Modern thoracoscopy with a video-assisted system clearly demonstrates the pleural cavity, and its application under local anesthesia is useful in diagnosing pleural diseases. However, its influence on the cardiorespiratory system is not well understood. The aim of the current study was to evaluate this problem by performing cardiorespiratory monitoring during thoracoscopy in 66 patients with focal bullous lung disease. Duration of thoracoscopy was 12.3 ± 5.1 minutes (mean ± standard deviation). After establishing open pneumothorax with a thoracoscope inserted into the pleural cavity, the average respiratory rate increased (29.7 ± 24.6%; p < 0.01) and average oxygen saturation (SpO2) remained at 96.0 ± 0.9% under atmospheric conditions. However, SpO2 decreased as low as 92.1 ± 2.6% and was less than 90% in 11 patients (16.7%) who required oxygen inhalation. Average heart rate increased and average blood pressure decreased in 39 patients (59.1%), both heart rate and blood pressure increased in 16 patients (24.2%), and both decreased in 11 patients (16.7%). Furthermore, at the minimal blood pressure level during thoracoscopy, the corresponding heart rate decreased paradoxically in 20 patients (30.3%). Actual systolic hypotension less than 100 mmHg was observed in 16 patients (24.2%), bradycardia less than 60 beats per minute was evident in 9 patients (13.6%), and both occurred in 6 patients (9.1%). Three patients with hypotension required adrenergic medication to restore blood pressure. Thoracoscopy under local anesthesia causes tachypnea and a moderate decrease in SpO2 in most patients and causes hypotension and bradycardia in a certain numbers of patients. Careful monitoring of the cardiorespiratory system is beneficial to the safe performance of this procedure.
Journal of Bronchology7:215-220, 2000.
HR, heart rate; RR, respiratory rate; SpO2, oxygen saturation; BP, blood pressure; syst, systolic; diast, diastolic; avg, average; % Δ, percent change; min, minimum