Background: Thoracic surgery often demands separation of ventilation between the lungs. It is achieved with double-lumen tubes (DLTs), video double-lumen tubes (VDLTs) or bronchial blockers. We tested the hypothesis that intubation with the VivaSight double-lumen tube would be easier and faster than with a standard DLT.Methods: Seventy-one adult patients undergoing thoracic procedures that required general anaesthesia and one-lung ventilation (OLV) were enrolled in this randomized, prospective study. Patients were randomly assigned to procedure of intubation with a standard DLT or VDLT. The collected data included: patients' demographics, surgery information, anthropometric tests used for difficult intubation prediction, specifics of intubation procedure, tube placement, fiberoptic bronchoscopy (FOB) use, lung separation, trachea temperature, and reported complications of intubation.Results: For DLTs compared to video-double lumen tubes, intubation time was significantly longer (125 vs. 44 s; P<0.001), intubation graded harder (P<0.05) and FOB use was more prevalent [8 (20.5%) vs. 0; P<0.05]. Conclusions:The use of VDLTs when compared with standard-double lumen tubes offers reduced intubation time and is relatively easier. Also, the reduced need for fibreoptic bronchoscopy may improve the cost-effectiveness of VDLT use. In addition, constant visualization of the airways during the procedure allows to quickly correct or even prevent the tube malposition.Trial Registration: The study was registered in the ClinicalTrials.gov registry, ID: NCT04101734.
Substantial efforts have been undertaken to identify and minimise factors responsible for the development of ventilator-induced lung injury. A novel approach to this problem addresses energy dissipated in lung tissue during the breathing cycle as one of the key problems. Flow-controlled ventilation is a new modality of mechanical ventilation based on a constant flow during both inspiration and expiration. This review aims to evaluate the current evidence available regarding flow-controlled ventilation. Lastly, three cases of flow-controlled ventilation application are presented: ventilation with a small lumen tube during tracheal resection, one-lung ventilation during thoracoscopic lobectomy, and ventilation of a critically ill patient with acute respiratory distress syndrome in an intensive care unit setting.
One-lung ventilation is also used in some thoracic or cardiac surgery, vascular surgery and oesophageal procedures. We conducted a search of the literature for relevant studies in PubMed, Web of Science, Embase, Scopus and Cochrane Library. The final literature search was performed on 10 December 2022. Primary outcomes included the quality of lung collapse. Secondary outcome measures included: the success of the first intubation attempt, malposition rate, time for device placement, lung collapse and adverse events occurrence. Twenty-five studies with 1636 patients were included. Excellent lung collapse among DLT and BB groups was 72.4% vs. 73.4%, respectively (OR = 1.20; 95%CI: 0.84 to 1.72; p = 0.31). The malposition rate was 25.3% vs. 31.9%, respectively (OR = 0.66; 95%CI: 0.49 to 0.88; p = 0.004). The use of DLT compared to BB was associated with a higher risk of hypoxemia (13.5% vs. 6.0%, respectively; OR = 2.27; 95%CI: 1.14 to 4.49; p = 0.02), hoarseness (25.2% vs. 13.0%; OR = 2.30; 95%CI: 1.39 to 3.82; p = 0.001), sore throat (40.3% vs. 23.3%; OR = 2.30; 95%CI: 1.68 to 3.14; p < 0.001), and bronchus/carina injuries (23.2% vs. 8.4%; OR = 3.45; 95%CI: 1.43 to 8.31; p = 0.006). The studies conducted so far on comparing DLT and BB are ambiguous. In the DLT compared to the BB group, the malposition rate was statistically significantly lower, and time to tube placement and lung collapse was shorter. However, the use of DLT compared to BB can be associated with a higher risk of hypoxemia, hoarseness, sore throat and bronchus/carina injuries. Multicenter randomized trials on larger groups of patients are needed to draw definitive conclusions regarding the superiority of any of these devices.
