Anesthetic considerations for video-assisted thoracoscopic surgery in a child with Glenn shunt for thoracic duct ligation and pleurodesis

Abstract

Glenn shunt is an anastomosis between superior vena cava and right pulmonary artery to palliate patients with single ventricle physiology of the heart. Chylothorax is a frequent and troublesome complication after the creation of this shunt, which if not controlled with medical management, might require pleurodesis, and thoracic duct ligation. Video-assisted thoracoscopic surgery (VATS) causes less postoperative pain, earlier mobilization, lower overall morbidity, a shortened hospital stay with reduced cost, and a cosmetic incision. A comprehensive understanding of physiology of Glenn shunt and implications of the proposed surgical procedure (VATS) is necessary to plan the anesthetic agents, cardiovascular drugs, ventilation strategies, and other perioperative factors.

Clinical value and application of preoperative CT-guided hookwire localization of solitary pulmonary nodules for video-assisted thoracic surgery

“…A primary factor that limits the success rate of thoracoscopic resection of subcentimeter or lowattenuation pulmonary nodules via VATS is the accurate localization of the target nodule as it is difficult to distinguish or palpate thesenodules intraoperatively [13]. Moreover, a majority of small nodules that are deeply situated in the lung, or have ground glass opacities, can be difficult to localize with VATS.…”

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

“…5. Conservative treatment Methods of conservative treatment were presented in 77 articles and referred to 531 children described in the chart 1 [2-3], [7], [11][12][13][14], [17], [19][20], [22][23], [25][26][27][28][29], [31][32][33], [35][36][37][38][39][40][41][42][43][44][45],…”

“…It is possible to achieve such a result by introducing dietary supplements containing medium chain triglycerides (MCT) or starting the patient on a total parenteral nutrition (TPN) [5], [82], [83]. As much as 33.7 % of children from the reviewed literature was treated with the first of the abovementioned methods [2], [17], [19], [23], [25], [33], [40], [40], [43], [52], [56], [72], [77], [79], [81], [84]- [89]. It is preferred mainly in patients with normal circulatory and respiratory function [5].…”

“…Treatment with somatostatin or octreotide has been implemented in more than half of the patients from the reviewed literature, in addition to dietary modifications (56,3%) and it achieved a desired therapeutic effect in 63.2 % of them. [2-3], [11][12], [17], [19][20], [25]- [28], [31]- [33], [37], [39], [41]- [43], [45], [52], [54]-[57], [62]- [64], [66], [70][71], [73], [77]- [80], [84], [86][87], [91][92], [95][96], [98], [103] Due to certain differences in pharmacokinetic properties and route of administration, octreotide is a more popular choice (79,9 % of patients) than somatostatin (10,4 %) [3], [11][12], [17], [19][20], [25]- [27], [31][32][33], [37], [39], [41]- [43], [45], [52],...…”

“…In such circumstances, a specific treatment was administered in order to limit the risk of further chylothorax progression and deterioration of patient's clinical status. Sildenafil, which is a phosphodiesterase type 5 (PDE5) inhibitor, increases the concentration of cGMP in the cells of the smooth muscles of the pulmonary vessels, leading to pulmonary vasodilation, which prevents the development of pulmonary hypertension [17], [26], [55]. In the event of chyle infection in the pleural cavity, antibiotic therapy is initiated [17], [41], [66], [75].…”