The Year in Thoracic Anesthesia: Selected Highlights from 2016

Boisen, Michael L.; Rao, Vidya K.; Kolarczyk, Lavinia; Hayanga, Heather K.; Gelzinis, Theresa A.

doi:10.1053/j.jvca.2017.02.182

Cited by 10 publications

(9 citation statements)

References 65 publications

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“…Ventilator-induced lung injury, compounded by residual muscle relaxation, can lead to atelectasis, hypoxemia, and the impairment of protective reflexes and [ 5 ] volatile agents as well as muscle relaxants and reversal agents can induce nausea and vomiting. Other disadvantages of video-assisted thoracoscopy with general endotracheal anesthesia (VATS-GETA) include compromised cardiac performance and impaired early postoperative respiratory function due to residual paralysis, postoperative pain, nausea, and vomiting and the inability to cough, increasing the risk of pneumonia [ 6 ].…”

Section: Advantagesmentioning

confidence: 99%

“…There were no differences between in surgical time, intraoperative blood loss, and perioperative complications. In select populations, patients undergoing minor procedures using tubeless NIVATS have been managed as day surgery patients [ 6 ].…”

Section: Uniportal Approachmentioning

confidence: 99%

“…Single-lung ventilation is achieved by an artificial pneumothorax, created by the equalization of the intrapleural and atmospheric pressures. The lung collapse produced by the surgical pneumothorax is similar to that seen with intubated single-lung ventilation [ 6 ]. Hypoxia is less frequent with NIVATS than VATS-GETA due to spontaneous ventilation with efficient diaphragmatic contraction in the lateral decubitus position that optimizes ventilation perfusion matching in the dependent lung.…”

Section: Surgical Techniquementioning

confidence: 99%

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The Anesthetic Management of Patients Undergoing Nonintubated Video-Assisted Thoracic Surgery

Gelzinis

2021

Curr Anesthesiol Rep

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Purpose of Review This review focuses on describing the procedural and anesthetic management of patients undergoing nonintubated video-assisted thoracoscopy surgery. Recent Findings Most thoracic surgery is performed under general endotracheal anesthesia with either a double lumen endotracheal tube or a bronchial blocker. In an attempt to lessen the incidence and severity of postoperative complications, the nonintubated videoassisted thoracoscopic technique was developed, where the surgical procedure is performed under regional anesthesia with sedation. Currently, this technique is recommended for the elderly and in patients with severe cardiopulmonary disease who are at increased risk of complications after general anesthesia. It is the role of the anesthesia team to assist in the decisions whether the patient is a candidate and which block should be performed and to carefully monitor these patients in the operating room. Summary Nonintubated video-assisted thoracic surgery is an emerging technique with the goal of reducing postoperative complications. The anesthetic technique is highly variable and ranges from general anesthesia with a laryngeal mask airway with a truncal block to thoracic epidural anesthesia with minimal to no block. It is important to have excellent communication with the surgical team and the patient to ensure a safe, successful procedure.Keywords Video-assisted thoracic surgery . Uniportal technique . Thoracic epidural analgesia . Paravertebral block . Intercostal block . Serratus anterior block . Erector spinae plane block . Pendular respiration . Artificial pneumothorax Upon completion of this lesson, the reader should be able to: 1. Define the concept of nonintubated video-assisted thoracic surgery. 2. Discuss the potential advantages of NIVATS. 3. Consider the patient population that would benefit from the NIVATS technique. 4. Review the patient, anesthetic, and surgical contraindications for NIVATS. 5. Discuss the procedures that can be performed using the NIVATS technique. 6. Discuss the preoperative assessment for NIVATS. 7. Review the anesthetic technique for NIVATS. 8. Review the regional blocks used for NIVATS. 9. Demonstrate the goals of the intraoperative management for patients undergoing the NIVATS procedure. 10. Recognize and treat complications that can occur during NIVATS. This article is part of the Topical Collection on Thoracic Anesthesia

