Thoracoscopic wedge resection of the upper lobe of the left lung achieved by a new approach of laryngeal mask general anesthesia with preservation of spontaneous breathing: A case report

Abstract

Introduction: General laryngeal mask anesthesia with the preservation of spontaneous breathing has accelerated the advancement of the enhanced recovery after surgery concept in thoracoscopic surgery. However, the need for increased doses of anesthetic drugs to reduce laryngeal mask airway (LMA) stimulation poses challenges due to the increased risk of hypotension, respiratory depression, susceptibility to hypoxemia, and carbon dioxide retention, particularly in the lateral position. Patient concerns: During the perioperative period, reducing the dose of anesthetic drugs while simultaneously improving LMA tolerance and preventing circulatory and respiratory depression poses a challenge. Diagnoses: The patient was diagnosed with a nodule in the upper lobe of the left lung. Interventions: In this case, we chose remimazolam sedation, which mildly inhibits circulatory respiration, and used mucosal surface anesthesia in the pharynx. This approach improved the patient’s tolerance to LMA, reduced the dose of anesthetic drugs, and facilitated the successful thoracoscopic wedge resection of the upper lobe of the left lung with preservation of spontaneous respiration. Outcomes: During 2 weeks follow-up, the patient recovered satisfactorily and did not report any discomfort. Conclusion: We used pharyngeal mucosal surface anesthesia and thoracic paravertebral nerve block in combination with remimazolam sedation to provide precise analgesia, moderate sedation, and successful LMA general anesthesia with preservation of spontaneous respiration in patients undergoing thoracoscopic pulmonary wedge resection.