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Chris Durkin, Travis Schisler, Jens Lohser
PURPOSE OF REVIEW: Despite marked improvements in perioperative outcomes, esophagectomy continues to be a high-risk operation associated with significant morbidity and mortality. Progress has been achieved through evidence-based changes in preoperative optimization, intraoperative ventilation strategies, fluid therapy, and analgesia, as well as expedited postoperative recovery pathways. This review will summarize the recent literature on the anesthetic management of patients undergoing esophageal resection...
October 18, 2016: Current Opinion in Anaesthesiology
Sarah Townsend, Michelle L Oblak, Ameet Singh, Michele A Steffey, Jeffrey J Runge
OBJECTIVE: To report the diagnosis, treatment, and short-term outcome in dogs with suspected persistent right aortic arch (PRAA) undergoing thoracoscopy with concurrent esophagoscopy. STUDY DESIGN: Multi-institutional retrospective case series. ANIMALS: Dogs with suspected PRAA (n=9). METHODS: Medical records were reviewed from 2012 to 2016. Dogs undergoing thoracoscopy for PRAA at 3 referral hospitals were included...
October 12, 2016: Veterinary Surgery: VS
Jing-Yu Tan, Janelle Yorke, Amelie Harle, Jacky Smith, Fiona Blackhall, Mark Pilling, Alex Molassiotis
CONTENT: The Dyspnoea-12 (D-12) is a well validated instrument in respiratory illnesses for breathlessness assessment, but its psychometric properties have not been tested in lung cancer. OBJECTIVES: To demonstrate the psychometric properties of the D-12 in lung cancer patients. METHODS: Baseline data from a lung cancer feasibility trial were adopted for this analysis. D-12 and a series of patient-reported tools including five Numeric Rating Scales (NRS), the Hospital Anxiety and Depression Scale (HADS) and the Lung Cancer Symptom Scale (LCSS) were employed for the psychometric assessment...
October 5, 2016: Journal of Pain and Symptom Management
Jun-Yen Pan, Chu-Chuan Lin, Jen-Ping Chang
Assessment of the pulmonary circulation status including pressure, resistance, size, and absence of anatomical distortion, is crucial to the successful Fontan operation. Most patients are found to have acceptable pulmonary arteries after previous palliation, although some degree of distortion is not uncommon. However, in rare instances, some patients have only one functioning lung with another pulmonary artery seriously hypoplastic or atretic. For theses patients, completion of a Fontan operation will be challenging...
September 2016: Acta Cardiol Sin
Joanne F Irons, Lachlan F Miles, Kaustuv R Joshi, Andrew A Klein, Marco Scarci, Piergiorgio Solli, Guillermo Martinez
OBJECTIVE: General anesthesia with endobronchial intubation and one-lung positive-pressure ventilation always has been considered mandatory for thoracic surgery. Recently, there has been interest in nonintubated techniques for video-assisted thoracoscopic surgery (VATS) in awake and sedated patients. The authors' center developed a nonintubated technique with spontaneous ventilation with the patient under general anesthesia using a supraglottic airway device. The authors believe that this was the first study to compare a nonintubated general anesthetic technique with an intubated general anesthetic technique for VATS...
July 7, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Sean J Callahan, Meng Xia, Susan Murray, Kevin R Flaherty
BACKGROUND: A group of patients with idiopathic pulmonary fibrosis (IPF) presents with disease affecting one lung markedly more than the other. At this time, it is unclear how this population differs from those who present with more symmetric disease. We sought to explain the characteristics of the asymmetric group and how their disease progresses. METHODS: In this retrospective case-control study we accessed an interstitial lung disease (ILD) database and identified 14 asymmetric IPF cases via high-resolution computed tomography (HRCT) scoring of each lung lobe's disease severity...
October 2016: Respiratory Medicine
Willemijn M H Zijlstra, Johannes M Douwes, Mark-Jan Ploegstra, Usha Krishnan, Marcus T R Roofthooft, Hans L Hillege, D Dunbar Ivy, Erika B Rosenzweig, Rolf M F Berger
Congenital heart disease (CHD) is a frequent cause of pediatric pulmonary arterial hypertension (PAH), with diverse etiology and outcome. We aimed to describe phenotypic heterogeneity in pediatric PAH associated with CHD (PAH-CHD), assess the applicability of the Nice CHD classification, and explore whether this classification accurately reflects patient/disease characteristics and survival. All children with CHD from a contemporary cohort of consecutive pediatric PAH patients followed in three major referral centers (Denver, New York, the Netherlands) were characterized and classified on the basis of the latest proposed clinical classification for PAH-CHD (World Symposium on Pulmonary Hypertension, Nice, 2013)...
