A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery

BACKGROUND: We aimed to compare patient-controlled thoracic or lumbar epidural analgesia methods after thoracotomy operations. METHODS: One hundred and twenty patients were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or lumbar epidural analgesia (LEA group). In both groups, epidural catheters were administered. Hemodynamic measurements, visual analog scale scores at rest (VAS-R) and after coughing (VAS-C), analgesic consumption, and side effects were compared at 0, 2, 4, 8, 16, and 24 hours postoperatively. RESULTS: The VAS-R and VAS-C values were lower in the TEA group in comparison to the LEA group at 2, 4, 8, and 16 hours after surgery (for VAS-R, P = 0.001, P = 0.01, P = 0.008, and P = 0.029, respectively; and for VAS-C, P = 0.035, P = 0.023, P = 0.002, and P = 0.037, respectively). Total 24-hour analgesic consumption was different between groups (175 +/- 20 mL versus 185 +/- 31 mL; P = 0.034). The comparison of postoperative complications revealed that the incidence of hypotension (21/57, 36.8% versus 8/63, 12.7%; P = 0.002), bradycardia (9/57, 15.8% versus 2/63, 3.2%; P = 0.017), atelectasis (1/57, 1.8% versus 7/63, 11.1%; P = 0.04), and the need for intensive care unit (ICU) treatment (0/57, 0% versus 5/63, 7.9%; P = 0.03) were lower in the TEA group in comparison to the LEA group. CONCLUSIONS: TEA has beneficial hemostatic effects in comparison to LEA after thoracotomies along with more satisfactory pain relief profile

The use of oxygen reserve index in one-lung ventilation and its impact on peripheral oxygen saturation, perfusion index and, pleth variability index

Background Our goal is to investigate the use of the oxygen reserve index (ORi) to detect hypoxemia and its relation with parameters such as; peripheral oxygen saturation, perfusion index (PI), and pleth variability index (PVI) during one-lung ventilation (OLV). Methods Fifty patients undergoing general anesthesia and OLV for elective thoracic surgeries were enrolled in an observational cohort study in a tertiary care teaching hospital. All patients required OLV after a left-sided double-lumen tube insertion during intubation. The definition of hypoxemia during OLV is a peripheral oxygen saturation (SpO2) value of less than 95%, while the inspired oxygen fraction (FiO2) is higher than 50% on a pulse oximetry device. ORi, pulse oximetry, PI, and PVI values were measured continuously. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and accuracy were calculated for ORi values equal to zero in different time points during surgery to predict hypoxemia. At Clinicaltrials.gov registry, the Registration ID is NCT05050552. Results Hypoxemia was observed in 19 patients (38%). The accuracy for predicting hypoxemia during anesthesia induction at ORi value equals zero at 5 min after intubation in the supine position (DS5) showed a sensitivity of 92.3% (95% CI 84.9-99.6), specificity of 81.1% (95% CI 70.2-91.9), and an accuracy of 84.0% (95% CI 73.8-94.2). For predicting hypoxemia, ORi equals zero show good sensitivity, specificity, and statistical accuracy values for time points of DS5 until OLV30 where the sensitivity of 43.8%, specificity of 64%, and an accuracy of 56.1% were recorded. ORi and SpO2 correlation was found at DS5, 5 min after lateral position with two-lung ventilation (DL5) and at 10 min after OLV (OLV10) (p = 0.044, p = 0.039, p = 0.011, respectively). Time-dependent correlations also showed that; at a time point of DS5, ORi has a significant negative correlation with PI whereas, no correlations with PVI were noted. Conclusions During the use of OLV for thoracic surgeries, from 5 min after intubation (DS5) up to 30 min after the start of OLV, ORi provides valuable information in predicting hypoxemia defined as SpO2 less than 95% on pulse oximeter at FiO2 higher than 50%

Video assisted thoracic surgery outcomes for primary spontaneous pneumothorax, analysis of 56 cases, single university hospital experience

BACKGROUND/AIMS To evaluate patients with primary spontaneous pneumothorax (PSP) who were treated via the video-assisted thoracic surgery (VATS) procedure by means of clinical features, surgical outcomes, and follow-up results. MATERIAL and METHODS We retrospectively analyzed 56 consecutive patients who underwent VATS procedure for PSP between 2012 and 2018. There were 47 male and 9 female patients with a mean age of 26.01 +/- 7.4 (18-38) years. VATS was performed under general anesthesia with double lumen intubation. Apical wedge resection and mechanical abrasion or apical pleurectomy was performed in 60% of the patients with uniportal VATS and in 40% of the patients with two portal VATS by the same surgical team. RESULTS The operation indications were recurrence in 40 (71.5%) patients, prolonged air leak in 14 (25%), and bilateral pneumothorax in 2 (3.5%). Pleurodesis procedures included upper pleural mechanical abrasion in 44 (78.5%) patients and apical pleurectomy in 12 (22.5%). Bilateral VATS procedure was performed for two patients who had bilateral pneumothorax. The mean operation time, chest tube removal time, and length of hospital stay were 26.04 +/- 4.61 (20-45) min, 1.4 +/- 0.6 (1-3) days, and 1.7 +/- 0.8 (2-4) days, respectively. No significant difference was found between uniportal and biportal VATS or mechanical abrasion and apical pleurectomy groups compared with statistical evaluation with demographic and clinical features and surgical outcomes (p>0.05). There was no mortality, and complications occurred in 16 (28.5%) patients. Only 3 (5.3%) recurrence occurred during the mean follow-up period of 48.4 +/- 11.4 (9-70) months. CONCLUSION Video-assisted thoracic surgery stapled bullectomy for PSP when followed by mechanical pleurodesis is still the gold standard and is a reliable, safe method with a low recurrence rate, complication, length of hospital stay, and quicker recovery time. The formation of new bullae-blebs could be related to continued smoking behavior that can be seen as the main reason for late period recurrences

