Abstract
INTRODUCTION: The rapid advancement of medical technology has enabled the application of single-lumen endotracheal tube (SLET) incubation anesthesia in thoracoscopic surgeries for thoracic diseases, demonstrating promising results. This study aims to explore the application of extracorporeal circulation (ECC) and combined intravenous-inhalation anesthesia (CIIA) with SLET intubation in totally thoracoscopic cardiac surgery (TTCS). METHODS: In this single-center, double-blind, randomized controlled trial, we assessed primary outcomes, including intraoperative metrics and postoperative conditions. Secondary outcomes included the number of patients achieving spontaneous resuscitation and those requiring extracorporeal defibrillation after opening the ascending aorta, alertness/sedation scores five minutes post-extubation, and incidence of postoperative complications. RESULTS: The observation group showed shorter durations in the anesthesia recovery room, intensive care unit retention, extubation, eye-opening time, and postoperative hospital stay compared to the control group (t = 5.913, 8.820, 7.792, 6.904, 11.140; all P < 0.001) and had higher proportion of patients with an alertness/sedation score of five (43/109, 39.45%) and rate of spontaneous resuscitation after opening the ascending aorta (97/109, 88.99%) compared to the control group ([8/109, 34%], [84/109, 77.06%]). In contrast, the rate of external electrical defibrillation (12/109, 11.01%) and the incidence of postoperative complications (2/109, 1.83%) were lower than in the control group ([25/109, 22.94%], [10/109, 9.17%]) (χ = 31.350, 5.501, 5.644; all P < 0.05). CONCLUSION: Maintaining oxygen saturation in thoracoscopic surgery requires effective cooperation of anesthesia and ECC. The combined use of ECC and CIIA with SLET intubation in TTCS is a safe, effective approach that warrants broader clinical application.