{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T04:03:08Z","timestamp":1784520188584,"version":"3.55.0"},"reference-count":11,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"vor","delay-in-days":199,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Anesthesiology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Thoracic surgery is conventionally performed under general anesthesia with one\u2010lung ventilation. However, this approach may pose considerable perioperative risks in selected patients with advanced pulmonary disease and significant medical comorbidities. Thoracic segmental spinal anesthesia (TSSA), combined with adjunctive regional techniques, has emerged as a potential alternative in carefully selected high\u2010risk patients undergoing nonintubated thoracic surgery [1\u20133].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Presentation<\/jats:title>\n                    <jats:p>A 76\u2010year\u2010old man with spontaneous left\u2010sided pneumothorax, persistent air leak despite chest tube drainage and two autologous blood patch pleurodesis attempts, resolving pneumonia, cerebellar atrophy, parkinsonian tremor, and anterior fascicular block was referred for surgical management. His respiratory reserve was severely compromised, with oxygen saturation decreasing to 72% before admission and persistent oxygen dependence despite chest drainage [1,2]. Pulmonary function testing could not be performed because of his clinical condition. Following multidisciplinary discussion, conventional general anesthesia with one\u2010lung ventilation was considered to carry a substantial perioperative respiratory risk. The patient subsequently underwent awake video\u2010assisted thoracoscopic surgery (VATS) under low\u2010dose TSSA at the T5\u2013T6 interspace using 6\u2009mg isobaric bupivacaine, combined with an ultrasound\u2010guided cervical vagus nerve block using 4\u2009mL of 1% lidocaine to suppress the intraoperative cough reflex. The patient remained awake, maintained spontaneous ventilation throughout surgery, demonstrated stable hemodynamics, and required no conversion to general anesthesia. Wedge resection of a giant pulmonary bulla and mechanical pleurodesis were completed successfully without intraoperative complications. Postoperatively, lung re\u2010expansion was achieved, the persistent air leak resolved, and the patient recovered without neurological complications, postdural puncture headache, urinary retention, dysphagia, hoarseness, or respiratory deterioration. He was discharged home on postoperative day two in stable condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case illustrates that TSSA combined with ultrasound\u2010guided vagus nerve block may represent a feasible anesthetic option for carefully selected high\u2010risk patients undergoing awake thoracoscopic surgery when conventional general anesthesia is considered undesirable. Larger prospective studies are required to further evaluate the safety, efficacy, and patient selection criteria for this approach [2,3].<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/cria\/2418831","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T03:36:21Z","timestamp":1784518581000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Thoracic Segmental Spinal Anesthesia for Bullectomy in a Patient With Severe Pulmonary Compromise: A Case Report"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1680-6943","authenticated-orcid":false,"given":"Sari","family":"Anani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seedra","family":"Nassr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1515-6460","authenticated-orcid":false,"given":"Tasnim","family":"Herbawi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamoun","family":"Halawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majde","family":"Ghanem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fayez","family":"Mujahed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,19]]},"reference":[{"key":"e_1_2_8_1_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.119.2.590"},{"key":"e_1_2_8_2_2","first-page":"38","article-title":"Awake Thoracic Surgery: Anesthesiological Considerations","volume":"27","author":"Guarracino F.","year":"2014","journal-title":"Current Opinion in Anaesthesiology"},{"key":"e_1_2_8_3_2","first-page":"682","article-title":"Segmental Spinal Anaesthesia for Surgery in Patients With Severe Pulmonary Disease","volume":"98","author":"van Zundert A. A. J.","year":"2007","journal-title":"British Journal of Anaesthesia"},{"key":"e_1_2_8_4_2","article-title":"Awake Thoracic Surgery\u2014State of the Art","volume":"3","author":"Pompeo E.","year":"2015","journal-title":"Annals of Translational Medicine"},{"key":"e_1_2_8_5_2","first-page":"e71","article-title":"Ultrasound-Guided Vagus Nerve Block for Suppression of Cough Reflex During Thoracic Surgery: A Case Report","volume":"32","author":"Sato M.","year":"2018","journal-title":"Journal of Cardiothoracic and Vascular Anesthesia"},{"key":"e_1_2_8_6_2","first-page":"420","article-title":"Thoracic Epidural Anesthesia for Thoracic Surgery","volume":"26","author":"Karakaya D.","year":"2004","journal-title":"European Journal of Cardio-Thoracic Surgery"},{"key":"e_1_2_8_7_2","first-page":"633","article-title":"Thoracic Spinal Anesthesia: Anatomical and Clinical Considerations","volume":"60","author":"Imbelloni L. E.","year":"2010","journal-title":"Revista Brasileira De Anestesiologia"},{"key":"e_1_2_8_8_2","first-page":"1475","article-title":"Nonintubated Thoracic Surgery: Evolution and Outcomes","volume":"90","author":"Mineo T. C.","year":"2010","journal-title":"Annals of Thoracic Surgery"},{"key":"e_1_2_8_9_2","first-page":"3060","article-title":"Non-Intubated Video-Assisted Thoracic Surgery: A Review","volume":"8","author":"Liu J.","year":"2016","journal-title":"Journal of Thoracic Disease"},{"key":"e_1_2_8_10_2","first-page":"48","article-title":"Regional Anesthesia Techniques in Thoracic Surgery: Current Concepts","volume":"33","author":"Bello G.","year":"2020","journal-title":"Current Opinion in Anaesthesiology"},{"key":"e_1_2_8_11_2","first-page":"S3981","article-title":"Nonintubated Thoracic Surgery: Review of Literature and Future Perspectives","volume":"10","author":"Mineo D.","year":"2018","journal-title":"Journal of Thoracic Disease"}],"container-title":["Case Reports in Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/cria\/2418831","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/cria\/2418831","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/cria\/2418831","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T03:36:24Z","timestamp":1784518584000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/cria\/2418831"}},"subtitle":[],"editor":[{"given":"Manzo","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":11,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/cria\/2418831"],"URL":"https:\/\/doi.org\/10.1155\/cria\/2418831","archive":["Portico"],"relation":{},"ISSN":["2090-6382","2090-6390"],"issn-type":[{"value":"2090-6382","type":"print"},{"value":"2090-6390","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-06-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"2418831"}}