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https://www.readbyqxmd.com/read/28203541/anesthetic-considerations-in-robotic-mitral-valve-surgery
#1
Kent H Rehfeldt, J Valery Andre, Matthew J Ritter
The robotic approach to cardiac surgery offers patients numerous potential advantages compared with a traditional sternotomy approach including shorter hospital length of stay, reduced pain, fewer blood transfusions, and a quicker return to normal daily activities. At the same time, robotic cardiac surgery requires that the anesthesiologist employs several subspecialty skillsets in order to provide optimal care for these patients. Multiple different regional anesthesia techniques may be used to improve analgesia, reduce opioid dosages, and facilitate rapid extubation at the conclusion of the case...
January 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28203413/better-perioperative-outcomes-in-thoracoscopic-esophagectomy-with-two-lung-ventilation-in-semi-prone-position
#2
Lei Cai, Yan Li, Li Sun, Xue-Wen Yang, Wen-Bin Wang, Fan Feng, Guang-Hui Xu, Man Guo, Xiao Lian, Hong-Wei Zhang
BACKGROUND: One-lung ventilation (OLV) anesthesia intubation route is often used in patients undergoing thoracoscopic-esophagectomy in semi-prone position. Recently, the two-lung ventilation (TLV) approach becomes popular. However, limited studies have compared the two ventilation approaches in parallel. Here, we report a single-center, retrospective study of comparing TLV and OLV approach in patients undergoing thoracoscopic-esophagectomy in semi-prone position. METHODS: From January 2013 to November 2014, 147 patients were enrolled into the current study and were given thoracoscopic-esophagectomy in semi-prone position either by OLV or TLV...
January 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28126982/novel-one-lung-ventilation-strategy-olv-for-a-patient-with-complete-unilateral-endobronchial-obstruction-causing-hypoxic-respiratory-failure
#3
Amaraja Kanitkar, Sarah J Lee
BACKGROUND Mechanical ventilation strategies for one lung ventilation (OLV) differ from conventional modalities in that it can adapt to greater degrees of ventilation/perfusion (V/Q) mismatch. We present a case of cancer causing complete unilateral endobronchial obstruction with refractory hypoxia that improved with OLV strategy. CASE REPORT Our patient was an elderly male, admitted to our intensive care unit (ICU) on mechanical ventilation with worsening hypoxic respiratory failure secondary to lung mass and post-obstructive atelectasis...
January 27, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28100177/effect-of-desflurane-remifentanil-vs-propofol-remifentanil-anesthesia-on-arterial-oxygenation-during-one-lung-ventilation-for-thoracoscopic-surgery-a-prospective-randomized-trial
#4
Youn Joung Cho, Tae Kyong Kim, Deok Man Hong, Jeong-Hwa Seo, Jae-Hyon Bahk, Yunseok Jeon
BACKGROUND: One-lung ventilation during thoracic surgery frequently disturbs normal systemic oxygenation. However, the effect of anesthetics on arterial oxygenation during one-lung ventilation has not been well established in human study. In this clinical trial, we investigated whether a difference between desflurane-remifentanil and propofol-remifentanil anesthesia can be observed with regard to oxygenation during one-lung ventilation for thoracoscopic surgery. METHODS: Adult patients with lung cancer, scheduled for video-assisted thoracoscopic lobectomy without preoperative oxygen support, were screened and randomized to receive desflurane or propofol, with remifentanil continuous infusion in both groups...
January 18, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28096575/the-effect-of-epidural-dexmedetomidine-on-oxygenation-and-shunt-fraction-in-patients-undergoing-thoracotomy-and-one-lung-ventilation-a-randomized-controlled-study
#5
Prachi Kar, Padmaja Durga, Ramachandran Gopinath
BACKGROUND AND AIMS: Role of epidural dexmedetomidine in providing analgesia is well documented, but its effect on oxygenation and shunt fraction is not well established. We studied the hypothesis that epidural dexmedetomidine may improve oxygenation and shunt fraction during one-lung ventilation (OLV). MATERIAL AND METHODS: After taking Institutional Ethics Committee approval, sixty patients undergoing thoracotomy and OLV were randomized to receive epidural ropivacaine with saline (RS group) or epidural ropivacaine with dexmedetomidine (RD group)...
