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Cauti FM, Capone S, Rossi P, Polselli M, Venuta F, Vannucci J, Bruno K, Pugliese F, Tozzi P, Bianchi S, Anile M. Cardiac sympathetic denervation for untreatable ventricular tachycardia in structural heart disease. Strengths and pitfalls of evolving surgical techniques. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01404-9. [PMID: 36282370 DOI: 10.1007/s10840-022-01404-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/19/2022] [Indexed: 10/31/2022]
Abstract
Cardiac sympathetic denervation (CSD) is a valuable option in the setting of refractory ventricular arrhythmias in patient with structural heart disease. Since the procedure was introduced for non structural heart disease patients the techniques evolved and were modified to be adopted in several settings. In this state-of-the-art article we revised different techniques, their rationale, strengths, and pitfalls.
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Affiliation(s)
- Filippo Maria Cauti
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy.
| | - Silvia Capone
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
- Cardiology Unit, Dipartimento Cuore E Grossi Vasi, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Pietro Rossi
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
| | - Marco Polselli
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
| | - Federico Venuta
- Thoracic Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Jacopo Vannucci
- Thoracic Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Katia Bruno
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Francesco Pugliese
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Pierfrancesco Tozzi
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Stefano Bianchi
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
| | - Marco Anile
- Thoracic Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
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Yao W, Li M, Zhang C, Luo A. Recent Advances in Videolaryngoscopy for One-Lung Ventilation in Thoracic Anesthesia: A Narrative Review. Front Med (Lausanne) 2022; 9:822646. [PMID: 35770016 PMCID: PMC9235869 DOI: 10.3389/fmed.2022.822646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Since their advent, videolaryngoscopes have played an important role in various types of airway management. Lung isolation techniques are often required for thoracic surgery to achieve one-lung ventilation with a double-lumen tube (DLT) or bronchial blocker (BB). In the case of difficult airways, one-lung ventilation is extremely challenging. The purpose of this review is to identify the roles of videolaryngoscopes in thoracic airway management, including normal and difficult airways. Extensive literature related to videolaryngoscopy and one-lung ventilation was analyzed. We summarized videolaryngoscope-guided DLT intubation techniques and discussed the roles of videolaryngoscopy in DLT intubation in normal airways by comparison with direct laryngoscopy. The different types of videolaryngoscopes for DLT intubation are also compared. In addition, we highlighted several strategies to achieve one-lung ventilation in difficult airways using videolaryngoscopes. A non-channeled or channeled videolaryngoscope is suitable for DLT intubation. It can improve glottis exposure and increase the success rate at the first attempt, but it has no advantage in saving intubation time and increases the incidence of DLT mispositioning. Thus, it is not considered as the first choice for patients with anticipated normal airways. Current evidence did not indicate the superiority of any videolaryngoscope to another for DLT intubation. The choice of videolaryngoscope is based on individual experience, preference, and availability. For patients with difficult airways, videolaryngoscope-guided DLT intubation is a primary and effective method. In case of failure, videolaryngoscope-guided single-lumen tube (SLT) intubation can often be achieved or combined with the aid of fibreoptic bronchoscopy. Placement of a DLT over an airway exchange catheter, inserting a BB via an SLT, or capnothorax can be selected for lung isolation.
