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Zardo P, Starke H. [Non-Intubated Video-assisted Thoracoscopic Surgery (niVATS)]. Zentralbl Chir 2024; 149:S73-S83. [PMID: 39137765 DOI: 10.1055/a-2193-8821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Non-intubated minimally invasive lung surgery garnered renewed interest during the past decade and many centers across the country successfully implemented the technique for minor procedures like pleurodesis or wedge resection. Anatomical lung resection under spontaneous breathing still is considered as challenging, and as existing data to support it is conflicting and confusing, the approach remains limited to few dedicated outfits. We seek to present the historical perspective, critically report potential advantages and limitations of the technique and hand out a guideline that might prove to be helpful in building up a dedicated program.
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Lyberis P, Verri G, Solidoro P, Femia F, Perotti C, Limerutti G, Delsedime L, Della Beffa E, Papotti MG, Ruffini E, Albera C, Guerrera F. Correlation between high-resolution computed tomography appearance and histopathological features in the diagnosis of interstitial lung diseases. A real-life study. Minerva Surg 2024; 79:133-139. [PMID: 37218142 DOI: 10.23736/s2724-5691.23.09948-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND According to current guidelines, a surgical biopsy is rarely required when a high-confidence radiologic interstitial lung disease (ILD) diagnosis is made on thin-section high-resolution computed tomography (HRCT). Nevertheless, disowning HRCT scans diagnosed by biopsy are more common than presumed. Our study aimed to describe the concordance rate between HRCT scans and pathological diagnoses of ILDs obtained by surgical biopsy. The current guideline suggests the use of surgical lung biopsy (SLB) in patients with newly detected ILD of unknown cause. METHODS Patients who underwent mini-invasive surgical biopsies for interstitial lung diseases from January 2018 to August 2022 were analyzed. The HRCT scans were reviewed by an observer blinded to the patient's clinical information. The concordance between histological and HRCT-scan were assessed. RESULTS Data from 104 patients with uncertain low confidence diagnosis of interstitial lung diseases at HRCT were analyzed. Most of the patients are male (65; 62.5%). The more frequent HRCT pattern were: alternative diagnoses (46; 44.23%), UIP probable (42; 40.38%), UIP indeterminate (7; 6.73%), and non-specific interstitial pneumonia (NSIP) (9, 8.65%). The more common histological diagnosis was UIP definite (30; 28.84%), hypersensitivity pneumonia [HP](19; 18.44%), NSIP (15; 14.42%), sarcoidosis (10; 9.60%). In 7 (20%) cases, the final pathological finding denies HRCT-scans diagnoses; indeed, a moderate agreement was observed between HRCT-scan findings and the definitive histological diagnosis (kappa index: 0.428). CONCLUSIONS HRCT-scan has limitations if the objective is to define interstitial lung diseases accurately. Consequently, pathological assessment should be taken into account in order to provide more accurate tailored treatment strategies because the risk is to wait from 12 to 24 months to ascertain if the ILD will be treatable as progressive pulmonary fibrosis (PPF). Undeniably true, video-assisted surgical lung biopsy (VASLB) with endotracheal intubation and mechanical ventilation is associated with a risk of mortality and morbidity that is far from nil. Nevertheless, in recent years a VASLB approach performed in awake subjects under loco-regional anesthesia (awake-VASLB) has been suggested as an effective method to obtain a highly confident diagnosis in patients with diffuse pathologies of the lung parenchyma.
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Affiliation(s)
- Paraskevas Lyberis
- Unit of Thoracic Surgery, Cardio-Vascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giulia Verri
- Unit of Pulmonology, Cardio-Vascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Paolo Solidoro
- Department of Medical Sciences, University of Turin, Turin, Italy -
| | - Federico Femia
- Department of Surgical Science, University of Turin, Turin, Italy
| | - Costanza Perotti
- Unit of Pulmonology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giorgio Limerutti
- Unit of Radiology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Luisa Delsedime
- Unit of Pathology, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | | | - Enrico Ruffini
- Department of Surgical Science, University of Turin, Turin, Italy
| | - Carlo Albera
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco Guerrera
- Unit of Thoracic Surgery, Cardio-Vascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
- Department of Surgical Science, University of Turin, Turin, Italy
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Alfaras-Melainis K, Fernando RJ, Boisen ML, Hoffman PJ, Rosenkrans DJ, Teeter E, Cardi AI, Laney J, Reagan A, Rao VK, Anderson M, Luke CB, Subramani S, Schisler T, Ritchie PJ, Gelzinis TA. The Year in Thoracic Anesthesia: Selected Highlights from 2022. J Cardiothorac Vasc Anesth 2024; 38:29-56. [PMID: 37802689 DOI: 10.1053/j.jvca.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
This article reviews research highlights in the field of thoracic anesthesia. The highlights of this year included new developments in the preoperative assessment and prehabilitation of patients requiring thoracic surgery, updates on the use of devices for one-lung ventilation (OLV) in adults and children, updates on the anesthetic and postoperative management of these patients, including protective OLV ventilation, the use of opioid-sparing techniques and regional anesthesia, and outcomes using enhanced recovery after surgery, as well as the use of expanding indications for extracorporeal membrane oxygenation, specialized anesthetic techniques for airway surgery, and nonintubated video-assisted thoracic surgery.
