The effects of combined acupuncture anesthesia and serratus anterior plane block with ropivacaine on postoperative analgesia in patients undergoing chest surgery

OBJECTIVE

To investigate the effects of combined acupuncture anesthesia and ropivacaine on postoperative analgesia and neuro-related factors in patients undergoing chest surgery.

METHODS

The analgesic drug dosage, postoperative PCIA pressing times, VAS scores at rest and during activity at 6 h (T1), 12 h (T2), 18 h (T3), and 24 h (T4) postoperatively.

RESULTS

The analgesic drug dosage and postoperative PCIA pressing times were lower in the observation group than in the control group (p < 0.05). The VAS scores at T1-T4 postoperatively were lower in the observation group than in the control group (p < 0.05). The SAS scores at T1-T4 postoperatively were lower in the observation group than in the control group (p < 0.05). The levels of IL-6 and IL-10 on postoperative day 1 were higher than those on preoperative day 1 in both groups, with a smaller change in the observation group (p < 0.05). The levels of S100β protein on postoperative day 1 were higher than those on preoperative day 1 in both groups, while the BDNF levels were lower, with a smaller change in the observation group (p < 0.05). There was no significant difference in the incidence of adverse reactions between the control group (11.36%) and the observation group (15.56%) (p > 0.05).

CONCLUSION

Combined acupuncture anesthesia and ropivacaine can effectively improve postoperative analgesia and agitation in patients undergoing chest surgery, reduce the dosage of analgesic drugs, regulate the levels of inflammatory factors and neurotrophic factors in patients, and do not increase the risk of adverse reactions related to patients.

Does Structured Patient Education Reduce the Peri-Operative Anxiety and Depression Levels in Elective Chest Surgery Patients? A Double-Blinded Randomized Trial of 300 Patients

Psychological distress associated with surgery is an emerging issue. The study was conducted to assess the impact of structured patient education viz-a-viz routine patient education on anxiety and depression levels in patients undergoing elective chest surgery. It is a prospective, double-blind randomized study, conducted from February 2019 to February 2020 at a tertiary care center in India, on patients who underwent elective chest surgeries. A total of 300 patients were randomized using a computer-generated randomization sequence, into 2 equal groups (150 subjects each). Study group included patients who underwent structured patient education (Group A), whereas control group included patients who underwent routine patient education (Group B). The 2 groups were compared for anxiety and depression levels at admission as well as discharge using Hospital Anxiety and Depression Scale. Also, at the time of discharge, the groups were compared for the effectiveness of patient education using a validated Questionnaire B. In comparison to routine education, patients receiving structured education showed significantly lesser scores for anxiety and depression at discharge (P < .001). Also, structured patient education proved to be effective in comparison to the routine education in educating the patients in all parameters as determined by the Questionnaire B (P < .05). It can be concluded that structured educational intervention is strongly recommended in patients undergoing chest surgery which can help alleviate perioperative anxiety and depression. Such intervention helps patient get an understanding of the surgical procedure and assist them in facing the condition in a better way.

Spectral Entropy Monitoring Accelerates the Emergence from Sevoflurane Anesthesia in Thoracic Surgery: A Randomized Controlled Trial

The clinical efficacy of spectral entropy monitoring in improving postoperative recovery remains unclear. This trial aimed to investigate the impact of M-Entropy (GE Healthcare, Helsinki, Finland) guidance on emergence from anesthesia and postoperative delirium in thoracic surgery. Adult patients undergoing video-assisted thoracoscopic surgery for lung resection at a medical center were randomly allocated into the M-Entropy guidance group (n = 39) and the control group (n = 37). In the M-Entropy guidance group, sevoflurane anesthesia was titrated to maintain response and state entropy values between 40 and 60 intraoperatively. In the control group, the dosing of sevoflurane was adjusted based on clinical judgment and vital signs. The primary outcome was time to spontaneous eye opening. M-Entropy guidance significantly reduced the time proportion of deep anesthesia (entropy value <40) during surgery, mean difference: −21.5% (95% confidence interval (CI): −32.7 to −10.3) for response entropy and −24.2% (−36.3 to −12.2) for state entropy. M-Entropy guidance significantly shortened time to spontaneous eye opening compared to clinical signs, mean difference: −154 s (95% CI: −259 to −49). In addition, patients of the M-Entropy group had a lower rate of emergence agitation (absolute risk reduction: 0.166, 95% CI: 0.005−0.328) and delirium (0.245, 0.093−0.396) at the postanesthesia care unit. M-Entropy-guided anesthesia hastened awakening and potentially prevented emergence agitation and delirium after thoracic surgery. These results may provide an implication for facilitating postoperative recovery and reducing the complications associated with delayed emergence and delirium.