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Ramcharran H, Wallen J. Robotic-assisted thoracoscopic resection of anterior mediastinal cystic teratoma: a case report and literature review. J Cardiothorac Surg 2022; 17:67. [PMID: 35382841 PMCID: PMC8985258 DOI: 10.1186/s13019-022-01806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background Mediastinal teratomas are rare tumors that frequently occur in the anterior mediastinum. The majority of these tumors are benign and slow growing. Due to their low malignant potential, the treatment for these tumors is surgical resection. More recently, the surgical management has shifted from invasive approaches such as a sternotomy to minimally invasive ones such as robotic-assisted thoracoscopic resections utilizing lung isolation ventilation. We present a rare case of a locally advanced mediastinal teratoma requiring resection, which was initially attempted thoracoscopically using double lung ventilation. Case presentation A 43 year-old female was found to have an anterior mediastinal mass during work-up for an intermittent cough in 2009. Chest imaging and biopsy at the time showed evidence of a cystic teratoma without concerning features. She underwent imaging surveillance until 2018, when repeat chest imaging showed increasing growth and worrisome radiologic features concerning for malignant degeneration. She underwent an elective robotic-assisted thoracoscopic resection utilizing double lung ventilation, but due to extensive involvement of the right lung, pericardium, superior vena cava, and right phrenic nerve the patient had to be repositioned and started on single lung ventilation mid-procedure to facilitate a safe and complete resection. Conclusions Anterior mediastinal teratomas can be successfully removed by robotic-assisted thoracoscopic resections utilizing single lung ventilation. Though robotic-assisted thoracoscopic resection utilizing double lung ventilation can be effective in performing certain procedures such as lung wedge resections, thymectomy, pleural biopsies and minimally invasive cardiac procedures, it is limited in removing locally advanced mediastinal tumors.
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Affiliation(s)
- Harry Ramcharran
- Department of Thoracic Surgery, SUNY Upstate Medial University, 750 East Adams Street, Syracuse, NY, 13210, USA.
| | - Jason Wallen
- Department of Thoracic Surgery, SUNY Upstate Medial University, 750 East Adams Street, Syracuse, NY, 13210, USA
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Ren Y, Zhu X, Yan H, Chen L, Mao Q. Cardiorespiratory impact of intrathoracic pressure overshoot during artificial carbon dioxide pneumothorax: a randomized controlled study. BMC Anesthesiol 2022; 22:76. [PMID: 35321653 PMCID: PMC8941761 DOI: 10.1186/s12871-022-01621-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study is to evaluate cardiovascular and respiratory effects of intrathoracic pressure overshoot (higher than insufflation pressure) in patients who underwent thoracoscopic esophagectomy procedures with carbon dioxide (CO2) pneumothorax. METHODS This prospective research included 200 patients who were scheduled for esophagectomy from August 2016 to July 2020. The patients were randomly divided into the Stryker insufflator (STR) group and the Storz insufflator (STO) group. We recorded the changes of intrathoracic pressure, peak airway pressure, blood pressure, heart rate and central venous pressure (CVP) during artificial pneumothorax. The differences in blood gas analysis, the administration of vasopressors and the recovery time were compared between the two groups. RESULTS We found that during the artificial pneumothorax, intrathoracic pressure overshoot occurred in both the STR group (8.9 mmHg, 38 times per hour) and the STO group (9.8 mmHg, 32 times per hour). The recorded maximum intrathoracic pressures were up to 58 mmHg in the STR group and 51 mmHg in the STO group. The average duration of intrathoracic pressure overshoot was significantly longer in the STR group (5.3 ± 0.86 s) vs. the STO group (1.2 ± 0.31 s, P < 0.01). During intrathoracic pressure overshoot, a greater reduction in systolic blood pressure (SBP) (5.6 mmHg vs. 1.1 mmHg, P < 0.01), a higher elevation in airway peak pressure (4.8 ± 1.17 cmH2O vs. 0.9 ± 0.41 cmH2O, P < 0.01), and a larger increase in CVP (8.2 ± 2.86 cmH2O vs. 4.9 ± 2.35 cmH2O, P < 0.01) were observed in the STR group than in the STO group. Vasopressors were also applied more frequently in the STR group than in the STO group (68% vs. 43%, P < 0.01). The reduction of SBP caused by thoracic pressure overshoot was significantly correlated with the duration of overshoot (R = 0.76). No obvious correlation was found between the SBP reduction and the maximum pressure overshoot. CONCLUSIONS Intrathoracic pressure overshoot can occur during thoracoscopic surgery with artificial CO2 pneumothorax and may lead to cardiovascular adverse effects which highly depends on the duration of the pressure overshoot. TRIAL REGISTRATION Clinicaltrials.gov ( NCT02330536 ; December 24, 2014).
