Thoracotomy For Lung Resection Research Articles

201P Readability of thoracic surgery consent forms in Queensland, Australia

Written consent forms are a key component of obtaining informed consent from patients prior to lung cancer surgery. Reading literacy among Australians is generally poor, and it is recommended that written content is at a year 7 level to make it usable for most people. The aim of this project was to assess the readability of consent forms for thoracic surgery in Queensland, Australia. Queensland Health consent forms for “Thoracoscopy Surgical (VATS) &/or other procedures” and “Thoracotomy for Lung Resection” were obtained. The readability of the sections relating to risks of surgery (Section C), patient consent (Section G), and the patient information sheet were assessed via an online readability software program, using five separate validated methods: (i) Flesch-Kincaid grade level, (ii) the SMOG (Simple Measure of Gobbledygook), (iii) Coleman-Liau index, (iv) Automated readability index, (v) Linsear Wriste formula. Statistical analysis was performed using Microsoft Excel. The mean ± standard deviation reading grade level from all algorithms for risks of surgery, patient consent, and patient information was 7.81 ± 1.75, 10.77 ± 0.75, and 7.59 ± 1.14 respectively. The “Thoracotomy” form had the highest average grade level (8.81 ± 1.85) followed by “Thoracoscopy Surgical (VATS) &/or other procedures” (8.63 ± 2.06). Significant inter-algorithm differences were noted, with the Coleman-Liau nearly two grades higher than others, however the patient consent subsection was consistently above the recommended reading grade of year 7 among all algorithms. The readability of key sections of the Queensland Health thoracic surgery consent forms is above the recommended reading grade of year 7, and a large percentage of the population would be unable to fully comprehend the information. Consideration should be made to lower the reading grade level of patient consent forms.

One-lung ventilation in a patient with a large mass on the glottis

Rationale:One-lung ventilation (OLV) is required during most thoracic surgeries to facilitate surgical visualization by collapsing the lung. Double-lumen tubes and bronchial blockers are two commonly used devices for OLV; however, it may be difficult to place two devices in patients with narrow inlets, such as those that have tumor-induced airway stenosis.Patient concerns:We report the case of an adult patient with a lung tumor that was growing rapidly and hemorrhaging; thus, a thoracotomy for lung resection should have been performed as early as possible. However, a large mass on the glottis obstructed the entry of the double-lumen tube or bronchial blocker. Therefore, the operation could not be performed because of the inability to provide one-lung ventilation via the conventional intubation method.Diagnoses:Computed tomography (CT) revealed a lung tumor that was growing rapidly and preoperative bronchoscopy showed a large mass on the vocal cords.Interventions:After anesthesia induction, a Uniblocker and a small single lumen tube were intubated and the Uniblocker was inserted extraluminally of the single lumen tube. One-lung ventilation was achieved successfully in this patient.Outcomes:The surgery proceeded uneventfully for 4 hours without any complications.Lessons:Extraluminal use of the Uniblocker and a small single lumen tube may be recommended for patients receiving OLV and who have narrow inlets, especially under emergency situations.

Single-port video-assisted thoracoscopic surgery lung resection: experiences in Fujian Medical University Union Hospital.

Video-assisted thoracoscopic surgery (VATS) is currently a better choice than thoracotomy for lung resection, and then single-port VATS has been increasingly applied in clinical settings with the improvements in both endoscopic instruments and surgical skills. Our center began to perform single-port VATS lobectomy in May 2014 and had performed all sort of lung resection in 168 patients till December 2014, including wedge resection, routine lobectomy, sleeve lobectomy, segmentectomy and pneumonectomy. All these procedures were successfully performed without any severe complication. We believe the single-port VATS lung resection is a safe and feasible procedure after surgery practice.

Predictors of Prolonged Postoperative Endotracheal Intubation in Patients Undergoing Thoracotomy for Lung Resection

Predictors of Prolonged Postoperative Endotracheal Intubation in Patients Undergoing Thoracotomy for Lung Resection

Predictors of Prolonged Postoperative Endotracheal Intubation in Patients Undergoing Thoracotomy for Lung Resection

Predictors of Prolonged Postoperative Endotracheal Intubation in Patients Undergoing Thoracotomy for Lung Resection

Efficacy of Addition of Fentanyl to Epidural Bupivacaine on Postoperative Analgesia After Thoracotomy for Lung Resection in Infants

Efficacy of Addition of Fentanyl to Epidural Bupivacaine on Postoperative Analgesia After Thoracotomy for Lung Resection in Infants

Efficacy of Addition of Fentanyl to Epidural Bupivacaine on Postoperative Analgesia after Thoracotomy for Lung Resection in Infants

The authors evaluated the efficacy of adding fentanyl to epidural bupivacaine in infants up to 6 months of age after a thoracotomy in a prospective, randomized, double-blind study. The primary outcome was the total amount of rescue doses of intravenous nalbuphine in the first 24 h after surgery. Secondary outcomes included (1) time to first rescue dose of nalbuphine, (2) pain scores, and (3) behavior scores. Thirty-two infants were randomly assigned to receive an epidural infusion containing 0.1% bupivacaine (group B; n = 16) or 0.1% bupivacaine and 2 microg/ml fentanyl (group BF; n = 16). Patients were evaluated up to 24 h after surgery for pain; amount of analgesic rescues and time to first rescue; pain scores; behavior scores (five-item behavior score); and complications, including respiratory depression, oxygen requirement, vomiting, and urinary retention. The two groups had similar demographics. Nalbuphine consumption (P = 0.001) and pain scores (P < 0.001) in the first 24 h were significantly decreased in group BF compared with group B. The time to first analgesic rescue was significantly longer in group BF (P = 0.005). The five-item behavior score was significantly better in group BF than in group B (P = 0.01). The incidence of side effects, the time to first successful feeding, and the time to discharge were similar in both groups. Addition of 2 microg/ml epidural fentanyl to 0.1% bupivacaine results in improved postthoracotomy analgesia without any increase in side effects, compared with 0.1% bupivacaine, in infants up to 6 months of age.

