Ketamine Anesthesia for Maintenance of Spontaneous Breathing during Video-Assisted Thoracic Surgery

If you have conventional general anesthesia using muscle relaxants for video-assisted thoracic surgery, one lung ventilation with double lumen tube could be dangerous when residual lung volume of non-operated lung could be lacking, and positive pressure ventilation for maintenance of proper minute ventilation could be impossible when there could be too much air leakage. Also, if the abnormal bleeding tendency is, thoracic epidural anesthesia for maintenance of spontaneous breathing could be difficult to perform. A 66-year-old male with a consolidative lesion in involving right middle and lower lobe, and left pneumothorax and pleural effusion successfully underwent video-assisted thoracic bullectomy using ketamine with remifentanil for maintenance of spontaneous breathing and intermittent positive pressure support ventilation within 10 cmH2 O for protection of excessive air leakage. Key words: Ketamine; Remifentanil; Video-assisted thoracic surgery