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Affiliation(s)
- Yunqin Ren
- Department of Anesthesiology, Daping Hospital, Army Medical University, 10 ChangjiangZhilu, Yuzhong District, 400042, Chongqing, China
| | - Xing Zhu
- Department of Anesthesiology, Daping Hospital, Army Medical University, 10 ChangjiangZhilu, Yuzhong District, 400042, Chongqing, China
| | - Hong Yan
- Department of Anesthesiology, Daping Hospital, Army Medical University, 10 ChangjiangZhilu, Yuzhong District, 400042, Chongqing, China
| | - Liyong Chen
- Department of Anesthesiology, Daping Hospital, Army Medical University, 10 ChangjiangZhilu, Yuzhong District, 400042, Chongqing, China
| | - Qingxiang Mao
- Department of Anesthesiology, Daping Hospital, Army Medical University, 10 ChangjiangZhilu, Yuzhong District, 400042, Chongqing, China.
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Khidr AM, El Tahan MR. Difficult lung separation. An insight into the challenges faced during COVID-19 pandemic. Saudi J Anaesth 2021; 15:300-311. [PMID: 34764837 PMCID: PMC8579506 DOI: 10.4103/sja.sja_1086_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022] Open
Abstract
Difficult lung isolation or separation in patients undergoing thoracic surgery using one-lung ventilation might be attributed to upper airway difficulty or abnormal anatomy of the lower airway. Additionally, adequate deflation of the surgical lung can impair surgical exposure. The coronavirus disease 2019 (COVID-19) has a harmful consequence for both patients and anesthesiologists. Management of patients with difficult lung isolation can be challenging during the COVID-19 pandemic. Careful planning and preparation, preoperative routine testing, protective personal equipment, standard safety measures, proper preoxygenation, and individualize the patients care are required for successful lung separation. A systematic approach for management of difficult lung separation is centered around securing the airway and providing adequate ventilation using either a blocker or double-lumen tube. Several measures are described to expedite lung collapse.
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Affiliation(s)
- Alaa M Khidr
- Department of Anesthesiology, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Mohamed R El Tahan
- Department of Anesthesiology, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
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Feasibility, safety, and efficacy of artificial carbon dioxide pneumothorax for computed tomography fluoroscopy-guided percutaneous radiofrequency ablation of hepatocellular carcinoma. Jpn J Radiol 2021; 39:1119-1126. [PMID: 34089475 DOI: 10.1007/s11604-021-01148-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To retrospectively assess the feasibility, safety, and efficacy of artificial carbon dioxide (CO2) pneumothorax for computed tomography (CT) fluoroscopy-guided percutaneous radiofrequency (RF) ablation of hepatocellular carcinoma (HCC). MATERIALS AND METHODS This study included 26 sessions of 24 patients in whom the creation of artificial CO2 pneumothorax was attempted to avoid the transpulmonary route during CT fluoroscopy-guided percutaneous RF ablation of HCC between April 2011 and December 2017. In these 26 sessions, 29 HCCs (mean tumor diameter: 12 mm, range: 6-22 mm) were treated. RESULTS Adequate lung displacement after induction of artificial CO2 pneumothorax was achieved in 23 of the 26 sessions (88.5%). In the remaining three sessions, transpulmonary RF ablation, transthoracic extrapulmonary RF ablation after switching to an artificial pleural effusion procedure, or RF ablation with electrode insertion in the caudal-cranial oblique direction was performed. No major complications were found. Among the 29 treated tumors, one (3.4%) showed local progression, and the other 28 (96.6%) were completely ablated at the last follow-up (mean follow-up period: 39.3 months, range: 7-78 months). CONCLUSION Artificial CO2 pneumothorax for CT fluoroscopy-guided percutaneous RF ablation appeared to be a feasible, safe, and useful therapeutic option for HCC.
