1
|
Lee BH, Qiao WP, McCracken S, Singleton MN, Goman M. Regional Anesthesia Techniques for Shoulder Surgery in High-Risk Pulmonary Patients. J Clin Med 2023; 12:jcm12103483. [PMID: 37240589 DOI: 10.3390/jcm12103483] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/01/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Patients with pre-existing pulmonary conditions are at risk for experiencing perioperative complications and increased morbidity. General anesthesia has historically been used for shoulder surgery, though regional anesthesia techniques are increasingly used to provide anesthesia and improved pain control after surgery. Relative to regional anesthesia, patients who undergo general anesthesia may be more prone to risks of barotrauma, postoperative hypoxemia, and pneumonia. High-risk pulmonary patients, in particular, may be exposed to these risks of general anesthesia. Traditional regional anesthesia techniques for shoulder surgery are associated with high rates of phrenic nerve paralysis which significantly impairs pulmonary function. Newer regional anesthesia techniques have been developed, however, that provide effective analgesia and surgical anesthesia while having much lower rates of phrenic nerve paralysis, thereby preserving pulmonary function.
Collapse
Affiliation(s)
- Bradley H Lee
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - William P Qiao
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Stephen McCracken
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Michael N Singleton
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Mikhail Goman
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10021, USA
| |
Collapse
|
2
|
Yang M. Acute Lung Injury in aortic dissection : new insights in anesthetic management strategies. J Cardiothorac Surg 2023; 18:147. [PMID: 37069575 PMCID: PMC10109228 DOI: 10.1186/s13019-023-02223-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/02/2023] [Indexed: 04/19/2023] Open
Abstract
Acute aortic dissection (AAD) is a severe cardiovascular disease characterized by rapid progress and a high mortality rate. The incidence of acute aortic dissection is approximately 5 to 30 per 1 million people worldwide. In clinical practice, about 35% of AAD patients are complicated with acute lung injury (ALI). AAD complicated with ALI can seriously affect patients' prognosis and even increase mortality. However, the pathogenesis of AAD combined with ALI remains largely unknown. Given the public health burden of AAD combined with ALI, we reviewed the anesthetic management advances and highlighted potential areas for clinical practice.
Collapse
Affiliation(s)
- Ming Yang
- Department of Anesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, PLA, Chongqing, 400037, China.
| |
Collapse
|
3
|
Mares-Gutiérrez Y, Salinas-Escudero G, Aracena-Genao B, Martínez-González A, García-Minjares M, Flores YN. Preoperative risk assessment and spirometry is a cost-effective strategy to reduce post-operative complications and mortality in Mexico. PLoS One 2022; 17:e0271953. [PMID: 35895736 PMCID: PMC9328537 DOI: 10.1371/journal.pone.0271953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
Aim
Combining preoperative spirometry with the Assess Respiratory Risk in Surgical Patients in Catalunia (ARISCAT) risk scale can reduce post-operative complications and improve patient survival. This study aimed to assess the cost-effectiveness of performing spirometry or not in conjunction with the ARISCAT scale, to reduce post-operative complications and improve survival among adult patients undergoing elective surgery in Mexico.
Methods
A cost-effectiveness analysis (CEA) was performed to compare the specific cost and health outcomes associated with the combined use of the ARISCAT scale and preoperative spirometry (Group 1), and the use of the ARISCAT scale without preoperative spirometry (Group 2). The health outcomes evaluated were post-operative complications and survival. The perspective was from the health care provider (Hospital General de México) and direct medical costs were reported in 2019 US dollars. A decision tree with a time horizon of eight months was used for each health outcome and ARISCAT risk level.
Results
The combined use of the ARISCAT scale and spirometry is more cost-effective for reducing post-operative complications in the low and moderate-risk levels and is cost-saving in the high-risk level, than use of the ARISCAT scale without spirometry. To improve patient survival, ARISCAT and spirometry are also more cost-effective at the moderate risk level, and cost-saving for high-risk patients, than using the ARISCAT scale alone.
