scholarly journals Temporary Extrathoracic Vacuum Therapy Splint in Chest Wall Reconstruction

2021 ◽  
Author(s):  
Srikanth Vasudevan ◽  
Shriram Vaidya ◽  
Ritu Baath S. ◽  
Ashok Basur C. ◽  
Anantheswar Yellambalase N. ◽  
...  
Keyword(s):  
Chest Wall ◽  
Postoperative Recovery ◽  
Early Postoperative Period ◽  
Chest Wall Reconstruction ◽  
Anterolateral Thigh Flap ◽  
Vacuum Therapy ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Breathing Mechanics ◽  
Fraction Of Inspired Oxygen

Abstract Background Paradoxical respiration is a sinister consequence of bony chest cage defects which can persist even post chest wall reconstruction. It leads to prolonged dependence on mechanical ventilation postoperatively, thereby delaying recovery. Methods Negative pressure wound therapy (NPWT) was applied in early postoperative period to a patient with chest wall defect reconstructed with folded prolene mesh and free anterolateral thigh flap. Arterial blood gas (ABG), fraction of inspired oxygen (FiO2), peak end expiratory pressure (PEEP), oxygen saturation (SpO2), and blood pressure (BP) readings pre and post NPWT application were compared. Results There was marked improvement in the breathing mechanics and related parameters post NPWT application over the flap. Conclusions Negative extrathoracic pressure in the form of a temporary splint can enable early weaning off the ventilator and a smoother postoperative recovery in reconstructed chest wall defects.

Increasing the Quantity of Lungs for Transplantation Using High-Frequency Chest Wall Oscillation: A Proposal

2002 ◽  
Vol 12 (4) ◽  
pp. 266-274 ◽  
Author(s):  
Jane M. Braverman
Keyword(s):  
Chest Wall ◽  
High Frequency ◽  
Critical Factor ◽  
Chest Physiotherapy ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Donor Lung ◽  
Direct Data ◽  
Wall Oscillation ◽  
Better Than

The use of chest physiotherapy in donor patient management occupies an established place in most lung procurement protocols. Although its merits remain controversial and uncorroborated by direct data, some studies support the efficacy of chest physiotherapy in a variety of pulmonary patient populations. Comparative studies have shown that an airway clearance technology utilizing high-frequency chest wall oscillation clears pulmonary secretions as well as or better than chest physiotherapy, but has few of its contraindications and disadvantages. The implementation of high-frequency chest wall oscillation as part of the donor lung procurement protocol may increase rates of successful lung recovery by providing effective clearance of obstructing pulmonary secretions containing destructive by-products of inflammation and entrapped pathogens. High-frequency chest wall oscillation may also improve arterial blood gas values, a critical factor in increasing lung procurement rates. Although speculative, the benefits of high-frequency chest wall oscillation on donor lungs might improve perfusion and oxygenation of other organs for possible transplantation.

scholarly journals Nosocomial Methemoglobinemia Resulting from Self-Administration of Benzocaine Spray

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Christopher Hoffman ◽  
Hawa Abubakar ◽  
Pramood Kalikiri ◽  
Michael Green
Keyword(s):  
Methylene Blue ◽  
Respiratory Distress ◽  
Nasogastric Tube ◽  
Clinical Presentation ◽  
Postoperative Recovery ◽  
Blood Gas ◽  
Self Administration ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Life Threatening

Methemoglobinemia is life-threatening and bears pathognomonic signs difficult to diagnose in real time. Local anesthetics are widely used and are known for eliciting this condition. We report a case of methemoglobinemia secondary to self-administered use of benzocaine spray. A 27-year-old woman was found to be in respiratory distress during postoperative recovery. After desaturation persisted, arterial blood gas yielded a methemoglobin level of 47%. The patient was successfully treated with intravenous methylene blue. Review of the events revealed self-administered doses of benzocaine spray to alleviate discomfort from a nasogastric tube. We review this case in detail in addition to discussing methemoglobinemia and its relevant biochemistry, pathophysiology, clinical presentation, and medical management. Given the recognized risk of methemoglobinemia associated with benzocaine use, we recommend its removal from the market in favor of safer alternatives.