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Ren Y, Yan H, Ge H, Peng J, Zheng H, Zhang P. CO2 artificial pneumothorax on coagulation and fibrinolysis during thoracoscopic esophagectomy. Medicine (Baltimore) 2021; 100:e23784. [PMID: 33466128 PMCID: PMC7808481 DOI: 10.1097/md.0000000000023784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/12/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND CO2 artificial pneumothorax creates a sufficient operative field for thoracoscopic esophagectomy. However, it has potential complications and continuous CO2 insufflation may impede coagulation and fibrinolysis. We sought to compare the effects of CO2 artificial pneumothorax on perioperative coagulation and fibrinolysis during thoracoscopic esophagectomy. METHODS We investigated patients who underwent thoracoscopic esophagectomy with (group P, n = 24) or without CO2 artificial pneumothorax (group N, n = 24). The following parameters of coagulation-fibrinolysis function: intraoperative bleeding volume; serum levels of tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), thromboelastogram (TEG), D-Dimer; and arterial blood gas levels were compared with two groups. RESULTS Group P showed higher levels of PaCO2, reaction time (R) value and kinetics (K) value, but significantly lower pH value, alpha (α) angle and Maximum Amplitude (MA) value at 60 minutes after the initiation of CO2 artificial pneumothorax than group N ((P < .05, all). The t-PA level after CO2 insufflation for 60 minutes was significantly higher in group P than in group N (P < .05), but preoperative levels were gradually restored on cessation of CO2 insufflation for 30 min (P > .05). There was no significant difference in D-dimer. CONCLUSION CO2 artificial pneumothorax during thoracoscopic esophagectomy had a substantial impact on coagulation and fibrinolysis, inducing significant derangements in pH and PaCO2. TRIAL REGISTRATION The study was registered at the Chinese clinical trial registry (ChiCTR1800019004).
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Shah RL, Perino A, Obafemi O, Lee A, Badhwar N. Intentional pneumothorax avoids collateral damage: Dynamic phrenic nerve mobilization through intrathoracic insufflation of carbon dioxide. HeartRhythm Case Rep 2020; 5:480-484. [PMID: 31934546 PMCID: PMC6951311 DOI: 10.1016/j.hrcr.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rajan L Shah
- Section of Cardiac Electrophysiology, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Alexander Perino
- Section of Cardiac Electrophysiology, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Oluwatomisin Obafemi
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Anson Lee
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Nitish Badhwar
- Section of Cardiac Electrophysiology, Division of Cardiology, Stanford University School of Medicine, Stanford, California
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Wang YC, Chang CH, Wang YT, Huang CH, Lin PL, Cheng YJ. A survey of one-lung ventilation device in lung resection surgeries in Taiwan—A population-based nationwide cohort study. J Formos Med Assoc 2020; 119:449-454. [DOI: 10.1016/j.jfma.2019.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 08/01/2019] [Accepted: 08/12/2019] [Indexed: 11/27/2022] Open
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Zhao M, Jiang T, Li M, Yang X, Dai X, Shen Y, Lin M, Feng M, Wang Q. Video-assisted thoracoscopic total thymectomy: two-lung ventilation with artificial pneumothorax. MINIM INVASIV THER 2019; 29:380-384. [PMID: 31691623 DOI: 10.1080/13645706.2019.1660681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Double-lumen endotracheal tube (DLET) and one-lung ventilation (OLV) have been generally accepted as the classic anesthetic method in video-assisted thoracoscopic total thymectomy (VATT). However, there are still some disadvantages of DLET. Two-lung ventilation (TLV) with single-lumen endotracheal tube (SLET) is considered to be an alternative in VATT to avoid these disadvantages. This study evaluated the safety and feasibility of TLV in VATT by comparing it with OLV cases.Material and methods: We retrospectively screened 198 patients who received TLV unilateral thoracic incision VATT and 117 patients who received OLV unilateral thoracic incision VATT. Perioperative data were analyzed, including surgical variables, intraoperative hemodynamic parameters, and postoperative complications and hospital stay.Results: No significant differences with regard to operative time (p = .146), postoperative hospital stay (p = .553), complications (p = .254), hemodynamic parameters and pulse oxygen saturation (SpO2) were found between TLV group and OLV group. However, end-tidal CO2 (EtCO2) was higher in TLV group at 15 min (39.95 ± 5.03 vs 38.70 ± 4.57, p = .021) and 30 min (41.91 ± 5.50 vs 38.91 ± 4.51, p < .001) after initiation of the operation.Conclusions: It is safe and feasible to adopt TLV using SLET with CO2 insufflation artificial pneumothorax in unilateral thoracic incision VATT.
