Open Lung Surgery Research Articles

Follow-Up of Surgical or Nonsurgical Patients with Pulmonary Cryptococcosis: A Real-World Study.

BackgroundSurgical and medical treatments are applied to pulmonary cryptococcosis (PC) in the real world, while the prognosis of different therapies is uncertain. This study investigated diagnosis, real-world therapy, follow-up outcomes, and prognosis factors, aiming to deepen our understanding of PC.MethodsPatients pathologically diagnosed with PC were retrospectively reviewed and followed up. Further comparisons and subgroup analyses were conducted in surgical and nonsurgical treatment individuals. Univariable and multivariable logistic regression methods were used to explore the risk factors associated with treatment failure.ResultsOne hundred and sixty-three patients were included in this study, of whom 92 underwent surgical removal of VATS or open lung surgery (68 of them received postoperative antifungal treatment) and 71 got antifungal drugs only. Compared with nonsurgical patients, surgical patients were more immunocompetent (73 [79.3%] cases vs 33 [46.5%]), showed milder symptoms and more limited pulmonary lesions. Although they had instant treatment response owing to lesions resection, there is no significant advantage in the rate of treatment failure. Multivariable regression showed independent predictive factors associated with treatment failure were polymorphonuclear (PMN)>6.30*109/L, albumin (Alb) <40g/L and antifungal dosage <400mg/d. Further analysis among patients with different immune statuses or symptoms demonstrated that sufficient antifungal dosage could reduce the rate of treatment failure.ConclusionPC showed variable and nonspecific clinical features. PC patients with limited nodules/masses and mild symptoms often led to misdiagnosis and unnecessary lung resections. The potential risk factors including higher PMN and hypoalbuminemia could help clinicians to identify PC patients with poor treatment efficiency at an early stage. To note, sufficient antifungal dosage may improve the treatment outcomes.

Efficacy and safety of general anesthesia combined with paravertebral blockade on postoperative recovery in patients undergoing pulmonary surgery: a systematic review and meta-analysis.

BackgroundResearch on analgesic effect, stress response, and lung function of thoracic epidural blockade (TEB) and paravertebral blockade (PVB) are inconsistent. This study conducted a meta-analysis of related literature, aiming at comparing the clinical efficacy and safety of two analgesic methods, and providing scientific evidence-based basis for clinical choice of analgesic methods.MethodsPubMed, Embase, MEDLINE, Science Direct, Cochrane Library, CNKI, China Biomedical Resources Database, Wanfang Database, VIP, and Foreign Medical Journal Full-Text Service were searched. Keywords were as follows: thoracic epidural block (TEB), paravertebral blockade (PVB), paravertebral catheterization, thoracotomy, and analgesia. Two professionals independently screened documents and extracted data, and used Cochrane System Evaluator Manual (version 5.1.0) to repeatedly assess the bias risk of the documents included in the study.ResultsA total of 9 articles were included. Of the 9 RCTs in the present study, 5 described the allocation concealment in detail, 9 described the correct random allocation method, and 1 did not use the blind method. The visual simulation scores of the PVB group and TEB group at 24 and 48 h were not statistically significant [mean difference (MD): −0.17, 95% confidence interval (CI): −0.43 to 0.08, P=0.18; MD: 0.21, 95% CI: −0.06 to 0.48, P=0.13]. The fixed-effects model was used to analyze the incidence of hypotension, nausea, vomiting, and urinary retention. The results showed that there was significant difference between the PVB group and TEB group [hypotension: relative risk (RR): 0.16, 95% CI: 0.06–0.46, P=0.0006; nausea: RR: 0.40, 95% CI: 0.25–0.66, P=0.0002; vomiting: RR: 0.23, 95% CI: 0.06–0.87, P=0.03; urinary retention: RR: 0.36, 95% CI: 0.15–0.87, P=0.02].DiscussionThe meta-analysis confirmed that PVB has the same analgesic effect and postoperative pulmonary function as epidural blockade in open thoracotomy lung surgery. In addition, PVB can reduce the incidence of analgesia-related complications and postoperative chronic pain.