September 2016: Pulmonary Circulation
Youn Joung Cho, Jungil Bae, Tae Kyong Kim, Deok Man Hong, Jeong-Hwa Seo, Jae-Hyon Bahk, Yunseok Jeon
General anesthesia can affect microcirculatory properties. However, differential effects on the microcirculation according to the anesthetic technique used during thoracoscopic surgery have not been well documented. We conducted a randomized clinical trial in which the effects of desflurane and propofol, both with remifentanil, on systemic arterial oxygenation during one-lung ventilation were compared in patients undergoing thoracoscopic surgery. As a subgroup analysis, we compared the effects of two commonly used anesthetic techniques, desflurane-remifentanil (n = 52) and propofol-remifentanil (n = 48), on tissue oxygen saturation using a vascular occlusion test in patients undergoing thoracoscopic surgery...
September 26, 2016: Journal of Clinical Monitoring and Computing
Ali Sait Kavakli, Nilgun Kavrut Ozturk, Raif Umut Ayoglu, Mustafa Emmiler, Lutfi Ozyurek, Kerem Inanoglu, Sadik Ozmen
OBJECTIVES: Various minimally invasive surgical approaches have been used in mitral valve (MV) surgery. The transapical off-pump mitral valve intervention with NeoChord implantation (TOP-MINI) is a minimally invasive, alternative procedure for the treatment of degenerative mitral regurgitation. There are several special considerations for the anesthesiologist during the TOP-MINI procedure. The main purpose of this study was to present the anesthetic management of the TOP-MINI procedure...
June 28, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Dongkai Shen, Qian Zhang, Yan Shi
In recent studies on the dynamic characteristics of ventilation system, it was considered that human had only one lung, and the coupling effect of double lungs on the air flow can not be illustrated, which has been in regard to be vital to life support of patients. In this article, to illustrate coupling effect of double lungs on flow dynamics of mechanical ventilation system, a mathematical model of a mechanical ventilation system, which consists of double lungs and a bi-level positive airway pressure (BIPAP) controlled ventilator, was proposed...
2016: Computational and Mathematical Methods in Medicine
Qingming Bian, Lianbing Gu, Zeping Xu, Pengyi Li, Yanning Qian, Dongya Zhu
Objective To investigate the effect of dexmedetomidine on lung injury and the expressions of Toll-like receptor 4 (TLR4), nuclear factor κB p65 (NF-κB p65) and intercellular adhesion molecular 1 (ICAM-1) mRNA during one-lung ventilation (OLV) in rabbits. Methods Thirty healthy New Zealand white rabbits were randomly divided into three groups ( n=10 in each group): two-lung ventilation (TLV) group (group T), OLV group (group O), dexmedetomidine used during OLV group (group D-O). The rabbits in group T were treated with TLV for 3...
September 2016: Xi Bao Yu Fen Zi Mian Yi Xue za Zhi, Chinese Journal of Cellular and Molecular Immunology
Adrienne Carr, Nelson Gonzalez, Roberto Hernandez-Alejandro, Ramiro Arellano
A 64-year-old woman with a previous liver transplant developed graft failure with biliary complications including a bronchobiliary fistula, which did not respond to preoperative conservative therapy. Liver retransplantation provided definitive therapy for the liver failure and bronchobiliary fistula. We present anesthestic considerations for the intraoperative management of a liver retransplant with one-lung ventilation.
September 7, 2016: A & A Case Reports
Kyu Nam Kim, Dong Won Kim, Mi Ae Jeong, Yeong Hun Sin, Soo Kyung Lee
BACKGROUND: Not only arterial hypoxemia but acute lung injury also has become the major concerns of one-lung ventilation (OLV). The use of pressure-controlled ventilation (PCV) for OLV offers the potential advantages of lower airway pressure and intrapulmonary shunt, which result in a reduced risk of barotrauma and improved oxygenation, respectively. METHODS: We searched Medline, Embase, the Cochrane central register of controlled trials and KoreaMedto find publications comparing the effects of PCV with those of volume-controlled ventilation (VCV) during intraoperative OLV in adults...
