Comparing the Utility of Retinal Nerve Fiber Layer and Ganglion Cell Inner Plexiform Layer OCT Changes to Detect Glaucoma Progression.

Previous studies suggest that in lung cancer treatment, video-assisted thoracoscopic surgery (VATS) during unilateral lung ventilation may compromise cerebral oxygen balance and increase the risk of postoperative cognitive dysfunction (POCD), severely affecting patients’ postoperative recovery and quality of life, while imposing additional burdens on society and families. To reduce the ventilatory impact caused by tracheal intubation during VATS, it is necessary to select more appropriate ventilation methods to minimize damage. Studies have found that patients receiving non-intubated anesthesia can increase intraoperative carbon dioxide partial pressure concentration, leading to elevated regional cerebral oxygen saturation and reduced POCD rate. During VATS procedures in elderly lung cancer patients, artificial pneumothorax and unilateral lung ventilation result in pulmonary compression and mediastinal shift, thereby reducing the ventilation-perfusion ratio of the contralateral lung. Consequently, respiratory frequency or tidal volume must be increased to meet gas exchange requirements. However, few studies have yet explored the efficacy of non-tracheal intubation anesthesia with preserved spontaneous breathing in elderly lung cancer patients undergoing VATS. Therefore, this perspective study aimed to analyze the effects of non-tracheal intubation anesthesia with preserved spontaneous breathing on cerebral oxygen saturation and the occurrence of POCD. After approval by the Ethics Committee of Jinhua Municipal Central Hospital [No. (Research) 2022840101], 104 elderly patients with lung cancer who underwent VATS surgery at Jinhua Municipal Central Hospital from January 2023 to October 2024 were selected as study subjects. Patients and their legal guardians were informed about the study and signed informed consent forms. The study protocol was conformed to the principles outlined in the Declaration of Helsinki. The patients met the following inclusion criteria: (1) Histopathologically confirmed non-small cell lung cancer meeting the indications for radical surgery; (2) Age ≥ 60 years; (3) American Society of Anesthesiologists Standard classification grade I-II, and tumor-node-metastasis staging I–II; (4) Mini-Mental State Examination score ≥ 24 points. Patients who meet the following criteria are excluded from the trial: (1) Patients with severe chronic obstructive pulmonary disease, pulmonary infection, or extensive pleural adhesions; (2) Patients with preoperative hypoxemia, hypercapnia, or other complications; (3) Patients with hematological or immunological diseases; (4) Patients with contraindications to paravertebral nerve block and intercostal nerve block; (5) Patients with severe hepatic or renal dysfunction; (6) Patients with difficult airway management; (7) Patients with changes in surgical plan or anesthetic method; (8) Patients requiring other treatments due to postoperative deterioration or hospital transfer. Using a random number table method, enrolled patients were divided into a non-intubated group ( = 52) and an intubated group ( = 52). General data, including sex, age, body mass index, smoking history, drinking history, education level, American Society of Anesthesiologists standard classification, tumor–node–metastasis staging, Mini-Mental State Examination score, pathological types and tumor location, were collected. The study design was detailed in .