Burgessmccarthy4798
Video-assisted thoracoscopic surgery (VATS) is a commonly performed minimally invasive procedure that has led to lower levels of pain, as well as procedure-related mortality and morbidity. However, VATS requires analgesia that blocks both visceral and somatic nerve fibers for more effective pain control. This randomized controlled trial evaluated the effect of erector spinae plane block (ESPB) in the postoperative analgesia management of patients undergoing VATS.
We performed a prospective, randomized, single-center study between December 2018 and December 2019. Fifty-four patients were recruited to two equal groups (ESPB and control group). Following exclusion, 46 patients were included in the final analysis. Patients were randomly assigned to receive preoperative ultrasound-guided ESPB with either ropivacaine or saline. The primary outcome was the numeric rating scale (NRS) score, assessed 12 hours postoperatively. Secondary outcomes were the Riker Sedation-Agitation Scale (SAS) score for emergence agitp [4 (1.0)] than that in the control group [5 (1.25); P<0.001] in PACU.
A single preoperative injection of ESPB with ropivacaine may improve acute postoperative analgesia and emergence agitation in patients undergoing VATS.
A single preoperative injection of ESPB with ropivacaine may improve acute postoperative analgesia and emergence agitation in patients undergoing VATS.
To present a 2-year follow-up regarding safety and hemodynamic performance of a new restorative vascular graft used as extracardiac cavo-pulmonary connection in patients with univentricular congenital heart malformations.
The graft was implanted in five patients (aged 4-12 years) as extracardiac connection between the inferior vena cava and the pulmonary artery. The conduit consists of a bioabsorbable polymer-based implant able to generate endogenous tissue restoration leading to a fully functional neo-vessel while the polymer progressively absorbs. All patients have reached more than 24 months following surgery and underwent echocardiography and magnetic resonance imaging.
All patients are doing well at 24 months follow-up, with no graft-related serious adverse events. Transthoracic echocardiography demonstrated adequate function of the conduit in all patients while magnetic resonance imaging showed anatomical and functional stability of the restorative grafts.
The new restorative conduit has been suthrombogenicity and ability to grow.
Spirometry is used to evaluate postoperative outcomes in thoracic surgery. However, the clinical utility of spirometry for predicting postoperative complications has not been determined. check details We used big-data analysis to examine the relationship between pulmonary function tests and postoperative complications.
We retrospectively analysed clinical data from 31,827 patients who underwent spirometry within the 3 months prior to their surgery between January 2000 and December 2014 at a single tertiary referral hospital. The data were extracted in de-identified form via the automated clinical research information system. Surgical procedures included thoracic and upper abdominal surgery.
Multivariable logistic regression analysis showed that type of surgery, older age (>65 years), low albumin and smoking were associated with postoperative infections [95% confidence interval (CI) of the odds ratio (OR) 1.27-1.60 (>65 years); 1.52-1.96 (low albumin); 1.40-1.98 (current smoker)]. Notably, lower forced vital capacity (FVC) was an independent risk factor for postoperative infection, prolonged intensive care unit stay, and in-hospital death, regardless of airflow limitation [OR 95% CI 1.31-1.69 (FVC 50-80%); 2.02-4.24 (FVC <50%)]. Lower forced expiratory volume in 1 sec (FEV
) was also an independent risk factor for postoperative infection [OR 95% CI 1.61-2.26 (FEV
50-80%); 2.27-4.21 (FEV
<50%)]. Airflow limitation assessed by FEV
was negatively correlated with postoperative infection in multivariable analysis (OR 95% CI 0.51-0.88).
Lower preoperative FVC could be used to predict postoperative infection and complications in thoracic and upper abdominal surgery regardless of airflow limitation.
Lower preoperative FVC could be used to predict postoperative infection and complications in thoracic and upper abdominal surgery regardless of airflow limitation.
Computed tomography (CT) is now able to detect small pulmonary nodules. Surgical resection for diagnosis of these nodules is widely performed with video-assisted thoracoscopic surgery (VATS). However, it is very difficult to localize a small tumor by palpation via a small access port. In this study, we aimed to describe a novel intraoperative method for marking the location of the pulmonary nodule.
In 46 cases, a virtual thoracoscopic image was reconstructed using the CT images of the chest using volume rendering software before surgery. During thoracoscopic surgery, a pleural marker was affixed to the parietal pleura, just above the tumor, by referring to the virtual thoracoscopic image. The pleural marker dye was then transferred to the point on the visceral pleura just above the nodule. The distance between the center of the marking and the visceral pleura closest to the tumor was measured to evaluate the accuracy of the marking.
The mean distance between the center of the marking and the visceral pleura closest to the tumor was 10.2 mm. In 42 cases (92%), the tumor was within 30 mm of the marked point. All tumors were fully resected. No morbidity occurred intra- or postoperatively.
Our pleural marking, using a virtual thoracoscopic image, identified the tumor location with high accuracy, may help surgeon to confirm whether the palpated nodule is the target one. This new procedure can assist in the localization of the pulmonary nodule with ease of application, safety, and accuracy.
Our pleural marking, using a virtual thoracoscopic image, identified the tumor location with high accuracy, may help surgeon to confirm whether the palpated nodule is the target one. This new procedure can assist in the localization of the pulmonary nodule with ease of application, safety, and accuracy.