Should clinicians make chest surgery available to transgender male adolescents?

Bioethicists are increasingly engaged in considering the ethical issues associated with the care of transgender people. One such issue facing paediatric clinicians is requests for chest surgery from transgender male adolescents. For transgender young people who identify as male but have already progressed through the mid to late stages of puberty, hormone treatment will not reverse breast development. Some of these young people are distressed by their chest, and request surgery to remove this tissue. Demand for this surgery during adolescence is increasing. However, few paediatric hospitals make this intervention available to adolescents. This paper focuses on the following ethical question: Should clinicians make chest surgery available to transgender male adolescents? We argue that making chest surgery available to transgender male adolescents under some circumstances is ethically justifiable for three reasons, based on the concepts of beneficence, privacy, and non-discrimination. Firstly, the limited evidence to date suggests that chest surgery is beneficial to transgender male adolescents who seek this intervention. Secondly, chest surgery protects transgender adolescents' privacy by enabling them to better control disclosure of their transgender identity. Thirdly, chest surgery is already performed on other adolescent males for psychosocial reasons, such as in the case of gynaecomastia; non-discrimination thus provides a further reason for making chest surgery available to transgender male adolescents whose male gender identity is consistent. We suggest that the ethical justifiability of chest surgery in any specific transgender adolescent's case will depend on the individual patient's circumstances.

Feasibility, Safety, and Satisfaction of Combined Hysterectomy with Bilateral Salpingo-Oophorectomy and Chest Surgery in Transgender and Gender Non-Conforming Individuals

The demand for masculinizing breast surgery and hysterectomy with bilateral salpingo-oophorectomy (HBSO) from transmen has increased. With a multidisciplinary approach, these surgeries can be performed in a single session. The objective of this study was to retrospectively evaluate the feasibility, safety, and satisfaction of HBSO and chest surgery in transmen. A cohort of 142 subjects who underwent HBSO alone or combined with chest surgery at Sant’Orsola Hospital was analyzed. Intra and post operation events were evaluated. Subjective post-intervention satisfaction, acceptability, and impact of intervention were assessed via a semi-structured interview. Nineteen transmen underwent HBSO alone and 123 underwent combined surgery. HBSO was performed laparoscopically in 96.5% of transmen (137/142). As expected, length of hospital stay and blood loss were significantly higher in the combined surgery group. A total of 13 intra or post-operative complications occurred in the combined surgery group (10.5%) with thoracic hematoma being the most frequent complication (7.6%). Only one rare complication occurred in the HBSO group (omental herniation through a laparoscopic breach). The overall subjective satisfaction score was 9.9 out of 10 for both groups. Positive changes in all areas of life were reported, with no significant differences. We found that the combined surgery appears to be well tolerated, safe, and feasible in transmen and satisfaction with the combined procedure was high in all subjects.

Breast augmentation for transfeminine patients: methods, complications, and outcomes

Gender-affirming procedures are critical steps in helping transgender patients reach identity actualization and maximal quality of life. Although there are many techniques for gender-affirming care, surgical breast augmentation, or "top surgery," is often cited as the most important-and sometimes only-procedure sought by transfeminine patients. Unfortunately, years of individual and systemic prejudice placed barriers between transgender patients and the healthcare providers needed to affirm gender identity. Policy has recently begun to change as research proving the safety, need, and outcomes of breast augmentation in transfeminine patients dismantles long-established systemic inequalities. With this change, more patients are seeking knowledgeable and respectful providers who can address their unique gender-affirming needs. Overall, breast augmentation in transfeminine patients is technically similar to procedures performed in cisgender peers, but with significant considerations. The most common method of augmentation relies on breast implants, since removable prostheses, exogenous hormones, and fat grafting alone often produce unsatisfactory results. Special attention needs to be directed towards anatomic differences in transgender versus cisgender patients in order to achieve optimal size and position of the breast and nipple-areolar complex. Complications for transfeminine patients undergoing breast augmentation are rare, and complication rates are equivalent with cisgender peers who pursue similar procedures. Short- and long-term benefits to quality of life have been well-documented. The aim of this review is to give providers the technical knowledge concerning breast augmentation options, pre-surgical evaluation, post-surgical care, and special considerations in transfeminine patients so that provider and patient can have a successful, respectful partnership in reaching gender-affirming goals.