Cardiac Anaestiology with a Large Atrial Tumor and Types of Cardiac Tumors

Cardiac anesthesiology is subspecialty of the medical practice of anesthesiology, devoted to the pre-operative, intraoperative and post-operative care of adult and pediatric patients undergoing cardiothoracic surgery, and related invasive procedures. The anesthetic aspects of the care related to the surgery cases such as open heart surgery, lung surgery and other operations of the human chest. The perioperative care with expert handling of patient cardiopulmonary physiology through precise and move along with the application of pharmacology, resuscitative techniques, critical care medicine, and invasive procedures.

Anesthesia for double lung transplant in a patient with confirmed COVID-19 infection: a case report

IntroductionLung transplantation has been performed in a small number of patients suffering from COVID-19 related pulmonary fibrosis or end-stage COVID-19 pneumonia. (1) There are no reports of lung transplantations to receipients with positive Covid-19-PCR at the time of the operation.MethodsA 42-year-old woman without comorbidities was hospitalized and diagnosed with COVID-19 pneumonia. After being intubated and tracheotomized, VV-ecmo support had to be initiated, no tendency of improvement ensued. Lung transplantation proceedings were made despite viral RNA test results from BAL being consistently positive (while negative culture growth suggested no active viral disease) since a small intracerebral bleeding had occurred after 45 days on ECMO. An adequate donor organ was found, double lung transplantation was performed.Two experienced anesthetists, two nurse anesthetists and a runner provided anesthesia. The OR was set to positive pressure and 26 air changes h-1, the team wore full PPE (multilayer gloves, gown/overall, FFP-3 masks, glasses, faceshield).Videolaryngoscopic intubation using a ViVaSight® (Ambu, Denmark) left double lumen tube with integrated camera was performed, TEE and bronchoscopy were avoided. We used near infrared spectropscopy and total intravenous anesthesia with Propofol 5,5mg kg-1 h-1 and Sufentanil 5mcg kg-1 h-1. Being on VV-Ecmo with 4,7l of blood and 5,5l O2 flow min-1 we used a second, centrally cannulated parallel ecmo circuit with 3l of blood and 2l of oxygen flow min-1, the VV circuit was reduced.The operation was prolonged due to adhesions, coagulopathy, rupture of the dilated right atrium. Transfusion of 30 units of packed red cells, 40 units of fresh frozen plasma, 5 units of platelets, 2000IE of PPSB, 30mcg of desmopressin acetate, 5 grams of fibrinogen concentrate guided by repetitive viscoelastic testing was performed. Bilateral pulmonary edema occurred, leading to an oxygenation index of 72 on 1l min-1 VV ecmo flow. We therefore switched to a femorally cannulated VA-ecmo circuit to minimize hemodynamic stress for the newly transplanted lungs.At the end of the operation the patient was stable with oxygenation index of 76 with 2,8l min-1 blood flow of ECMO support, sedated with Propofol 5,5mg kg-1 h-1 and Sufentanil 5mcg kg-1 h-1 and received Norepinephrine 0,06 mcg kg-1 min-1. We proned the patient immediately. COVID-19 polymerase chain reaction testing was performed in all team members and was negative in all cases.ResultsDiscussion: Double lung transplantation is possible in selective patients suffering from COVID-19 pneumonia, intraoperative care is troublesome and strains resources due to open lung surgery and airway maneuvers increasing infection risk exponentially. (2)

Surgical treatment of lung injuries and diseases in patients with blunt chest trauma

To establish the indications for optimal open lung surgery in patients with severe blunt chest injury. Hematomas, lung wounds and purulent pulmonary complications were studied in four groups of victims. Causes of injuries included road accidents (n=426), falling and beating (n=387), catatrauma (n=217), squeezing the body with a massive weight (n=46). Majority of victims (n=731, 67.9%) were transferred to the hospital within 1-5 hours after injury; 345 (32.1%) patients were transferred from other hospitals to treat combined injuries of head, chest, abdomen and complications within 1-49 days after injury. Lung surgery was applied in 48 patients. Typical resections and pneumonectomies made up 77.1%. Indications for surgery included lung wounds complicated by pulmonary hemorrhage grade IIa and severe hemothorax, intrapulmonary hematoma ≥6 cm with high risk of bleeding and suppuration, gangrene, gangrenous and purulent abscesses of aspiration genesis, lung cancer first diagnosed in victims. Postoperative mortality was 14.6%. Twelve victims with unrecognized deep lung wounds and pulmonary root rupture were not operated. Thus, 5.6% of victims with severe blunt chest trauma need for open lung surgery.