October 2016: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/28086849/successful-outcome-following-pneumonectomy-in-a-teenage-boy-with-cystic-fibrosis-a-case-report
#6
Zheyi Liew, Santosh Mallikarjuna, Asif Hasan, F Kate Gould, Su Bunn, Matthew F Thomas, Jim L Lordan, Christopher O'Brien, Malcolm Brodlie
BACKGROUND: Cystic fibrosis lung disease is generally a diffuse process however rarely one lung may become particularly damaged through chronic collapse and consolidation resulting in end-stage bronchiectasis with relative sparing of the contralateral lung. This clinical situation is sometimes referred to as "destroyed lung". Lung resection surgery is seldom indicated in cystic fibrosis and the associated medical literature is relatively sparse. CASE PRESENTATION: A 14 year old boy was referred to our centre for lung transplantation assessment...
January 13, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28079851/corticosteroid-and-cyclophosphamide-in-acute-exacerbation-of-idiopathic-pulmonary-fibrosis-a-single-center-experience-and-literature-review
#7
Luca Novelli, Roberto Ruggiero, Federica De Giacomi, Alice Biffi, Paola Faverio, Luca Bilucaglia, Silvia Gamberini, Grazia Messinesi, Alberto Pesci
Acute Exacerbation (AEx) is a frequent and severe complication of Idiopathic Pulmonary Fibrosis (IPF). In the absence of consensus regarding treatment, studies evaluating the efficacy of specific therapies, such as corticosteroids and immunosuppresant agents, are needed. In this case series we evaluated the outcome in terms of survival of intravenous pulse doses of high-dose corticosteroid (methylprednisolone 1000 mg per day for 3 consecutive days) followed by montlhy cyclophosphamide administration (maximum 6 doses) in a cohort of patients with AEx-IPF referred to the Respiratory Unit, San Gerardo University Hospital, Monza, Italy, from 2009 to 2013...
December 23, 2016: Sarcoidosis, Vasculitis, and Diffuse Lung Diseases: Official Journal of WASOG
https://www.readbyqxmd.com/read/28076290/tailored-interactive-sequences-for-continuous-mr-image-guided-freehand-biopsies-of-different-organs-in-an-open-system-at-1-0-tesla-t-initial-experience
#8
Florian Streitparth, Christian Althoff, Martin Jonczyk, Felix Guettler, Martin Maurer, Hendrik Rathke, Keno Moritz Sponheuer, Bernd Hamm, Ulf K Teichgräber, Maximilian de Bucourt
OBJECTIVES: To assess the feasibility, image quality, and accuracy of freehand biopsies of liver, bone, muscle, vertebral disc, soft tissue, and other lesions using balanced steady-state free precession (SSFP, balanced fast field echo: bFFE), spoiled and nonspoiled gradient echo (FFE), and turbo spin echo (TSE) sequences for interactive continuous navigation in an open magnetic resonance imaging (MRI) system at 1.0 tesla (T). METHODS: Twenty-six MR-guided biopsies (five liver, five bone, four muscle, four vertebral disc, one lung, one kidney, one suprarenal gland, and five soft or other tissue) were performed in 23 patients in a 1...