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Affiliation(s)
- Mengnan Zhao
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Tian Jiang
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ming Li
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China.,Eight-Year Program Clinical Medicine, Grade of 2014, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinyu Yang
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China.,Eight-Year Program Clinical Medicine, Grade of 2014, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiyu Dai
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China.,Eight-Year Program Clinical Medicine, Grade of 2014, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Miao Lin
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
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Koto MZ, Matsevych OY, Nsakala L. Evaluation of Thoracoscopy with Single-Lumen Endotracheal Tube Intubation and Laparoscopy in the Diagnosis of Occult Diaphragmatic Injuries in Penetrating Thoracoabdominal Trauma. J Laparoendosc Adv Surg Tech A 2019; 29:785-789. [PMID: 30628853 DOI: 10.1089/lap.2018.0733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The diagnosis of traumatic diaphragmatic injuries (TDIs) after penetrating thoracoabdominal trauma is challenging and conventional imaging is unreliable. Laparoscopy and thoracoscopy are minimally invasive modalities of choice in the diagnosis and management of TDI. A little is known on the value of thoracoscopy with single-lumen endotracheal tube intubation (SLETI) in the diagnosis of occult diaphragmatic injuries, and how it compares with laparoscopy. Methods: A prospective study evaluated thoracoscopy with SLETI as a diagnostic tool for occult TDI. Thoracoscopy was followed by diagnostic laparoscopy to confirm the findings and manage diaphragmatic and intra-abdominal injuries. Results: Thirty-one patients underwent thoracoscopy followed by laparoscopy. Majority were men (n = 27, 87%). The median age was 30 years. Twenty-six patients had stab wounds (83.8%), and 5 had gunshot wounds (16.1%). The incidence of diaphragmatic injury was 42% (n = 13). Thoracoscopy with SLETI correctly identified 12 (92%) patients with diaphragmatic injury, but 1 patient had dense pleural adhesions. Diagnostic laparoscopy identified all injuries. Conclusion: Thoracoscopy with SLETI and laparoscopy are feasible, safe, and accurate approaches in detecting TDI in stable patients with penetrating thoracoabdominal injuries. However, dense pleural adhesions may prevent thoracoscopy. Laparoscopy allows inspection of both hemidiaphragms and diagnoses associated intra-abdominal injuries. The choice of primary technique will depend on the individual clinical scenario.