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Affiliation(s)
| | - Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Paul J Hoffman
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Emily Teeter
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Alessandra I Cardi
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Jeremy Laney
- Department of Anesthesiology, University of Southern California, Los Angeles, CA
| | - Aaron Reagan
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX
| | - Vidya K Rao
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Michael Anderson
- Department of Anesthesiology and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Charles B Luke
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Travis Schisler
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia Canada
| | - Peter J Ritchie
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
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Neitzert L, Balzani E, Petitti M, Rosboch GL, Ceraolo E, Brazzi L. Thoracic spinal anaesthesia for thoracic surgery. Comment on Br J Anaesth 2023; 130: e56-65. Br J Anaesth 2023; 130:e500-e501. [PMID: 37080869 DOI: 10.1016/j.bja.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Luca Neitzert
- Department of Surgical Science, University of Turin, Turin, Italy
| | - Eleonora Balzani
- Department of Surgical Science, University of Turin, Turin, Italy.
| | - Martina Petitti
- Department of Surgical Science, University of Turin, Turin, Italy
| | - Giulio L Rosboch
- Department of Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Turin, Italy
| | - Edoardo Ceraolo
- Department of Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Turin, Italy
| | - Luca Brazzi
- Department of Surgical Science, University of Turin, Turin, Italy; Department of Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Turin, Italy
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KOH LY, HWANG NC. ANESTHESIA FOR NON-INTUBATED VIDEO-ASSISTED THORACOSCOPIC SURGERY. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00132-5. [PMID: 37024392 DOI: 10.1053/j.jvca.2023.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/06/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
With the growing adoption of Enhanced Recovery After Surgery protocols across all surgical groups, including thoracic surgery, coupled with improved video-assisted thoracoscopic surgery (VATS) equipment and techniques, nonintubated thoracoscopic surgery has gained significant popularity in recent years. Avoiding tracheal intubation with an endotracheal or double-lumen tube and general anesthesia may reduce or eliminate the risks associated with traditional mechanical ventilation, one-lung ventilation, and general anesthesia. Studies have shown a trend toward better preservation of postoperative respiratory function and improved postoperative lengths of hospital stay, morbidity, and mortality; however, these have not been conclusively proven. This review article discusses the advantages of nonintubated VATS, the types of thoracic surgery in which this technique has been described, patient selection, appropriate anesthetic techniques, surgical concerns, potential complications relevant to the anesthesiologist during the conduct of nonintubated VATS surgery, and suggested management of these complications.
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Antonio T, Eleonora B, Paolo C, Anna V, Chiara P, Erika S, Mauro R, Luca B. Awake cardiac surgery using the novel pectoralis-intercostal-rectus sheath (PIRS) plane block and subxiphoid approach. J Card Surg 2022; 37:2923-2926. [PMID: 35665964 DOI: 10.1111/jocs.16658] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postoperative pain after cardiac surgery is a very important issue and affects recovery, risk of postoperative complications and quality of life. The pain management has been traditionally based on intravenous opioids with growing evidence suggesting the use of opioid-free and opioid-sparing techniques to reduce its adverse effects. CASE PRESENTATION We report the case of a 75-year-old frail patient underwent awake mediastinal revision with subxiphoid access due to deep sternal wound infection using a pectoralis-intercostal rectus sheath (PIRS) plane block. During the procedure the patient never reported pain receiving acetaminophen 1 g every 8 h for postoperative pain management without others pain relievers. CONCLUSION Ultrasound guided PIRS block could be an effective and safe analgesic technique to manage sternal and subxiphoid drainage pain in patients undergoing cardiac surgery via subxiphoid approach.
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Affiliation(s)
- Toscano Antonio
- Department of Anesthesia, Critical Care and Emergency, 'Città della Salute e della Scienza' Hospital, Torino, Italy
| | - Balzani Eleonora
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Capuano Paolo
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT, UPMC, Palermo, Italy
| | - Vaninetti Anna
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Perrucci Chiara
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Simonato Erika
- Department of Cardiovascular and Thoracic Surgery, 'Città della Salute e della Scienza' Hospital, Torino, Italy
| | - Rinaldi Mauro
- Department of Surgical Sciences, University of Turin, Torino, Italy.,Department of Cardiovascular and Thoracic Surgery, 'Città della Salute e della Scienza' Hospital, Torino, Italy
| | - Brazzi Luca
- Department of Anesthesia, Critical Care and Emergency, 'Città della Salute e della Scienza' Hospital, Torino, Italy.,Department of Surgical Sciences, University of Turin, Torino, Italy
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