January 11, 2017: Biomedizinische Technik. Biomedical Engineering
https://www.readbyqxmd.com/read/28074800/effectiveness-of-ventilation-of-nondependent-lung-for-a-brief-period-in-improving-arterial-oxygenation-during-one-lung-ventilation-a-prospective-study
#9
Keerthi Chigurupati, Suneel Puthuvassery Raman, Unnikrishnan Koraparambil Pappu, Unnikrishnan Madathipat
BACKGROUND: Hypoxemia is common during one-lung ventilation(OLV), predominantly due to transpulmonary shunt. None of the strategies tried showed consistent results. We evaluated the effectiveness of ventilating the operated, non-dependent lung (NDL) with small tidal volumes in improving the oxygenation during OLV. METHODS: 30 ASA 1 and 2 patients undergoing elective, open thoracotomy were studied. After standard induction of anesthesia, lung seperation was acheived with left sided DLT...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28074791/selection-of-an-appropriate-left-sided-double-lumen-tube-size-for-one-lung-ventilation-among-asians
#10
Siti Salwani Ideris, Muhamad Rahimi Che Hassan, Mohd Ramzisham Abdul Rahman, Joanna Su Min Ooi
CONTEXT: Selecting an appropriate size double-lumen tube (DLT) for one-lung ventilation has always been a challenge as most choose it based on experience or using the existing guidelines based on gender and height. AIMS: The aim of this study was to determine if the appropriate choice of this tube could be based on the patients' height, weight, tracheal diameter (TD), or the left main stem bronchus diameter (LMBD) and also to determine the relationship between height and depth of insertion among Asians...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28066625/the-anesthesia-of-trachea-and-bronchus-surgery
#11
REVIEW
Zehra Hatipoglu, Mediha Turktan, Alper Avci
The trachea and bronchus surgery is generally performed due to stenosis, traumatic injury, foreign body and tumors. Preoperative evaluation and anesthesia management are very important issues because of higher mortality and morbidity rates. Patients may be asymptomatic, but airway difficulties, hypoxia, stridor, cough, hemoptysis are common conditions in these patient population. The collaboration between the surgeon and the anesthesiologist is very substantial and necessary. Anesthetic techniques include various applications such as one lung ventilation, fiberoptic intubation, jet ventilation, and apneic oxygenation, general anesthesia with or without neuromuscular blockade...
November 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28059848/hemodynamic-monitoring-in-thoracic-surgical-patients
#12
Jacob Raphael, Lindsay A Regali, Robert H Thiele
PURPOSE OF REVIEW: This article reviews the technology and clinical data describing hemodynamic monitoring devices available to anesthesiologists and intensivists caring for patients undergoing thoracic surgical procedures, so that they may better utilize available technology to improve outcomes in this high-risk surgical population. RECENT FINDINGS: Noninvasive stroke volume monitors are based on several different technology platforms, all of which have distinct performance characteristics...
January 3, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28048275/su-f-j-168-dosimetric-impact-of-mr-image-distortion-in-treatment-planning
#13
Y Yan, J Yang, S Beddar, G Ibbott, P Balter, R Kudchadker, S Krishnan, C Fuller, J Wang
PURPOSE: To evaluate the dosimetric impact of MR image distortion in treatment planning. METHODS: Based on the realistic MRI distortion measurement data from an integrated MRI-Linac system, we created a generalized distortion model and applied it to CT images to simulate distorted MRI images. Ten patients with IMRT plans generated in Pinnacle treatment planning system in 5 anatomical cancer sites (lung, prostate, spinal cord, liver, and pancreas) were retrospectively selected for the simulation...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28047339/tu-ab-202-03-prediction-of-pet-transfer-uncertainty-by-dir-error-estimating-software-autodirect
#14
H Kim, J Chen, J Phillips, N Kirby
PURPOSE: Deformable image registration (DIR) is a powerful tool, but DIR errors can adversely affect its clinical applications. To estimate voxel-specific DIR uncertainty, a software tool, called AUTODIRECT (automated DIR evaluation of confidence tool), has been developed and validated. This work tests the ability of this software to predict uncertainty for the transfer of standard uptake values (SUV) from positron-emission tomography (PET) with DIR. METHODS: Virtual phantoms are used for this study...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28046273/su-f-t-586-pre-treatment-qa-of-incise2-mlc-plans-on-a-cyberknife-m6-using-the-delta4-system-in-sbrt
#15
D Schmidhalter, D Henzen, M Malthaner, D Frauchiger, M K Fix, P Manser
PURPOSE: Performing pre-treatment quality assurance (QA) with the Delta4 system (ScandiDos Inc., Madison, WI) is well established for linac-based radiotherapy. This is not true when using a Cyberknife (Accuray Inc., Sunnyvale, CA) where, typically film-based QA is applied. The goal of this work was to test the feasibility to use the Delta4 system for pre-treatment QA for stereotactic body radiation therapy (SBRT) using a Cyberknife-M6 equipped with the InCise2 multileaf collimator (MLC)...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28030449/hemodynamic-monitoring-in-thoracic-surgical-patients
#16
Jacob Raphael, Lindsay A Regali, Robert H Thiele
PURPOSE OF REVIEW: This article reviews the technology and clinical data describing hemodynamic monitoring devices available to anesthesiologists and intensivists caring for patients undergoing thoracic surgical procedures, so that they may better utilize available technology to improve outcomes in this high-risk surgical population. RECENT FINDINGS: Noninvasive stroke volume monitors are based on several different technology platforms, all of which have distinct performance characteristics...
