Introduction Double-lumen endotracheal tubes (DLTs), which are commonly used for single-lung ventilation during surgery, are difficult to insert. In addition, they often move during surgical lung manipulation which can cause lifethreatening complications. Flexible bronchoscopy is used routinely to establish and confirm proper DLT placement. The newly designed VivaSight DLT has an integrated camera, allowing continuous visualization of its position in the trachea. We hypothesized that the time to intubation using the VivaSight DLT would be faster than with a conventional DLT. Methods We enrolled 40 adults scheduled for thoracic surgery. Patients were randomized to conventional DLT (n = 20) or VivaSight DLT (n = 20). Time to intubation was our primary outcome. Secondary outcomes were insertion success without flexible bronchoscopy, frequency of tube displacement, ease of insertion, quality of lung collapse, postoperative complaints, and airway injuries. Results Time [mean (SD)] to successful intubation was significantly faster with the VivaSight DLT [63 (58) sec] compared with the conventional DLT [97 (84) sec; P = 0.03]. The VivaSight DLTs were correctly inserted during all attempts. When malpositioning of the VivaSight DLT occurred, it was easily remedied, even in the lateral position. The devices were comparable with respect to postoperative coughing, hoarseness, and sore throat. Airway injuries tended to be more common with the VivaSight DLT, although this study was underpowered for airway injuries.Author contributions Rolf Schuepbach and Bastian Grande made substantial contributions to study conception and design, acquisition of data, and manuscript writing. Giovanni Camen and Alexander R. Schmidt made substantial contributions to acquisition and interpretation of data and helped draft the manuscript. Henrik Fischer made substantial contributions to analysis and interpretation of data and revised the article for important intellectual content. Daniel I. Sessler made substantial contributions to study conception and design, analysis and interpretation of data, and drafting the manuscript. Burkhardt Seifert made substantial contributions to analysis and interpretation of data and revised the manuscript for intellectual content. Donat R. Spahn made substantial contributions to study conception and design and assisted with manuscript revision. Kurt Ruetzler made substantial contributions to study conception and design; acquisition of data analysis and interpretation; and was responsible for drafting the manuscript. Single-lung ventilation is required in several clinical situations and for various surgical procedures. Perhaps the most frequent indication is thoracic surgery during

Although TEE provided important findings and therapeutic impact in postoperative cardiac surgical patients, patients with comparable preoperative risk who had postoperative TEE examinations had a significantly worse outcome than those without the need for postoperative TEE.

AIM OF THE STUDY: Non-intubated, video-assisted thoracoscopic surgery (NiVATS) has been successfully developed in several centres worldwide. Local anaesthesia techniques and techniques to perform thoracoscopic surgery on a spontaneously breathing lung are the two key elements which must be adopted to establish a NiVATS programme. We established NiVATS by performing bilateral, uniportal sympathectomies, and compared it to classical video-assisted thoracoscopic surgery (VATS) under general anaesthesia with double-lumen intubation.METHODS: Ten consecutive bilateral VATS sympathectomies were compared with ten consecutive NiVATS procedures. Nineteen of the procedures were for palmar hyperhidrosis and one was for facial blushing. Duration of anaesthesia, surgery and hospitalisation, perioperative complications, side effects and quality of life before and after sympathectomy were analysed. RESULTS: Median age was 26.5 years (range 17-55) and mean BMI in the NiVATS group was 21.8 (range 19.1-26.3). NiVATS sympathectomies were performed as outpatient procedures significantly more often (9/10 vs 3/ 10, p = 0.008). Quality of life was significantly increased after sympathectomy in all patients, with no significant differences between the NiVATS and the VATS groups. There were no differences between the two groups regarding compensatory sweating (40 vs 50%, p = 0.66). The duration of anaesthesia, not including the time required for the surgery, was significantly shorter in the Ni-VATS group (p <0.001). The duration of surgery, from the first local anaesthesia until the last skin suture, was significantly longer in the NiVATS group (p = 0.04), but showed a constant decline during the learning curve, from 95 minutes initially to 48 minutes for the last procedure. Costs were significantly lower in the NiVATS group (p = 0.04).CONCLUSION: Thoracoscopic sympathectomy is a suitable procedure with which to establish a NiVATS programme. Patients are usually young and of healthy weight, facilitating the learning curve for the local anaesthesia techniques and the surgery. Compared to VATS, sympathectomy is more likely to be performed as an outpatient procedure and has a lower cost, while safety and efficacy are maintained.

of LVAD support (932 §369 days vs. 462 §298 days, P=0.10), mean blood pressure (86 §9 mmHg vs. 83 §4 mmHg, P=0.43) or estimated pump flow (4.8 §0.9 L/min vs. 4.3 §0.6 L/min, P=0.32). Pulsatility index was higher in Group A than in Group B (5.6 §1.2 vs. 3.6 §0.6, P=0.006). Despite similar leukocyte counts (6.7 §0.9 £ 10 9 /L in Group A vs. 7.3 §0.8 £ 10 9 /L in Group B, P=0.52), hemoglobin (12.6 §7.3 g/dL vs. 13.5 §1.6 g/dL, P=0.28) and serum iron (16 §10 mmol/L vs. 14 §5 mmol/L, P=0.66) we found significantly higher peripheral CD34 + cell count in Group A than in Group B (2.4 §0.7 £ 10 6 /L vs. 1.6 §0.8 £ 10 6 /L, P=0.03). Overall, CD34 + cell count was inversely related to red cell distribution width (R2=0.-58, P=0.05). Conclusion: Non-pulsatile flow appears to be associated with lower numbers of peripheral CD34 + cells in LVAD-supported patients. This suggests that hemodynamic changes after prolonged LVAD support may significantly alter angiogenesis and vasculogenesis pathways in chronic heart failure.