A randomised trial comparing real-time double-lumen endobronchial tube placement with the Disposcope® with conventional blind placement

Double-lumen endobronchial tube placement is challenging. This study compared double-lumen tube placement with the Disposcope^® , a wireless videostylet allowing real-time visualisation, with conventional blind placement. Patients undergoing elective thoracic surgery with normal airways requiring one-lung ventilation were randomly allocated into two groups (27 patients in each group). The Disposcope was used to assist left-sided double-lumen tube placement in one group, and conventional blind placement was performed in the control group. Placement in both groups was checked with fibreoptic bronchoscopy. The Disposcope-assisted group had a shorter total mean (SD) placement time (18.6 (2.5) s vs. 21.4 (2.9) s, p < 0.001), laryngoscopy to end of auscultation time (83.4 (3.0) s vs. 93.9 (5.7) s, p < 0.001) and total operation time (130.7 (6.1) s vs. 154.5 (6.3) s, p < 0.001). In the Disposcope-assisted group, the double-lumen tube was inserted in the correct side in all patients (100.0%), whereas in the conventional group, the double-lumen tube was placed in the correct side in 25 (92.6%) patients and in the wrong side in 2 (7.4%) patients; the difference was not significant (p = 0.150). In the Disposcope-assisted group, the double-lumen tube was inserted to the optimal depth in 24 (88.9%) patients, whereas in the conventional group it was inserted to the optimal depth in one (4.0%) patient. The Disposcope increased the success rate of double-lumen tube placement, and shortened the total operation time when compared with standard placement with confirmation using fibreoptic bronchoscopy, and may replace the conventional method.

Establishing Equipoise: National Survey of the Treatment of Pediatric Para-Pneumonic Effusion and Empyema

BACKGROUND

Despite six randomized trials of various treatments for pediatric para-pneumonic effusion (PPE), management approaches differ. The purpose of this study was to gain insight into opinions on PPE treatment with the goal of designing a definitive trial to generate consensus intervention guidelines.

METHODS

To evaluate physician opinions regarding PPE management, we developed a survey based on input from a nationwide, multi-disciplinary advisory group that established content validity. The survey was disseminated broadly to six pediatric medicine and interventional radiology groups. Descriptive and χ² statistics were calculated.

RESULTS

There were 741 respondents (response rate 13.1%), of whom 52.2% were surgeons, 15.2% hospitalists, 14.2% pulmonologists, 12.4% intensivists, and 6.0% interventional radiologists. Nearly all respondents (97.3%) reported caring primarily for pediatric patients. Eighty percent reported no written institutional treatment guidelines. Nearly all (90.3%) agreed that patients require antibiotics, but there was disagreement regarding their duration. Respondents also were split as to how often PPE required drainage. There were multiple absolute indications for drainage, including mediastinal shift on chest radiograph (67.2%) and loculations on imaging (47.7%). There were substantial differences in the preferred first-line methods of drainage based on the treating physician's specialty, with surgeons preferring tube thoracostomy and a fibrinolytic agent (42.0%) or video-assisted thoracoscopic surgery (41.6%), whereas interventional radiologists preferred either a tube thoracostomy (46.4%) or a tube thoracostomy with a fibrinolytic agent (39.3%) (p < 0.001). A large majority (75.3%) believed that the published evidence does not identify the optimal intervention.

CONCLUSIONS

There is a lack of consensus regarding the optimal treatment of PPE. Respondents believed the published evidence is inconclusive and were willing to participate in a prospective trial. These findings will help inform the design of a randomized, pragmatic clinical trial to optimize PPE management.