A rare mediastinal occurrence of neuroblastoma in an adult: case report

ABSTRACT CONTEXT: Neuroblastoma is the most common extracranial malignant solid tumor that occurs during childhood. It arises from primitive cells and is seen in the adrenal medulla and sympathetic ganglia of the sympathetic nervous system. CASE REPORT: We present a rare case of a 40-year-old man who was diagnosed with the onset of neuroblastoma arising in the mediastinum. He was treated by means of surgical resection in the superior mediastinum after neoadjuvant chemotherapy. The patient’s surgical outcome was satisfactory. CONCLUSION: There are still no standard treatment guidelines for adult neuroblastoma patients. Although they have a poor prognosis, the main treatment option should be complete surgery at an early stage. This situation may become clarified through biological and genetic studies in the future

Awake Videothoracoscopic Resection With The Help Of Thoracal Paravertebral Block: Two Case Report And Review Of Literature

Thoracic paravertebral block (TPB) can be administered for VATS (video-assisted thoracic surgery) method and often used for analgesic purposes and provides good results. Awake VATS (AVATS) has been increasingly employed in a variety of procedures involving pleura, lungs, and mediastinum. AVATS had been reported local anesthesia and sedation, intercostal blocks or TEA was used in terms of regional anesthesia in many studies. We present our experience with the two cases undergoing AVATS accompanied by TPB due to such cases are rarely seen in the literature. Specially, our second case of spontaneous pneumothorax surgery using AVATS with TPB anesthesia has not been reported previously in the literature

Can Awake Thoracoscopy Procedure be Performed with the Help of Thoracic Paravertebral Anesthesia?

Aim: The aim of this study was to present our experience with 11 patients who were spontaneously breathing with Awake Video Thoracoscopy (AVATS) procedure with the help of TPB because of rareness in the literature. Materials and Methods: Between December 2015 and December 2017, a total of 125 VATS cases were performed; 11 cases underwent VATS operation with the help of TPB; age, gender, operation performed, duration of operation, time of onset of mobilization-oral intake, duration of hospital stay, Visual Analogue Scale (VAS) scores were evaluated retrospectively. Results: All cases were treated with uniportal AVATS procedure with the help of TPB. The mean age was 40,3 +/- 17,4 years (range 18-64 years), nine (82%) of the pateints were male and two (18%) were female. Operation procedures included wedge resection in eight (73 %) patients (six of them for pneumothorax, two of them for diagnosis), in three (27%) patients pleural biopsy (one of them used talc pleurodesis). There were no perioperative events. The mean operation time was 27,7 +/- 6,4 minutes (range, 20-40 min) and the mean anesthesia time was 25 +/- 3,8 minutes (range 20-30 min). The mean time of mobilizitation, oral intake opening time and length of hospital stay was 1,1 +/- 0,4 hours (1-2 hours), 3,5 +/- 0,5 hours (3-4 hours), 2,6 +/- 0,5 days (2-3 days), respectively. Conclusion: Awake Video Asssited Thoracoscopic Surgery with the help of TPB has less side effects and less complication risks than other awake procedures with the help of other regional anesthesia techniques. We conclude that; although AVATS with the help of TPB has some minor complications, it has advantages such as early discharge, early mobilization and early oral intake, low pain levels in well-selected patient groups

Extra-Abdominal Aggressive Fibromatosis Presenting As an Intrathoracic Tumor

Tumors of fibrous tissue origin (fibromatosis) in chest and mediastinum have been rarely reported in the literature. Herein, we report a rare case of aggressive fibromatosis presenting as an intrathoracic tumor. A 36-year-old woman admitted to our hospital due to a feeling of oppression and pain in the left chest. A chest X-ray, thorax computed tomography revealed a large mass filling two thirds of lower left thorax. Widely surgical resection of the tumor was performed thoracotomy via seventh intercostal space. The tumor was 20x15x15 mm in size and diagnosed pathologically as aggressive fibromatosis. The patient has been well without recurrence for 15 months after surgery

3-Year Follow-Up After Uniportal Thoracoscopic Sympathicotomy for Hyperhidrosis: Undesirable Side Effects

Objective: Endoscopic thoracic sympathectomy or sympathicotomy, for the treatment of palmar, axillary, and plantar hyperhidrosis, is generally performed at one or two levels, between T2 and T5. Compensatory sweating (CS) is a severe and undesirable side effect of this procedure. Here, we describe the success of treatment and degree of postoperative CS in sympathicotomy patients

3-Year Follow-Up After Uniportal Thoracoscopic Sympathicotomy for Hyperhidrosis: Undesirable Side Effects

Objective: Endoscopic thoracic sympathectomy or sympathicotomy, for the treatment of palmar, axillary, and plantar hyperhidrosis, is generally performed at one or two levels, between T2 and T5. Compensatory sweating (CS) is a severe and undesirable side effect of this procedure. Here, we describe the success of treatment and degree of postoperative CS in sympathicotomy patients