Cardiac tamponade: An unusual complication following left upper lobectomy for post-tubercular aspergilloma: A case report

Pulmonary aspergilloma is a potentially life threatening disease resulting from the colonization of lung cavity by the ubiquitous fungus Aspergillus fumigatus. Surgical resection of lobe containing fungal ball is the accepted treatment modality. The average reported mortality for resection is approximately 10% with a range of 0 to 43%1-3, and a similar wide variability has been reported for postoperative complications. The most common complications after thoracotomy for lung resection have been bronchopleural fistula, persistent air space, and empyema. Cardiac complications occur less frequently and include rhythm disturbances, myocardial infarction and congestive heart failure4. Although cardiac tamponade resulting from air or other gases has been reported, that because of bleeding is not commonly cited in the literature5. We present one such case following left upper lobectomy for post tubercular aspergilloma due to inadvertent injury of epicardial vein on the obtuse border of left ventricle

Epidural clonidine, bupivacaine or methadone as the sole analgesic agent after thoracotomy for lung resection

Department of Anaesthesia and Critical Care Medicine, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel

Thoracic epidural analgesia: Its role in postthoracotomy atrial arrhythmias

Objective: To determine the effects of thoracic epidural analgesia (TEA) management on the incidence of atrial arrhythmias (AAs) after thoracotomy for lung resection. Design: Retrospective. Setting: A major university medical center. Participants: The medical records of 185 consecutive patients who underwent thoracotomy between 1993 and 1997 were reviewed; patients with TEA only were included in the analysis. Interventions: None. Measurements and Main Results: There was a 20% incidence of AAs after thoracotomy. Preoperative predictors of AAs were age >65 years, cardiac history, and an abnormal electrocardiogram (ECG). There was a temporal relationship between epidural catheter removal and occurrence of AAs. Fourteen patients developed AAs before TEA catheter removal, whereas 29 patients developed AAs after TEA catheter removal (p = 0.01). There was no relationship between anatomic site of epidural catheter placement or choice of epidural agent and AAs. Conclusions: AAs after thoracotomy were common. These AAs were associated with increased age, cardiac history, abnormal ECG, increased cost, increased length of hospital stay, and time of epidural catheter removal. Although a cause-and-effect relationship cannot be inferred from this study, the presence or absence of TEA was found to have a temporal relationship with the incidence of AAs. Copyright © 2000 by W.B. Saunders Company

Massive contralateral pneumonia following thoracotomy for lung resection

Separation of the lungs with a double-lumen endobronchial tube facilitates the surgical approach and protects the bronchial system from contamination by pus or blood from the operated lung. We report a case of a 49-year-old man who suffered a gram-negative pneumonia requiring mechanical ventilatory support and prolonged hospitalization after pulmonary resection. Contamination of the ventilated-dependent lung was documented intraoperatively. Current information on postoperative infectious complications and preventive measures are discussed.

Contralateral tension pneumothorax during thoracotomy for lung resection

A patient underwent right thoracotomy and upper lobectomy for a mass found on routine chest radiography. He became profoundly cyanosed with a bradycardia and severe reduction in oxygen saturation at completion of surgery. The diagnosis of tension pneumothorax on the contralateral side to surgery was made and treatment instituted. The causes, treatment and implications of such an event during general anaesthesia for lung resection are discussed.

Continuous high thoracic epidural administration of bupivacaine with sufentanil or nicomorphine for postoperative pain relief after thoracic surgery.

In a prospective study, 40 patients who had undergone thoracotomy for lung resection were investigated. During operation, all patients received intravenous anesthesics, halothane and an initial dose of bupivacaine 0.5% with epinephrine 5 micrograms.ml-1 (5 to 10 ml) by thoracic epidural catheter. One hour after the initial dose of bupivacaine 0.5% with epinephrine, patients were divided in two groups for analgesia, the sufentanil group (50 micrograms sufentanil in 60 ml bupivacaine 0.125%) or the nicomorphine group (3 mg nicomorphine in 60 ml bupivacaine 0.125%) by a continuous epidural infusion (5 to 10 ml.h-1) for three days. Cardiovascular differences between the sufentanil group and the nicomorphine group were not statistically significant per- or postoperatively. The minimum respiratory frequency on either Day 1, 2, or 3 was 12 breaths.min-1 in the sufentanil group, corresponding to a PaCO2 of 32 mmHg, and 11 breaths.min-1, corresponding to a PaCO2 of 41 mmHg in the nicomorphine group. On Day 1, the PaCO2 in the sufentanil group was significantly lower (p less than 0.01), but in both groups the PaCO2 on Day 1 was significantly higher than the preoperative value. An inverse visual analogue pain scale (0 to 10 IVAS) showed mean scores above 7.5 for all patients during the three days. Scoring pain relief during exercise showed a significant difference in favor of the sufentanil group on Days 1, 2, and 3 (p less than 0.0008). The mean plasma bupivacaine level doubled every day, 138 ng.ml-1 on Day 1, 290 ng.ml-1 on Day 2, and 596 ng.ml-1 on Day 3.(ABSTRACT TRUNCATED AT 250 WORDS)