Blood transfusion and lung surgeries in pediatric age group: A single center retrospective study.

Background:Blood transfusion is not without harm, and recent studies suggest association between transfusion and poor outcome in critically ill patients. Although it is prescribed for many reasons based on the firm belief that blood transfusion improves oxygen carrying capacity, it carries notable adverse hazards. Importantly, lung surgeries are counted as moderate to high-risk operations and take a significant risk of blood loss.Aim:This study aims to reveal the association between blood transfusion and poor clinical outcomes and characterize the epidemiology of blood transfusion after pediatric chest surgery.Settings and Design:Retrospective cohort study, done throughout 3 years.Materials and Methods:A total of 248 patients who underwent open thoracotomy and lung surgery and aged ≤18 years were classified according to the need of intraoperative or postoperative blood transfusion into two groups: Group I (non-transfused = 130) and Group II (transfused = 118).Statistical Analysis:SPSS v25 was used for analysis.Results:Transfusion probability ranged between 42.8% and 50% according to type of surgery. As regard to postoperative variables, there was no significant difference between both groups regarding the duration of analgesia, allergic reactions, need of re-operation and in-hospital mortality. However, transfused group showed significant increase in duration of antibiotic, persistent postoperative fever, time to remove chest drains, ICU stays, hospital stay and pneumonia. Incidence of pneumonia had a relative risk 1.82 with transfused compared to non-transfused group.Conclusion:Transfusion group in pediatrics undergoing lung surgeries in our study was more prone to adverse outcomes such as pneumonia, delayed time to remove chest drains, prolonged ICU stay, and hospital stay.

Is There an Impact of Sex on Acute Postthoracotomy Pain? A Retrospective Analysis

Current knowledge about sex-related differences states that pain is generally more frequent and intense in women. Because severe postthoracotomy pain is associated with complications, sufficient pain control is essential. Data on sex-related aspects in the context of pain after thoracotomy are scarce. The study attempted to determine whether sex significantly affects pain and pain treatment after thoracotomy. This retrospective study assessed visual analogue scale (VAS) scores and analgesic consumption (opioids and diclofenac) during the first 5 days after surgery and the point in time when analgesics were changed from the intravenous to the oral route in patients who had open lung surgery. The influences of sex, PCEA (patient-controlled epidural analgesia), age, and surgical factors were evaluated with mixed-model analysis. The study was able to include 344 patients (130 female, 214 male). The VAS scores model did not consider sex as relevant. The opioid model showed a PCEA-time-sex interaction with increasing opioid demand after day 3 that predominantly affected male patients (P < .001). Diclofenac doses where significantly higher in an interaction of female sex and small extent of surgery (P= .007). Posterolateral thoracotomy led to significantly higher VAS scores (P < .001) and higher demand for opioids (P= .007) and diclofenac (P= .012). The study concluded that there are no general sex-related differences in pain intensity and analgesic requirement after thoracotomy. Anterolateral thoracotomy was the less painful surgical approach. PCEA had favorable results, although there seemed to a rebound pain phenomenon after epidural catheter removal on postoperative day 3 that mainly affected male patients.