August 31, 2016: BMC Anesthesiology
Man-Ling Wang, Ming-Hui Hung, Kuang-Cheng Chan, Jin-Shing Chen, Ya-Jung Cheng
OBJECTIVE(S): Less general anesthetic is required in patients with regional blocks than in those without, as assessed through commonly used anesthesia monitoring parameters such as blood pressure, heart rate, and bispectral index (BIS). Although intraoperative regional anesthesia has become more widely adopted, few studies have confirmed or monitored its anesthetic-sparing effects. Using recent reports of nonintubated video-assisted thoracoscopic surgery (VATS) by BIS-targeted propofol infusion and intraoperative multilevel thoracoscopic intercostal nerve blocks (TINBs), this retrospective study investigated whether the anesthetic-sparing effect can be realized by reducing the effect-site concentration (Ce) to the targeted BIS level or by reducing the blood pressure at the onset of regional blocks...
August 23, 2016: Acta Anaesthesiologica Taiwanica: Official Journal of the Taiwan Society of Anesthesiologists
Zhen Liu, Xiaowen Liu, Yuguang Huang, Jing Zhao
BACKGROUND: Postoperative pulmonary complications (PPCs), which are not uncommon in one-lung ventilation, are among the main causes of postoperative death after lung surgery. Intra-operative ventilation strategies can influence the incidence of PPCs. High tidal volume (V T) and increased airway pressure may lead to lung injury, while pressure-controlled ventilation and lung-protective strategies with low V T may have protective effects against lung injury. In this meta-analysis, we aim to investigate the effects of different ventilation strategies, including pressure-controlled ventilation (PCV), volume-controlled ventilation (VCV), protective ventilation (PV) and conventional ventilation (CV), on PPCs in patients undergoing one-lung ventilation...
2016: SpringerPlus
Lu Gong, Lan Hu
OBJECTIVE: To investigate the value of electronic bronchoscopy in the etiological diagnosis and treatment of pediatric intensive care patients with difficult ventilator weaning. METHODS: A retrospective analysis was performed for the clinical data of 92 pediatric intensive care patients with difficult ventilator weaning and underwent electronic bronchoscopy. RESULTS: Among all the 92 children, the most common underlying disease was respiratory system disease (39 children)...
August 2016: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
Johannes Spaeth, Andrea Hojnik, Matthias Ott, Steffen Wirth, Matthias Schneider, Torsten Loop, Stefan Schumann
OBJECTIVES: To determine pressure-flow characteristics of double-lumen tubes (DLTs) with an outer diameter of 26 to 41 French and calculate bronchial pressure in a model setup and using data from patients who underwent one-lung ventilation with a DLT. DESIGN: Prospective experimental study and retrospective analysis of clinical measurements. SETTING: University medical center. PARTICIPANTS: Lung model and patients. INTERVENTIONS: Flow rates and pressure gradients across Robertshaw-type DLTs (∆P(DLT)) were measured in a physical model and the DLT-specific resistance coefficients were calculated from ∆P(DLT) according to Rohrer's approach...
August 2016: Journal of Cardiothoracic and Vascular Anesthesia
Malavika Kulkarni, Manjunath Prabhu, Sagar Maddineni
Direct injury to airway is a rare event and also a challenge to anaesthesiologist and surgeon. We present a case report of open tracheal injury with right pneumothorax in a young male following assault with a sharp weapon. In spite of a chest tube in situ, the patient came with collapse of one lung and tachypnoea which required surgical exploration. Lower airway was evaluated by fibre-optic bronchoscopy through the open tracheal wound while he was awake and tracheal tube was passed over the bronchoscope. There was no vascular or oesophageal injury detected...
July 2016: Indian Journal of Anaesthesia
Na Zhang, Wen-Juan Chen, Yue Zhou, Hongtao Zhao, Ru-Gang Zhong
Design of novel coumarin derivatives as CK2 inhibitors were attempted by targeting the interaction with the hinge region. A set of substituents capable of forming a hydrogen bond or halogen bond with the hinge region were screened in silico, and trifluoromethyl emerges as a promising motif by forming favorable electrostatic interaction and a presumable halogen bond with the hinge region. As proof of concept, three trifluoromethyl derivatives of coumarin were synthesized and tested in vitro. The results indicated that replacement of methyl by trifluoromethyl leads to a modest 5-fold improvement in potency, with the most active compound being 0...
January 2016: Molecular Informatics
Xinfeng Chen, Phil Prior, Guang-Pei Chen, Christopher J Schultz, X Allen Li
PURPOSE: The integration of MRI with a linear accelerator (MR-linac) offers great potential for high-precision delivery of radiation therapy (RT). However, the electron deflection resulting from the presence of a transverse magnetic field (TMF) can affect the dose distribution, particularly the electron return effect (ERE) at tissue interfaces. The purpose of the study is to investigate the dose effects of ERE at air-tissue and lung-tissue interfaces during intensity-modulated radiation therapy (IMRT) planning...
August 2016: Medical Physics
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