to light glabellar tap) and 5 (asleep; sluggish purposeful responses only to loud verbal commands or strong glabellar tap). After an appropriate sedation level was achieved based on MRS score, the bispectral index was monitored using electroencephalographic analysis (target at levels between 40 and 60) to ensure an adequate sedation level during the surgery. Remifentanil was simultaneously initiated at 0.5 ng/mL and titrated to within a range of 0.5–3.0 ng/mL to maintain a respiratory rate of ≥10 breaths/min.