Clinical analysis of 68 patients with pulmonary mycosis in China

Background: Due to the lack of specific clinical manifestations and imaging features, the diagnosis of pulmonary mycosis is difficult. This study aimed to investigate the pathogens, clinical manifestations, imaging features, diagnosis and management of pulmonary mycosis.&#x0D; Methods: Data on 68 patients diagnosed as pulmonary mycosis in Xiang Ya hospital from January 2001 to December 2010 were collected and their clinical manifestations, radiographic characterization, diagnostic methods and management were analyzed.&#x0D; Results: All patients were diagnosed by pathological examination. Of the 68 cases, 38 (55.9%) had pulmonary aspergillosis and 19 (27.9%) pulmonary cryptococcosis. Open-lung surgery was performed in 38 patients (55.9%), transbronchial biopsy in 15 (22.0%), and computerized tomography (CT)-guided percutaneous needle biopsy in 11 (16.2%). Main symptoms were as follows: cough in 51 cases (75.0%), expectoration in 38 (55.9%), hemoptysis in 25 (37.8%), fever in 20 (29.4%), while 6 cases (11.1%) were asymptomatic. X-ray and chest CT showed masses or nodular lesions in 52 cases (76.5%), patchy lesions in 10 (14.7%), cavity formation in 15 (22.0%), and diffuse miliary nodules in 1 case. In 51 cases (75.0%) misdiagnosis before pathological examination occurred. Surgical resection was performed in 38 patients (55.9%). In 25 patients (36.7%) systemic antifungal therapy was administered, and 20 patients (29.4%) experienced complete responses or partial responses.&#x0D; Conclusion: The main pathogens of pulmonary mycosis are Aspergillus, followed by cryptococcosis. Final diagnosis of pulmonary mycosis mainly depends on pathological examination. The clinical manifestations, imaging features, diagnostic methods and management differ depending on the pathogens. Satisfactory therapy can be obtained by both antifungal and surgical treatment.

Performance and Analysis of Ground-Glass Pattern Detection in Lung Disease based on High-Resolution Computed Tomography

Background/Aim: The aim of this work is to perform and analyze the Ground glass pattern Detection in Lung Disease based on High Resolution Computed Tomography (HRCT). Methods: The algorithm incorporates Gabor filter bank which is based on frequency spectrum analysis of image. Gabor filter banks assist in the frequency extraction process. This method when applied to HRCT images will help doctors to extract more information than from the CT images. This method is accomplished in three steps: Extraction of Preliminary mask formation, Extraction of Peripheral mask formation and finally post processing. By applying these methods, higher sensitivity and selectivity may be attained with fast processing time. In the post processing, binary noise removal technique is applied to remove noise from the detection mask. Findings: While interpreting the HRCT images we have to consider the blood being distributed to the dependent portions of the lungs. On the basis of the ground glass opacities, the bleeding site is determined as the area having more attenuation. In homogeneous attenuation, the bleeding site is determined as the upper lobes. Therefore, the bleeding site was thus determined keeping all the abnormalities (mass or clot or lesion) in mind. Application: The HRCT has also been used to guide and to provide information regarding an optimum site for open lung surgery. HRCT provides additional useful information to the CXR and directly influence the clinical management of pediatric patients with pulmonary disease, especially in detecting post-infection or post bone marrow transplant sequelae, bronchiectasis and in evaluating patients with nonspecific CXR findings.

Clinical benefits of preemptive thoracic epidural analgesia with hydromorphone and bupivacaine in open thoracotomy lung surgery

Clinical benefits of preemptive thoracic epidural analgesia with hydromorphone and bupivacaine in open thoracotomy lung surgery

The effects of deep and light propofol anesthesia on stress response in patients undergoing open lung surgery: a randomized controlled trial.

