Successful Implementation of Non-Endotracheal Anesthesia for Lung Resection Surgery: A Milestone in ERAS Approach in Thoracic Anesthesia

Introduction to ERAS (Enhanced Recovery After Surgery)

On November 3, 2025, the Department of Anesthesia at Beijing Chaoyang Hospital, led by Dr. Wu Anshi, in collaboration with the Department of Thoracic Surgery, successfully completed the first non-endotracheal anesthesia for right lung wedge resection combined with right middle lobe resection. This groundbreaking technique marks a significant achievement in the hospital’s application of the Enhanced Recovery After Surgery (ERAS) principles. This innovation showcases the team’s technical expertise and creativity, providing patients with a safer, minimally invasive, and more comfortable perioperative management approach.

Non-Endotracheal Anesthesia: A Revolutionary Shift from "Endotracheal" to "Non-Endotracheal"

Traditionally, thoracic surgeries rely on general anesthesia with endotracheal intubation and single-lung ventilation for clear surgical visibility. However, intubation often leads to complications such as throat injury, atelectasis, and ventilator-associated lung injury, which delay postoperative recovery. Non-endotracheal anesthesia maintains spontaneous breathing with precise sedation and analgesia management, ensuring surgical safety while significantly reducing the risk of airway trauma. Key advantages include: using ultrasound-guided paravertebral nerve block and vagus nerve block for multi-modal pain management, paired with supraglottic airway devices to maintain effective oxygenation during spontaneous breathing, enabling single-lung ventilation during surgery and achieving "non-intubation" perioperative care. This approach greatly accelerates recovery.

Multidisciplinary Collaboration for Safety

The success of this procedure reflects deep collaboration between the thoracic and anesthesia teams. Preoperatively, the anesthesia team performed a comprehensive assessment of the patient’s respiratory function, airway condition, and anesthesia risks, developing a tailored anesthetic plan. Intraoperatively, target-controlled intravenous anesthesia (TCI) was used with precise depth monitoring, alongside ultrasound-guided nerve blocks for effective pain control. A supraglottic airway device supported spontaneous breathing and single-lung ventilation. The procedure was smooth, and the patient recovered rapidly post-surgery, with no airway irritation symptoms, enabling them to walk on the same day. Recovery was significantly faster compared to traditional intubated anesthesia patients.

Advancing ERAS and Accelerated Recovery

The successful implementation of non-endotracheal anesthesia marks a pivotal step in ERAS-guided perioperative care, shifting from “passive protection” to “active management” throughout the surgical process. Moving forward, the anesthesia department will continue to deepen multidisciplinary collaboration and promote the use of non-endotracheal anesthesia in minimally invasive surgeries like thoracoscopic lobectomy, pulmonary segment resection, and mediastinal tumor resection. By optimizing anesthetic pathways and continually improving perioperative management, the department aims to improve comfort, safety, and recovery speed, always centered around patient well-being.