Background: Chest surgery is associated with significant pain, and potent opioid medications are the primary medications used for pain relief. Opioid-free anaesthesia (OFA) combined with regional anaesthesia is promoted as an alternative in patients with an opioid contraindication. Methods: Objective: To assess the efficacy of OFA combined with a paravertebral block in pain treatment during video-assisted thoracic surgery. Design: A randomized, open-label study. Setting: A single university hospital between December 2015 and March 2018. Participants: Sixty-six patients scheduled for elective video-assisted thoracic surgery were randomized into two groups. Of these, 16 were subsequently excluded from the analysis. Interventions: OFA combined with a paravertebral block with 0.5% bupivacaine in the OFA group; typical general anaesthesia with opioids in the control group. Main outcome measures: Intraoperative nociceptive intensity measured with a skin conductance algesimeter (SCA) and traditional intraoperative monitoring. Results: Higher mean blood pressure was observed in the control group before induction and during intubation (p = 0.0189 and p = 0.0095). During chest opening and pleural drainage, higher SCA indications were obtained in the control group (p = 0.0036 and p = 0.0253), while in the OFA group, the SCA values were higher during intubation (p = 0.0325). SCA during surgery showed more stable values in the OFA group. Pearson analysis revealed a positive correlation between the SCA indications and mean blood pressure in both groups. Conclusions: OFA combined with a paravertebral block provides effective nociception control during video-assisted thoracic surgery and can be an alternative for general anaesthesia with opioids. OFA provides a stable nociception response during general anaesthesia, as measured by SCA.
Breast cancer is the most common oncological disease among women in the population of Western countries. it affects nearly 1.5 million patients per year globally [1]. Despite the increasing number of cases, early detection and diagnosis are constantly improving. Growing social awareness and greater availability of oncological procedures cause more patients to require surgical treatment. Oncological breast surgery has evolved significantly in the last two decades, and breast conserving therapy (Bct), followed by radiotherapy and oncoplastic procedures, is replacing the less frequently performed radical procedures. Particular emphasis is placed on limiting the extent of the procedure, comprehensive treatment, and individualization. the change of approach, multidisciplinary and comprehensive treatment, and better knowledge about cancer biology have all improved patients' survival from 45-50% at the beginning of the 20 th century to almost 90% today [2]. currently, a patient suffering from breast
StreszczenieWstęp: Leczeniem przyczynowym chorych z nużliwością mięś-niową (ang. myasthenia gravis -MG) jest z wyboru usunięcie grasicy. U pacjentów z MG zastosowanie środków zwiotczających w celu przeprowadzenia operacji stanowi zagrożenie przedłużonej intubacji i wentylacji mechanicznej w okresie pooperacyjnym. Największym odkryciem ostatnich lat w anestezjologii jest środek odwracający blokadę nerwowo-mięśniową o nazwie sugammadeks. Preparat jest modyfikowaną gamma-cyklodekstryną, która opłaszcza i inaktywuje cząsteczki środków zwiotczających, tworząc z nimi kompleksy wydalane następnie przez nerki. Celem pracy była ocena użyteczności sugammadeksu w odwróceniu blokady nerwowo-mięśniowej wywołanej rokuronium po operacjach usunięcia grasicy u pacjentów z MG. Materiał i metody: Dwudziestu dwóch chorych z MG poddanych małoinwazyjnej operacji usunięcia grasicy podzielono na 2 grupy w zależności od użytego środka odwracającego zwiotczenie mięśni poprzecznie prążkowanych (S-sugammadeks vs. P-polstygmina). Monitorowanie głębokości blokady nerwowo-mięśniowej umożliwiło prawidłowe dawkowanie zarówno rokuronium, jak i środków odwracających blokadę nerwowo-mięśniową. Ocenie poddano czas od podania rokuronium do uzyskania blokady (T0), od podania środka odwracającego blokadę do powrotu wydolnego oddechu i ekstubacji (T1) oraz czas trwania zabiegu (T2). Oceniano wartości ciśnień tętniczych, skurczów serca i pulsoksymetrii w czterech punktach czasowych. Protokół znieczulenia w obu grupach zawierał indukcję i podtrzymanie znieczulenia metodą anestezji całkowicie dożylnej; analgezję zapewniono metodą zewnątrzoponową w odcinku piersiowym, z użyciem bupiwakainy.
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