BackgroundThis prospective, randomized controlled study was undertaken to compare stress hormone response to open thoracotomy for lung resection at different anesthetic depths, as determined by bispectral index (BIS) monitoring, in patients under propofol-remifentanil anesthesia.MethodsForty-eight adult patients scheduled for lung resection surgery using one-lung ventilation were randomly assigned to either a deep anesthesia group (BIS score of 40 ± 5, n = 24) or a light anesthesia group (BIS score of 60 ± 5, n = 24) by adjusting propofol infusion rates. Blood norepinephrine, epinephrine, adrenocorticotropic hormone, and cortisol levels were measured before the induction of anesthesia, at the end of surgery, and at 2 hours postoperatively. Blood glucose, hemodynamic, and oxygenation-ventilation variables, and postoperative outcomes were also measured.ResultsNorepinephrine and epinephrine levels remained unchanged over time in the deep group, but norepinephrine levels significantly increased in the light group at 2 h after surgery than at baseline (P = 0.007 and 0.004, respectively). Temporal changes in norepinephrine, but not in epinephrine, were significantly different between the two groups (P = 0.036). Plasma glucose levels in the light group increased with time and were significantly higher than in the deep group at the end of surgery (P = 0.002).ConclusionsA deep level of anesthesia achieved using high propofol infusion rates during lung surgery provided lower perioperative norepinephrine and glucose responses than light level of anesthesia during the early postoperative period but failed to affect immediate postoperative outcomes.

Comparison of thoracic epidural and paravertebral analgesia for postoperative pain control after thoracotomy

In the present randomized, controlled, and blinded study, the effects of thoracic paravertebral analgesia were compared to those of epidural analgesia on postoperative pain, hemodynamics, and respiration rate following thoracotomy. Patients scheduled for elective open-lung surgery were included. One hour prior to surgery, thoracic epidural catheters were used in 18 patients (ED group), and ultrasound-guided paravertebral catheters were used in 17 patients (PV group). Standard general anesthesia was administered to all. Following anesthesia, postoperative analgesia of levobupivacaine 0.1% and morphine 0.1 mg mL-1 was administered via catheter. Patient-controlled analgesia (PCA) regime with tramadol was initiated, and amounts of local anesthetics and tramadol demanded and delivered within the first 24 hours were recorded. Visual analog scale (VAS) pain score, sedation score, side effects, and vital signs (blood pressure, heart rate, and respiratory rate) were assessed by an observer blinded to patient data at 1, 2, 3, 4, 6, 12, and 24 hours. Differences in PCA bolus demands and deliveries were not statistically significant between the PV group (26.8±1.3 and 33.1±4.5) and the ED group (25.1±3.5 and 32.5±4.3). Neither were differences in VAS scores statistically significant (p=0.3). Rates of sedation among the PV group were lower than those of the ED group at 1 hour (p=0.001). Five patients in the ED (%28) group experienced hypotension (p=0.02). Paravertebral block with levobupivacaine 0.1% and morphine 0.1 mg mL-1 may be an alternative form of pain relief following thoracotomy.

Antiinflammatory effect of sevoflurane in open lung surgery with one-lung ventilation.

AimTo prospectively assess the antiinflammatory effect of volatile anesthetic sevoflurane in patients undergoing open lung surgery with one lung ventilation (OLV).MethodsThis prospective, randomized study included 40 patients undergoing thoracic surgery with OLV (NCT02188407). The patients were randomly allocated into two equal groups that received either propofol or sevoflurane. Four patients were excluded from the study because after surgery they received blood transfusion or non-steroid antiinflammatory drugs. Inflammatory mediators (interleukins 6, 8, and 10, C-reactive protein [CRP], and procalcitonin) were measured perioperatively. The infiltration of the nonoperated lung was assessed on chest x-rays and the oxygenation index was calculated. The major postoperative complications were counted.ResultsInterleukin 6 levels were significantly higher in propofol than in sevoflurane group (P = 0.014). Preoperative CRP levels did not differ between the groups (P = 0.351) and in all patients they were lower than 20 mg/L, but postoperative CRP was significantly higher in propofol group (31 ± 6 vs 15 ± 7 ng/L; P = 0.035); Pre- and postoperative procalcitonin was within the reference range (<0.04 µg/L) in both groups. The oxygenation index was significantly lower in propofol group (339 ± 139 vs 465 ± 140; P = 0.021). There was no significant difference between the groups in lung infiltrates (P = 0.5849). The number of postoperative adverse events was higher in propofol group, but the difference was not-significant (5 vs 1; P = 0.115).ConclusionThe study suggests an antiinflammatory effect of sevoflurane in patients undergoing thoracotomy with OLV.