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Affiliation(s)
- Modise Zacharia Koto
- Department of Surgery, Dr. George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Oleh Yevhenovych Matsevych
- Department of Surgery, Dr. George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Lendo Nsakala
- Department of Surgery, Dr. George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Single lumen endotracheal intubation with carbon dioxide insufflation for lung isolation in thoracic surgery. Surg Endosc 2018; 33:3287-3290. [PMID: 30511311 DOI: 10.1007/s00464-018-06614-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Double lumen tube (DLT) intubation is used for lung isolation but is not without disadvantages including increased intubation time, anesthesia expertise, risk of airway trauma, and costs over single lumen tube (SLT) intubation. SLT intubation with CO2 insufflation can be used as an alternative for lung isolation. We reviewed our experience with this technique during thoracoscopic surgery. METHODS We performed a retrospective review of a prospectively maintained IRB-approved database from 2009 to 2018. Operations were performed with CO2 insufflation up to 15 mmHg. Indications for surgery, operative details, intraoperative complications, pathology, and postoperative complications were reviewed. RESULTS We identified 123 patients (70 females [57%]) with a median age of 40 years (range 16-80 years) and a median BMI of 26.2 kg/m2 (range 15-59 kg/m2) that underwent minimally invasive thoracoscopic procedures with this technique. Procedures included: mediastinal mass resection or biopsy (41%), sympathectomy (37%), wedge resection (10%), first rib resection (6%), diaphragm plication (2%), segmentectomy (2%), decortication (2%), pleural biopsy (2%), and pericardial cyst resection (1%). Median operative time was 90 min (range 25-584 min) and median intraoperative blood loss was 10 mL (range 2-200 mL). Intraoperative hemodynamic parameters were obtained at procedure start, 1 h after CO2 insufflation, and at procedure completion: we observed significant changes in heart rate and systolic blood pressure (P = 0.027 and P < 0.001, respectively) although clinically inconsequential. Mean end-tidal CO2 1 h after insufflation was 36.6 ± 4.5 mmHg. There were no intraoperative complications and no conversions to a DLT. Median length of stay was 1 day (range 0-14 days). Five complications (4%) were observed and no mortalities. CONCLUSIONS SLT intubation and CO2 insufflation is a feasible and safe alternative to DLT intubation for lung isolation. This can be a useful strategy to accomplish lung isolation for some thoracoscopic procedures, in particular when expertise for DLT placement is unavailable.
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Mayhew PD, Pascoe PJ, Giuffrida MA, Mitchell J, Steffey MA, Culp WTN. Cardiorespiratory effects of variable pressure thoracic insufflation in cats undergoing video-assisted thoracic surgery. Vet Surg 2018; 48:O130-O137. [PMID: 30431172 DOI: 10.1111/vsu.13130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 07/27/2018] [Accepted: 08/09/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the effects of intrathoracic insufflation on cardiorespiratory variables and working space in cats undergoing video-assisted thoracic surgery. STUDY DESIGN Prospective randomized study. ANIMALS Six healthy cats. METHODS Cats were anesthetized using a standardized protocol. A Swan-Ganz catheter was positioned in the pulmonary artery under fluoroscopic guidance for measurement of cardiac output. Intrathoracic pressures (ITP) of 0 (baseline), 3, and 5 mm Hg were induced with CO2 and maintained for 30 minutes. Statistical comparison of cardiorespiratory variables was performed. After the procedures, all cats were recovered from anesthesia. Videos of thoracic working space at each ITP level were scored in a blinded fashion by 3 board-certified surgeons using a numerical scale from 0-10. RESULTS All cats tolerated insufflation with 3 and 5 mm Hg for 30 minutes without oxygen desaturation, although ventilatory levels had to be increased substantially to maintain eucapnia and oxygenation. Cardiac index was not significantly different from baseline after 30 minutes at 3 mm Hg but was significantly lower after 30 minutes at 5 mm Hg compared with 3 mm Hg. Oxygen delivery was unaffected by 3 or 5 mm Hg compared with baseline. Scores for working space increased between baseline and 3 and 5 mm Hg but were not different between 3 and 5 mm Hg. CONCLUSION CO2 insufflation to 5 mm Hg seems well tolerated in healthy cats, provided ventilatory settings are substantially increased as ITP increases. CLINICAL SIGNIFICANCE Thoracic CO2 insufflation of 3 mm Hg in cats during video-assisted thoracic surgery is associated with less hemodynamic perturbation than 5 mm Hg insufflation and may provide the benefit of improved working space compared with baseline.
