Feasibility and Safety of Nonintubated Anesthesia in Pediatric Video-assisted Thoracoscopic Surgery: A Preliminary Report.

Objective: There is a paucity of literature regarding the application of nonintubated anesthesia in pediatric thoracoscopic surgery. This study provides a systematic description of the authors' anesthetic regimen and evaluates the feasibility and safety of nonintubated anesthesia in pediatric video-assisted thoracoscopic surgery.

Design: A retrospective observational study.

Setting: Operating room in a tertiary teaching hospital.

Participants: Ninety-two pediatric patients underwent thoracoscopic surgery.

Interventions: Patients received either general anesthesia with endotracheal intubation or nonintubated general anesthesia.

Measurements And Main Results: Data from patients who underwent thoracoscopic surgery with nonintubated anesthesia from April 2024 to April 2025 was retrospectively reviewed. The anesthetic procedure was systematically documented. The primary outcome measure was the conversion rate from laryngeal mask airway to endotracheal intubation. Secondary outcomes of interest encompassed comprehensive perioperative safety assessments and complication parameters. A total of 94 patients were identified, with 92 meeting inclusion criteria for final analysis. The cohort comprised patients with the following primary diagnoses: pulmonary sequestration (n = 24), congenital cystic adenomatoid malformation (n = 19), mediastinal mass (n = 26), and pectus excavatum (n = 23). The conversion rate from laryngeal mask airway to endotracheal intubation was 2.1% (2/94). Secondary outcomes demonstrated clinically acceptable results across multiple parameters, including intraoperative surgical field view, vital signs, postoperative pain score, and incidence of nausea and vomiting. Furthermore, comparative analysis with historical data suggested potential benefits of nonintubated anesthesia, including reduced extubation time, decreased incidence of postoperative pulmonary complications, and shorter duration of postoperative hospital stay.

Conclusion: Nonintubated anesthesia demonstrates both feasibility and safety in pediatric thoracoscopic surgery, representing a valuable addition to contemporary anesthetic practice. However, further prospective, multicenter trials with larger sample sizes are warranted to validate these preliminary findings.