Background. General anesthesia with single-lung ventilation is considered mandatory for thoracoscopic pulmonary resection. We assessed in a randomized study the feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules.Methods. Between March 2001 and February 2003, 60 patients were randomized into two 30-patients arms: a general anesthesia arm entailing double-lumen intubation and thoracic epidural anesthesia (control group); and an awake arm entailing sole thoracic epidural anesthesia at T4-T5 (awake group). Anesthesia time; operative time; global operating room time; patient satisfaction with the anesthesia and technical feasibility scored into 4 grades (from 1 ‫؍‬ poor to 4 ‫؍‬ excellent); visual analog pain score (VAS), nursing care (number of patient calls per day), 24 hours changes in arterial oxygenation (⌬PaO 2 ), and hospital stay were assessed.Results. There was no mortality. There was no difference

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Post-herpetic neuralgia is the most challenging and debilitating complication of herpes zoster in the immunocompetent host. Because the effect of treatment is disappointing once the syndrome has developed, it is important to know which factors predict post-herpetic neuralgia occurrence to facilitate selection of herpes zoster patients with a higher risk of developing neuralgia and undertake preventative strategies. The present study aimed at identifying demographic, clinical and psychosocial correlates of postherpetic neuralgia in a sample of 219 immunocompetent patients, who were examined by dermatologists in private practice in Italy and who completed a questionnaire designed to evaluate their clinical and psychosocial profile at the time of clinical diagnosis of herpes zoster and at a follow-up visit 6 months later. In a univariate analysis, post-herpetic neuralgia was associated significantly with older age, longer duration of prodromal pain, greater acute pain intensity, greater extent of rash, presence of abnormal sensations and use of systemic antiviral therapy. Compared to the values at herpes zoster onset, at the follow-up visit patients with post-herpetic neuralgia presented with similar high mean scores of pain intensity, anxiety and depression and greatly reduced quality of life, whereas patients without neuralgia presented with improved scores. In a multivariate model, older age, greater acute pain intensity, greater extent of rash and longer duration of prodromal pain were independently associated with postherpetic neuralgia. The results of this study may help physicians to identify patients with a higher risk of developing post-herpetic neuralgia and undertaking preventative strategies.

Objective: To assess the feasibility, safety, and early results of awake lung volume reduction surgery (LVRS) performed under thoracic epidural anesthesia by a new nonresectional technique. Summary Background Data: So far, resectional LVRS under general anesthesia and one-lung ventilation is the more frequently used technique, but procedure-related morbidity has been considerable. Methods: The study cohort included 12 patients undergoing unilateral awake LVRS. Evaluated parameters included technical feasibility and anesthesia satisfaction scored into 4 grades (from 1 ϭ poor to 4 ϭ excellent), global operating room time, and arterial carbon dioxide tension (PaCO 2 ). In addition, 6-month changes in outcome measures, including forced expiratory volume in 1 second (FEV1), residual volume (RV), 6-minute walking test (SMWT), and dyspnea index were recorded. Perioperative and 6-month results were comparable with those of a control group undergoing unilateral resectional LVRS. Results: Technical feasibility was excellent to satisfactory in 11 patients. One patient required conversion to one-lung ventilation. Differences between the awake and control group included global operating room time (90 Ϯ 17 minutes versus 145 Ϯ 19 minutes, P Ͻ 0.00001); PaCO 2 24 hours after surgery (45 Ϯ 6 mm Hg versus 49 Ϯ 6 mm Hg, P ϭ 0.02); and hospital stay (7.8 Ϯ 5 days versus 11.7 Ϯ 4 days, P ϭ 0.02). Significant (P Ͻ 0.002) improvements occurred at 6 months in FEV1 (0.31 Ϯ 0.17 L), RV (Ϫ1.41 Ϯ 0.7 L), SMWT (73 Ϯ 25 m), and dyspnea index (Ϫ1.3 Ϯ 0.5) and were comparable with those of the control group. Conclusions: In this study, awake nonresectional LVRS proved feasible and safe. This new modality was associated with a faster recovery and satisfactory 6-month outcome, which did not differ from that of resectional LVRS. (Ann Surg 2006;243: 131-136)