Conclusions
The use of preoperative spirometry among patients with a high ARISCAT risk level was cost-saving, reduced post-operative complications, and improved survival. Our findings indicate an urgent need to implement spirometry as part of preoperative care in Mexico, which is already the standard of care in other countries.
Collapse
Affiliation(s)
- Yolanda Mares-Gutiérrez
- Pulmonary Physiology Department, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
- Universidad de la Salud, Mexico City, Mexico
| | - Guillermo Salinas-Escudero
- Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Adrián Martínez-González
- Facultad de Medicina, Departamento de Salud Pública, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Manuel García-Minjares
- Coordinación de Universidad Abierta, Innovación Educativa y Educación a Distancia, CUAIEED, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Yvonne N. Flores
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, México
- UCLA Center for Cancer Prevention and Control Research and UCLA-Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, United States of America
- UCLA Department of Health Policy and Management, Fielding School of Public Health, Los Angeles, United States of America
- * E-mail:
| |
Collapse
|
4
|
Du X, Li H, Liu L, Zhang M, Tang Z, Zhang J, Lin P, Xie H, Chen C. A preliminary study identifies early postoperative lung volume changes in patients with non-small cell lung cancer following video-assisted thoracic surgery using CT volumetry. Mol Clin Oncol 2021; 14:124. [PMID: 33936597 PMCID: PMC8082225 DOI: 10.3892/mco.2021.2286] [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: 08/16/2020] [Accepted: 03/17/2021] [Indexed: 11/22/2022] Open
Abstract
The present study aimed to investigate the changes in early postoperative lung volume in patients with non-small cell lung cancer (NSCLC) following video-assisted thoracic surgery (VATS) and to analyze the effects of the clinical characteristics on the lung volume of the patients. Therefore, 38 patients with NSCLC, who planned to undergo VATS at the Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University in June 2019, were enrolled into the present study. The clinical and computed tomography (CT) scan data from the patients was prospectively collected within 1 week preoperatively, and at 1, 3 and 6 months following surgery, then subsequently analyzed. A total of 34 patients successfully completed follow-up and were included in the datasets. The results showed that the volume of the right lung was larger compared with that in the left one, at each observational time point. The whole, right and left lung held the same trendline of volume changes, which was sharply decreased during the first postoperative month, increased quickly over the next 3 months, and slowly increased from months 3 to 6. There were 7 patients, whose whole lung volume was increased at 6 months following surgery compared with that preoperatively. In addition, significant differences were observed between males and females in the whole, right and left lung volume. However, the differences on the postoperative net expansion volume of the whole lung were not significant among sex, age, body mass index (BMI), smoking status and surgical side subgroups. The early changes of the postoperative lung volume were not linear, since the lung volume was significantly reduced during the first postoperative month, quickly increased in the next 3 months, and slowly increased from months 3 to 6. Sex, age, BMI, smoking status and surgical sides was not found to affect the postoperative volume and net expansion of the whole lung following VATS lobectomy.