Lung flooding enables efficient lung sonography and tumour imaging in human ex vivo and porcine in vivo lung cancer model

BackgroundSonography has become the imaging technique of choice for guiding intraoperative interventions in abdominal surgery. Due to artefacts from residual air content, however, videothoracoscopic and open intraoperative ultrasound-guided thermoablation of lung malignancies are impossible. Lung flooding is a new method that allows complete ultrasound imaging of lungs and their tumours.MethodsFourteen resected tumourous human lung lobes were examined transpleurally with B-mode ultrasound before (in atelectasis) and after lung flooding with isotonic saline solution. In two swine, the left lung was filled with 15 ml/kg isotonic saline solution through the left side of a double-lumen tube. Lung tumours were simulated by transthoracic ultrasound-guided injection of 5 ml of purified bovine serum albumin in glutaraldehyde, centrally into the left lower lung lobe. The rate of tumour detection, the severity of disability caused by residual gas, and sonomorphology of the lungs and tumours were assessed.ResultsThe ex vivo tumour detection rate was 100% in flooded human lung lobes and 43% (6/14) in atelectatic lungs. In all cases of atelectasis, sonographic tumour imaging was impaired by residual gas. Tumours and atelectatic tissue were isoechoic. In 28% of flooded lungs, a little residual gas was observed that did not impair sonographic tumour imaging. In contrast to tumours, flooded lung tissue was hyperechoic, homogeneous, and of fine-grained structure. Because of the bronchial wall three-laminar structure, sonographic differentiation of vessels and bronchi was possible. In all cases, malignant tumours in the flooded lung appeared well-demarcated from the lung parenchyma. Adenocarcinoma, squamous, and large cell carcinomas were hypoechoic. Bronchioloalveolar cell carcinoma was slightly hyperechoic. Transpleural sonography identifies endobronchial tumour growth and bronchial wall destruction. With transthoracic sonography, the flooded animal lung can be completely examined in vivo. There is no residual gas, which interferes with ultrasound. Pulmonary vessels and bronchi are clearly differentiated. Simulated lung lesions can easily be detected inside the lung lobe.ConclusionsLung flooding enables complete lung sonography and tumour detection. We have developed a novel method that efficiently uses ultrasound for guiding intraoperative interventions in open and endoscopic lung surgery.

Preoperatıve Ultrasound-Guıded Suprascapular Nerve Block for Postthoracotomy Shoulder Paın

BackgroundAcute postthoracotomy pain is a well-known potential problem, with pulmonary complications, ineffective respiratory rehabilitation, and delayed mobilization in the initial postoperative period, and it is followed by chronic pain. The type of thoracotomy, intercostal nerve damage, muscle retraction, costal fractures, pleural irritation, and incision scar are the most responsible mechanisms. ObjectiveOur aim was to assess whether preoperative ultrasound suprascapular nerve block with thoracic epidural analgesia was effective for postthoracotomy shoulder pain relief. MethodsThirty-six American Society of Anesthesiologist classification physical status I–III patients (2011–2012), with a diagnosis of lung cancer and scheduled for elective open-lung surgery, were prospectively included in the study. Eighteen of the patients received an ultrasound-guided suprascapular nerve block with 10-mL 0.5% levobupivacaine, using a 22-gauge spinal needle, 1 hour before operation (group S); 18 other patients had thoracic epidural analgesia only, and no nerve block was performed. Standard general anesthesia was administered. Degree of shoulder pain was assessed by a blinded observer when discharging patients from the recovery room, and thereafter at 1, 3, 6, 12, 24, 36, 48, and 72 hours on infusion at rest and 12, 24, 36, 48, and 72 hours on coughing. The same blinded observer also recorded the total amount of epidural levobupivacaine and fentanyl used by the 2 groups. ResultsIn the suprascapular block group, the total amount of levobupivacaine (P = 0.0001) and fentanyl (P = 0.005) used postoperatively was statistically lower than in the epidural group. Visual analogue scale measurements in the suprascapular group were statistically significantly lower at 0, 1, 3, 6, 12, 24, 36, and 48 hours than those in the epidural group, both at rest and coughing. ConclusionPostthoracotomy shoulder pain reduces patient function and postsurgical rehabilitation potential after thoracotomy, and various studies on explaining the etiology and management of postthoracotomy shoulder pain have been conducted. Theories of the etiology involved either musculoskeletal origin or referred pain. In this study, we concluded that preoperative ultrasound-guided suprascapular nerve block with thoracic epidural analgesia could achieve effective shoulder pain relief for 72 hours postoperatively, both at rest and coughing.