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Affiliation(s)
- Philipp D Mayhew
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Peter J Pascoe
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Michelle A Giuffrida
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Jeffrey Mitchell
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Michele A Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - William T N Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
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Lee DK, Kim H, Kim HK, Chung DI, Han KN, Choi YH. CO 2 during single incisional thoracoscopic bleb resection with two-lung ventilation. J Thorac Dis 2018; 10:5057-5065. [PMID: 30233880 DOI: 10.21037/jtd.2018.07.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background CO2 insufflation could provide a better surgical field during single-incision thoracoscopic surgery (SITS) with small tidal two-lung ventilation (ST-TLV). Here we compared the surgical field and physiological effects of ST-TLV with and without CO2 during SITS. Methods Patients underwent scheduled SITS bullectomy. Surgery under ST-TLV general anesthesia performed without CO2 (group NC) or with CO2 insufflation (group C). The surgical field was graded at thoracoscope introduction and at bulla resection as follows: good (more than half of the 1st rib visible; bleb easily grasped with the stapler), fair (less than half of the 1st rib visible; some manipulation needed to grasp the bleb with the stapler), or poor (1st rib non-visible; bleb ungraspable). Vital signs, arterial blood gas analysis (ABGA), and mechanical ventilation parameters, postoperative chest tube indwelling duration, length of hospital stays, and complications were recorded. Results A total of 80 patients were ultimately included. The surgical field at thoracoscope introduction was better in group C (P=0.022). However, at bleb resection, the surgical fields did not differ (P=0.172). The operation time was significantly longer in group C (P=0.019) and anesthesia recovery time was not different (P=0.369). During the CO2 insufflation, the airway pressure was higher in group C (P=0.009). Mean PaCO2 was significantly higher (P=0.012) and mean PaO2 was significantly lower (P=0.024) in group C, but both values were within the physiologically normal range. Postoperative chest tube indwelling duration and length of hospital stays were not statistically different (P=0.234 and 0.085 respectively). Postoperative complication frequencies were similar (12.5% for group NC, 10.0% for group C, P=0.723). Conclusions SITS with CO2 insufflation during ST-TLV did not produce a superior surgical field except at the beginning of surgery. CO2 insufflation required more time and resulted in higher mean PaCO2 and peak airway pressure.
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Affiliation(s)
- Dong Kyu Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Heezoo Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Dong Ik Chung
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Young Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Seoul, Korea
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Guo K, Tong L, Li X, Yan X. Video-assisted thoracoscopic completion thymectomy based on mediastinal pleura guidance. J Thorac Dis 2017; 9:1382-1385. [PMID: 28616293 PMCID: PMC5465128 DOI: 10.21037/jtd.2017.04.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/15/2017] [Indexed: 11/06/2022]
Abstract
We describe a practical video-assisted thoracoscopic surgery (VATS) technique for the en bloc resection of the thymoma, thymus, and bilateral mediastinum lipid based on mediastinal pleura guidance. By taking advantage of single-lumen endotracheal tube (SLET) anesthesia and artificial pneumothorax, we acquired excellent exposure of the anterior mediastinum operative field. In addition, our limited data showed that this surgical approach might have a potential tendency on reducing the blood loss and the operative times. Moreover, no complication of phrenic nerve paralysis or signs of myasthenia gravis were observed at the 6-month follow-up.
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Affiliation(s)
- Kai Guo
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Liping Tong
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Xiaolong Yan
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
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Okamura R, Takahashi Y, Dejima H, Nakayama T, Uehara H, Matsutani N, Kawamura M. Efficacy and hemodynamic response of pleural carbon dioxide insufflation during thoracoscopic surgery in a swine vessel injury model. Surg Today 2016; 46:1464-1470. [DOI: 10.1007/s00595-016-1323-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/16/2016] [Indexed: 11/25/2022]
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Abstract
Thoracic surgery encompasses a wide array of surgical techniques, most of which require lung isolation for surgical exposure in the pleural cavity; this, in turn, demands an extensive knowledge of respiratory mechanics and modalities of airway control. Likewise, effective treatment of an acute central airway obstruction calls for a systematic approach using clear communication between teams and a comprehensive knowledge of available therapeutic modalities by the surgeon.
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Sancheti MS, Lee R, Ahmed SU, Pickens A, Fernandez FG, Small WC, Nour SG, Force SD. Percutaneous Fiducial Localization for Thoracoscopic Wedge Resection of Small Pulmonary Nodules. Ann Thorac Surg 2014; 97:1914-8; discussion 1919. [PMID: 24725836 DOI: 10.1016/j.athoracsur.2014.02.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/19/2014] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
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