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Section: Advantagesmentioning

confidence: 99%

Section: Uniportal Approachmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

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The Anesthetic Management of Patients Undergoing Nonintubated Video-Assisted Thoracic Surgery

Gelzinis

2021

Curr Anesthesiol Rep

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“…The development of minimally invasive technique is one of the main elements of the new approach to surgery, in which the fulcrum is the quality of life of patients. Consequently, diffusion of programs such as ERAS and the reduction of invasiveness during the anesthesiologic phase, in particular intubation and analgesia management, is fundamental (27,28).…”

Section: Expert Opinion 2: Dr Carmelina C Zirafamentioning

confidence: 99%

The 100 most cited articles on thoracic surgery management of lung cancer

Jin

et al. 2019

J. Thorac. Dis.

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Identification of the top 100 cited articlesBetween July and August 2018 , we performed a retrospective bibliometric analysis, identifying articles through the Web of Science (Thomson Reuters, New York, USA) which searches the Science Citation Index Expanded database, allowing access to over 12,000 peer reviewed journals and collected citation data published since 1945.Using selected key terms ("lung cancer", "surgery'", "lobectomy", "segmentectomy", "pneumonectomy", "wedge resection", "video-assisted thoracic surgery", "thoracotomy"), our search performed between July and August 2018 yielded a total of 18,268 articles. The top 100 articles were identified subsequently which were ranked by the number of citations. Analysis of the top 100 cited articlesA further analysis of individual articles was carried out by three reviewers (J Shen, K Jin, and Q Hu) to extract relevant information for the analysis. Individual articles were reviewed to identify the authorship, journal title, journal IF, subject matter, article type (e.g., prospective analysis, retrospective analysis, meta-analysis or systematic review, randomized controlled trial, review article, guideline, technical note, or case report), institution and country of origin, level of evidence, and year of publication. The analysis method used the Australian National Health and Medical Research Council evidence hierarchy (11). Of note, this classification defines clinical guidelines as level I evidence and randomized control trials as level II evidence.Furthermore, the citation count and citations per year were extracted using the Web of Science. When there was disagreement or discordance between reviewers, the senior author (D Ma) was included to achieve consensus. ResultsThe top 100 articles regarding the thoracic surgery management of lung cancer according to the most citations received are listed in Table 1."Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer", published in The New England Journal of Medicine in 2004, has received totally 1,720 citations, the most citations in the past 14 years. Of note, it also remains the most cited article per year, being cited 122.86 times on average, per year. The article with the lowest number of citations in the top 100 list, "A practical molecular assay to predict survival in resected non-squamous, non-small-cell lung cancer: Development and international validation studies", received 177 citations. Overall, the mean number of citations was 356, with the top 100 articles cited an average of 26 times per year.Only one of the top 100 articles was published prior to 1980 (Table 2), with 63% (n=63) published since the year 2000 and 13% published within the past decade. Eighteen authors contributed four or more articles (Table 3). Rusch, Ginsberg, Johnson, and Livingston have contributed the most articles. Rusch and Ginsberg were the first named authors on four articles each. Rusch is the most published author, appearing on a total of ten articles.A total of 31 journals mad...

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“…Anaesthetic details were not reported as the study did not 'require sites to supply specific an[a]esthetic details' [30]. As with the database coding above, such an approach leads to significant variation within and between modes of anaesthesia and potentially combines disparate techniques: for example, the use of premedication; sedation in addition to LA/RA; or indeed the use of LA/RA in addition to GA. As the authors of a review on nonintubated video-assisted thorascopic surgery report, the 'anaesthetic management described for this surgical technique is just as varied as the indications themselves' [31]. This is demonstrated in a review across a range of surgical specialties comparing RA (neuraxial blockade) with GA and reporting a reduction in mortality and morbidity with the former [32].…”

Section: Implications For Clinical Trialsmentioning

confidence: 99%