February 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28012492/guidelines-concordant-empiric-antimicrobial-therapy-and-mortality-in-patients-with-severe-community-acquired-pneumonia-requiring-mechanical-ventilation
#17
Yukiyo Sakamoto, Yasuhiro Yamauchi, Hideo Yasunaga, Hideyuki Takeshima, Wakae Hasegawa, Taisuke Jo, Hiroki Matsui, Kiyohide Fushimi, Takahide Nagase
BACKGROUND: Community-acquired pneumonia (CAP) has high morbidity and mortality among adults. Several clinical guidelines recommend prompt administration of combined antimicrobial therapy. However, the association between guidelines concordance and mortality in patients with severe pneumonia remains unclear. The present study aimed to examine the impact of guidelines-concordant empiric antimicrobial therapy on 7-day mortality in patients with extremely severe pneumonia who required mechanical ventilation at admission, using a nationwide inpatient database in Japan...
January 2017: Respiratory Investigation
https://www.readbyqxmd.com/read/27941354/the-endothelial-glycocalyx-and-perioperative-lung-injury
#18
Florian Brettner, Vera von Dossow, Daniel Chappell
PURPOSE OF REVIEW: Ventilator-induced lung injury is a major contributor to perioperative lung injury. The end-expiratory lung volume, regional lung overdistension, and tidal recruitment are known to be the main factors causing subsequent alveolar damage and inflammation. The alveolar-capillary membrane including the endothelial glycocalyx as an integral part of the vascular endothelium seems to play a major role in different kinds of lung injury. RECENT FINDINGS: Recent studies underline the pivotal importance of the endothelial glycocalyx in lung injury...
February 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27919719/impact-of-left-heart-bypass-on-arterial-oxygenation-during-one-lung-ventilation-for-thoracic-aortic-surgery
#19
Kikuko Suga, Yoshiro Kobayashi, Ryoichi Ochiai
OBJECTIVE: The aim of this study was to reveal the mechanism of improved arterial oxygenation by measuring the changes in oxygenation before and after initiation of left heart bypass (LHB) during one-lung ventilation (OLV) for thoracic aortic surgery. DESIGN: Prospective, observational study. SETTING: Single-institution, private hospital. PARTICIPANTS: The study comprised 50 patients who underwent aortic surgery via a left thoracotomy approach with LHB circulatory support...
September 28, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27902842/vagal-denervation-inhibits-the-increase-in-pulmonary-blood-flow-during-partial-lung-aeration-at-birth
#20
Justin A R Lang, James T Pearson, Corinna Binder-Heschl, Megan J Wallace, Melissa L Siew, Marcus J Kitchen, Arjan B Te Pas, Robert A Lewis, Graeme R Polglase, Mikiyasu Shirai, Stuart B Hooper
Air entry into the lungs at birth triggers major cardiovascular changes, including a large increase in pulmonary blood flow (PBF) that is not spatially related to regional lung aeration. To investigate the possible underlying role of a vagally-mediated stimulus, we used simultaneous phase-contrast X-ray imaging and angiography in near-term (30 days of gestation) vagotomised (n = 15) or sham-operated (n = 15) rabbit kittens. Rabbits were imaged before ventilation, when one lung was ventilated (unilateral) with 100% nitrogen (N2 ), air or 100% oxygen (O2 ), before all kittens were switched to unilateral ventilation in air, then ventilation of both lungs using air...
November 30, 2016: Journal of Physiology
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