Collapse
Affiliation(s)
- Xiaojun Du
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Haojun Li
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Langbo Liu
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Min Zhang
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Zhongben Tang
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Jian Zhang
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Peng Lin
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Hong Xie
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Cheng Chen
- Department of Thoracic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563099, P.R. China
| |
Collapse
|
5
|
Wu H, Shang L, Du F, Fu M, Liu J, Fang Z, Li L. Transhiatal versus transthoracic surgical approach for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction: a meta-analysis. Expert Rev Gastroenterol Hepatol 2020; 14:1107-1117. [PMID: 32757864 DOI: 10.1080/17474124.2020.1806710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND With the increasing prevalence of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction (EGJ), the optimal surgical treatment is not universally agreed. This meta-analysis compares the safety and efficacy between the transhiahtal (TH) approach and the transthoracic (TT) approach. METHODS A systematic and electronic search of several databases was performed up to June 2020. The Newcastle-Ottawa scale was used to evaluate article quality and funnel plots were created to identify potential publication bias. The random-effects model was used when significant heterogeneity was identified. RESULTS In total, nine retrospective studies and two randomized controlled trials (RCTs) involving 2331 patients were included. Decreased intraoperative blood loss, shorter hospital stay, lower incidence of pulmonary complications, and longer 3-year overall survival were observed in the TH group. There were no significant differences concerning duration of surgery, R0 resection rate, number of dissected lymph nodes, perioperative mortality and morbidity rate, abdominal complication rate, or anastomotic leak rate. With regard to 5-year overall survival, a potential benefit may be achieved with the TH approach, which requires further confirmation. CONCLUSION In terms of surgery-related and long-term outcomes, the TH approach may be more appropriate for Siewert type Ⅱ adenocarcinoma of EGJ, especially for esophagus invasion ≤4 cm.
Collapse
Affiliation(s)
- Hao Wu
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University , Jinan, Shandong, China
| | - Liang Shang
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University , Jinan, Shandong, China.,Department of Gastroenterological Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University , Jinan, Shandong, China.,Key Laboratory of Engineering of Shandong Province, Shandong Provincial Hospital , Jinan, Shandong, China
| | - Fengying Du
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University , Jinan, Shandong, China
| | - Mengdi Fu
- Department of Clinical Medicine, Cheeloo College of Medicine, Shandong University , Jinan, Shandong, China
| | - Jin Liu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University , Jinan, Shandong, China
| | - Zhen Fang
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University , Jinan, Shandong, China
| | - Leping Li
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University , Jinan, Shandong, China.,Department of Gastroenterological Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University , Jinan, Shandong, China.,Key Laboratory of Engineering of Shandong Province, Shandong Provincial Hospital , Jinan, Shandong, China
| |
Collapse
|
6
|
Chandler D, Mosieri C, Kallurkar A, Pham AD, Okada LK, Kaye RJ, Cornett EM, Fox CJ, Urman RD, Kaye AD. Perioperative strategies for the reduction of postoperative pulmonary complications. Best Pract Res Clin Anaesthesiol 2020; 34:153-166. [PMID: 32711826 DOI: 10.1016/j.bpa.2020.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 01/01/2023]
Abstract
Postoperative pulmonary complications (PPCs), estimated between 2.0% and 5.6% in the general surgical population and 20-70% for upper abdominal and thoracic surgeries, are a significant factor leading to poor patient outcomes. Efforts to decrease the incidence of PPCs such as bronchospasm, atelectasis, exacerbations of underlying chronic lung conditions, infections (bronchitis and pneumonia), prolonged mechanical ventilation, and respiratory failure, begins with a detailed preoperative risk evaluation. There are several available preoperative tests to estimate the risk of PPCs. However, the value of some of these studies to estimate PPCs remains controversial and is still debated. In this review, the preoperative risk assessment of PPCs is examined along with preoperative pulmonary tests to estimate risk, intraoperative, and procedure-associated risk factors for PPCs, and perioperative strategies to decrease PPCs. The importance of minimizing these events is reflected in the fact that nearly 25% of postoperative deaths occurring in the first week after surgery are associated with PPCs. This review provides important information to help clinical anesthesiologists to recognize potential risks for pulmonary complications and allows strategies to create an appropriate perioperative plan for patients.
Collapse
Affiliation(s)
- Debbie Chandler
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Chizoba Mosieri
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Anusha Kallurkar
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Alex D Pham
- Department of Anesthesiology, LSU Health New Orleans, 1542 Tulane Ave, New Orleans LA 70112, USA.
| | - Lindsey K Okada
- Tulane University School of Medicine, 1430 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Rachel J Kaye
- Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Charles J Fox
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA; Vice Chancellor of Academic Affairs, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| |
Collapse
|