Risk of surgical glove perforation in oral and maxillofacial surgery

Oral and maxillofacial surgery, which involves several sharp instruments and fixation materials, is consistently at a high risk for cross-contamination due to perforated gloves, but it is unclear how often such perforations occur. This study aimed to address this issue. The frequency of the perforation of surgical gloves (n=1436) in 150 oral and maxillofacial surgeries including orthognathic surgery (n=45) was assessed by the hydroinsufflation technique. Orthognathic surgery had the highest perforation rate in at least 1 glove in 1 operation (91.1%), followed by cleft lip and palate surgery (55.0%), excision of oral soft tumour (54.5%) and dental implantation (50.0%). The perforation rate in scrub nurses was 63.4%, followed by 44.4% in surgeons and first assistants, and 16.3% in second assistants. The odds ratio for the perforation rate in orthognathic surgery versus other surgeries was 16.0 (95% confidence interval: 5.3–48.0). The protection rate offered by double gloving in orthognathic surgery was 95.2%. These results suggest that, regardless of the surgical duration and blood loss in all fields of surgery, orthognathic surgery must be categorized in the highest risk group for glove perforation, following gynaecological and open lung surgery, due to the involvement of sharp objects.

A survey of physiotherapeutic provision for patients undergoing thoracic surgery in the UK

ObjectivesEvaluation of physiotherapeutic provision for patients undergoing open thoracotomy and lung surgery in the UK. Timing of physiotherapy, modalities used and factors influencing practice were also investigated. DesignSurvey. SettingTertiary centres performing thoracic surgery. ParticipantsForty UK centres were identified, and senior physiotherapists were invited to participate. MethodsA postal survey was distributed to identified centres in August 2008, with further follow-up of non-responders. This was adapted from a similar study conducted in Australia and New Zealand. ResultsThirty-one responses were received (78%). Pre-operative physiotherapy was provided by 87% of respondents: 10% provided physiotherapy for all patients and 77% only provided physiotherapy for high-risk patients. Pre-operative pulmonary rehabilitation was reported in 13% of centres. Postoperative physiotherapeutic assessment was undertaken routinely by 97% of respondents: 81% provided physiotherapy to all patients, and 16% only provided physiotherapy when a specific problem was identified. The treatments given were relatively standardised. The provision of physiotherapy following hospital discharge was generally very sparse. ConclusionThis study provides a guide for physiotherapists working with patients undergoing thoracic surgery to use to compare their current practices. Postoperative physiotherapy is provided extensively to UK patients undergoing open thoracotomy. However, pre-operative provision is more variable and is mainly provided for high-risk patients. Despite the subsequent publication of pre- and postoperative pulmonary rehabilitation studies, UK physiotherapy practice remained similar to that reported in Australia and New Zealand. Further research in this field is necessary to investigate the role of pre-operative physiotherapy, the role of pre- and postoperative pulmonary rehabilitation, and the effectiveness of routine postoperative physiotherapy.

