病例報告：以漸增吩坦尼的用量作為高風險病患的非氣管內管插管胸腔內視鏡影像輔助手術的策略

Case Report: Incremental Use of Fentanyl as a Strategy for High-Risk Patient with Non-Intubated Video-Assisted Thoracoscopic Surgery

幾對年於來無氣管內管插管的胸腔手術的可行性與安全性已有初步的研究與探討。然而隨著外科術式的多樣化與標準化流程的缺乏，麻醉處置便成為一個值得討論的議題。在此案例將報告一位患有全身性硬皮炎的45歲男性，由於肺部會形成巨大肺疱而導致反覆復發的自發性氣胸。在與病患、胸腔外科醫師討論後，以無氣管內管插管的胸腔鏡手術，完成肺疱切除手術。術後恢復順利，並能早期進行復健工作。在此將討論本次的麻醉處置過程與探討現今其他相關的處置方式。

There are few preliminary studies and reviews of non-intubated thoracic surgery (NITS) in recent years considering its feasibility and safety. Anesthetic management also became an issue due to lack of standard protocol and wide range of surgical procedures. The case we presented is a 45-year-old male, who had systemic sclerodermatitis, suffered from recurrent spontaneous pneumothorax because of huge bullae formation in the lung. The patient under- went bullectomy via non-intubated video-assisted thoracoscopy with local anesthesia and neuroleptanesthesia successfully. He had fast recovery from surgery, which allowed early re- habilitation. Here, we share our anesthetic experience and review other current management.