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ResumenAntecedentesSe ha sugerido que puede haber un beneficio al utilizar la anestesia epidural torácica con el paciente despierto (AETD) para procedimientos toracoscópicos de invasión mínima en pacientes críticos. Sometimos a prueba la hipótesis de que la AETD es superior a la anestesia general (AG) al comparar las complicaciones tempranas en este escenario.MétodosSe realizó un estudio prospectivo de cohorte durante un período de 36 meses para comparar la AG con la AETD en pacientes con derrame pleural maligno programados para pleurodesis con talco por toracoscopia (PTT). Se analizaron las complicaciones pulmonares, cardíacas y renales, la mortalidad, la calidad de la analgesia y los eventos postoperatorios. Se realizaron análisis univariados y bivariados y se desarrollaron curvas de probabilidad de tiempo de sobrevida a fin de determinar una posible relación entre una técnica anestésica particular y las complicaciones postoperatorias. Se consideró significativo un valor de p<0,05.ResultadosSe incluyeron 47 pacientes en el análisis. Las características preoperatorias de los grupos fueron comparables (AG, n=24; AETD, n=23). La incidencia de complicaciones pulmonares (AG=19 [86%] vs. AETD=3 [14%]; RR: 6,0 [95%CI: 2,07-17,7]; p<0,001) y la severidad del dolor postoperatorio (EVA>8) a las 24h (AG=7 vs. AETD=1; RR: 6,7 [95%CI: 1,13-18,2]; p=0,023) fueron significativamente mayores cuando los pacientes recibieron AG. El tiempo necesario para suspender todo tipo de soporte ventilatorio y para la movilización sin mayores restricciones (AG=4 [3,5-5] vs. AETD=3 [2-3,5] días; p=0,029) y el tiempo de permanencia global (GA=10 [3,5-29,5] vs. ATEA=4 [3-15,2] días; p=0,003) fueron significativamente menores en el grupo que recibió AETD.ConclusionesNuestro estudio sugiere que la AETD no solamente es un método anestésico seguro para los pacientes de cáncer sometidos a PTT, sino que también se asocia con una reducción significativa de los eventos pulmonares postoperatorios y de la permanencia hospitalaria, y con un mejor control del dolor postoperatorio. Se requieren estudios aleatorizados para corroborar estos hallazgos.AbstractBackgroundIt has been suggested that there is some benefit when awake thoracic epidural anesthesia (ATEA) is used for minimally invasive thoracoscopic procedures in critical patients. We tested the hypothesis that ATEA is superior to general anesthesia (GA) when comparing early pulmonary complications in this setting.MethodsA prospective cohort study was carried out over a 36-month period, comparing patients with malignant pleural effusion scheduled for thoracoscopic talc pleurodesis (TTP) using GA vs. ATEA. Postoperative pulmonary, cardiac, and renal complications, death rate, quality of analgesia and events were analyzed. Univariate and bivariate analyses were performed and time survival probability curves were developed in order to find a possible relation between a particular anesthetic technique and postoperative complications. A p value of <0.05 was considered significant.ResultsForty-seven patients were included in the analysis. Preoperative characteristics were comparable between groups (GA n = 24; ATEA n = 23). Incidence of pulmonary complications [GA = 19 (86%) vs. ATEA = 3 (14%). RR 6.0 (95% CI 2.07–17.7); p < 0.001] and severity of post-operative pain (VAS > 8) at 24 h [GA = 7 vs. ATEA = 1 RR 6.7 (95% CI 1.13–18.2); p = 0.023] were significantly higher when patients received GA. Time required to absence of any postoperative ventilatory support and mobilization with no major restrictions [GA = 4 (3.5–5) vs. ATEA = 3 (2–3.5) days; p = 0.029] and global LOS [GA = 10 (3.5–29.5) vs. ATEA = 4 (3–15.2) days; p = 0.003] were significantly reduced in the ATEA group.ConclusionsOur study suggests that ATEA is not only a safe anesthetic approach for cancer patients undergoing TTP but is also associated with a significant reduction in pulmonary postoperative events, hospital stay, and a better postoperative pain control. Randomized studies are required to corroborate these findings

Anestesia epidural para pleurodesis por toracoscopia: un estudio prospectivo de cohorte