Comparison of Continuous Thoracic Epidural With Paravertebral Block on Perioperative Analgesia and Hemodynamic Stability in Patients Having Open Lung Surgery

Comparison of Continuous Thoracic Epidural With Paravertebral Block on Perioperative Analgesia and Hemodynamic Stability in Patients Having Open Lung Surgery

Comparison of Continuous Thoracic Epidural With Paravertebral Block on Perioperative Analgesia and Hemodynamic Stability in Patients Having Open Lung Surgery

Epidural analgesia can result in perioperative hypotension in patients having thoracotomy. This randomized prospective study assessed the effects of epidural and paravertebral analgesia on hemodynamics during thoracotomy. Thirty-two patients were randomized to receive either epidural analgesia (n = 16, 0.25% levobupivacaine and 30 μg/kg morphine) or paravertebral block (n = 16; 0.5% levobupivacaine and 30 μg/kg morphine). Oxygen delivery, stroke volume and systemic vascular resistance indices, heart rate, and mean arterial pressure measurements were performed before administration of local anesthetic, after induction of general anesthesia, institution of 1-lung ventilation, first skin incision, retractor placement, lung-inflation maneuver, and at last skin suture. The primary end point was the volume of the colloid infusion necessary to maintain oxygen delivery index of 500 mL/min per squared meter or higher. Postoperative analgesia was provided immediately after surgery by an infusion of 0.125% levobupivacaine and 20 μg/mL morphine in epidural/paravertebral infusion. Pain, rescue-analgesia consumption, arterial pressure, and heart rate were recorded at 6, 24, and 48 hrs after surgery. Administration of anesthesia and data collection were done by research staff blinded to the regional analgesia technique. The groups did not differ significantly in heart rate, mean arterial blood pressure, or systemic vascular resistance indices. However, to maintain the targeted oxygen delivery index, a greater volume of colloid infusion and phenylephrine were required, respectively, in the epidural than in the paravertebral group (554 ± 50 vs 196 ± 75 mL, P = 0.04; and 40 ± 10 vs 17 ± 4 μg, P = 0.04). Pain intensity before and after respiratory physiotherapy as well as 24 hr rescue piritramide consumption was similar in the epidural (4.1 ± 3.1 mg) and the paravertebral (2.5 ± 1.5 mg) groups (P = 0.14). Systolic blood pressure after 24 and 48 hrs was lower in the epidural group. Under the conditions of our study, continuous paravertebral block resulted in similar analgesia but greater hemodynamic stability than epidural analgesia in patients having thoracotomy. Paravertebral block also required smaller volume of colloids and vasopressors to maintain the target oxygen delivery index (DO2I).

Clinical analysis of 68 patients with pulmonary mycosis in China

BackgroundDue to the lack of specific clinical manifestations and imaging features, the diagnosis of pulmonary mycosis is difficult. This study aimed to investigate the pathogens, clinical manifestations, imaging features, diagnosis and management of pulmonary mycosis.MethodsData on 68 patients diagnosed as pulmonary mycosis in Xiang Ya hospital from January 2001 to December 2010 were collected and their clinical manifestations, radiographic characterization, diagnostic methods and management were analyzed.ResultsAll patients were diagnosed by pathological examination. Of the 68 cases, 38 (55.9%) had pulmonary aspergillosis and 19 (27.9%) pulmonary cryptococcosis. Open-lung surgery was performed in 38 patients (55.9%), transbronchial biopsy in 15 (22.0%), and computerized tomography (CT) guided percutaneous needle biopsy in 11 (16.2%). Main symptoms were as follows: cough in 51 cases (75.0%), expectoration in 38 (55.9%), hemoptysis in 25 (37.8%), fever in 20 (29.4%), while 6 cases (11.1%) were asymptomatic. X-ray and chest CT showed masses or nodular lesions in 52 cases (76.5%), patchy lesions in 10 (14.7%), cavity formation in 15 (22.0%), and diffuse miliary nodules in 1 case. In 51 cases (75.0%) misdiagnosis before pathological examination occurred. Surgical resection was performed in 38 patients (55.9%). In 25 patients (36.7%) systemic antifungal therapy was administered, and 20 patients (29.4%) experienced complete responses or partial responses.ConclusionThe main pathogens of pulmonary mycosis are Aspergillus, followed by cryptococcosis. Final diagnosis of pulmonary mycosis mainly depends on pathological examination. The clinical manifestations, imaging features, diagnostic methods and management differ depending on the pathogens. Satisfactory therapy can be obtained by both antifungal and surgical treatment.