scholarly journals Posterior chest wall reconstruction with a free anterolateral thigh flap

2007 ◽  
Vol 134 (2) ◽  
pp. 537-538 ◽  
Author(s):  
Raymond W.M. Ng ◽  
George K.H. Li ◽  
Jimmy Y.W. Chan ◽  
Josephine Y.W. Mak
Keyword(s):  
Chest Wall ◽  
Chest Wall Reconstruction ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh

scholarly journals Chest wall reconstruction still has place in Today’s modern practice:" a tertiary center experience"

2019 ◽  
Vol 1 (3) ◽  
pp. 75-84
Author(s):  
Amr Ibrahim Abd Elaal Osman ◽  
Mohamed A. K. Salama Ayyad ◽  
Hussein Elkhayat ◽  
Ali A. Elwahab
Keyword(s):  
Chest Wall ◽  
Average Length ◽  
Lung Resection ◽  
Flail Chest ◽  
Median Sternotomy ◽  
Surgical Techniques ◽  
Early Postoperative Period ◽  
Chest Wall Reconstruction ◽  
Chest Wall Resection ◽  
Tertiary Center

Background: The key factor following chest wall resection is the preservation of the stability and integrity of the chest wall to support the respiration and protect the underlying organs. The present study aims to evaluate the use of the available grafts and prosthetic materials at our center in chest wall reconstruction with adherence to the proper surgical techniques, good perioperative and postoperative care to obtain good results. Methods: This is a retrospective single center study that concludes all patients underwent chest wall reconstruction for a variety of defects resulting from resection of tumors, trauma due to primarily firearms or motor car accidents, resection of radio necrotic tissues, infection and dehiscence of median sternotomy wounds after cardiac surgery.  Results: Study population consisted of 30 patients between January 2015and may 2018, among them were 20 male (70%) and 10 female patients (30%), with a median age of 43 ± 16.3 years, resection and reconstruction was performed in 23 cases (15 neoplastic,5 infective and  3 firearm cases) while reconstruction alone was performed in 7 (traumatic flail chest)  cases. Eighteen patients, underwent rib resection with an average 4.18 ± 2.2 ribs (range 2-6). Associated lung resection was performed in 5 patients (27.8 %): diaphragmatic resection was done in 2 cases in addition total sternal resection was performed in 5 cases. Most of the patients (96.7%) had primary healing of their wounds. there was one death (3.3%) in the early postoperative period. The average length of hospital stay for all patients was 8.7 days (range: 5–15). Respiratory complications occurred in three cases in the form of atelectasis and pneumonia at the ipsilateral side of reconstruction. Three cases suffered wound seroma which successfully managed by daily dressing and antibiotic coverage. Conclusions: according to our study and the analysis of similar studies, adequate perioperative preparation of patient undergoing chest wall resection and reconstruction with adherence to effective surgical techniques allowed us to use the available materials at our center for chest wall reconstruction with good and effective results without adding burden in terms of cost on the patient.

Chest wall reconstruction using a turbocharged chimaeric anterolateral thigh flap

2008 ◽  
Vol 61 (4) ◽  
pp. 438-441 ◽  
Author(s):  
Sinclair M. Gore ◽  
Mohammed A. Akhavani ◽  
Norbert Kang ◽  
Jagdeep S. Chana
Keyword(s):  
Chest Wall ◽  
Chest Wall Reconstruction ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh

An anaesthetic technique employing the Accutronic VS-150 High Frequency Jet Ventilator.

1986 ◽  
Vol 72 (3) ◽  
pp. 149-152
Author(s):  
S. J. Squires
Keyword(s):  
High Frequency ◽  
Blood Gas Analysis ◽  
Postoperative Recovery ◽  
Gas Analysis ◽  
Anaesthetic Technique ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Surgical Field ◽  
Carbon Dioxide Levels ◽  
Microlaryngeal Surgery

AbstractAn anaesthetic technique is described for microlaryngeal surgery which employs high frequency jet ventilation via a narrow-bore nasotracheal catheter. In a series of 18 patients the method was assessed for ease of administration, maintenance of arterial bloodgases and adequacy of the surgical field.The technique was found to be simple to administer, providing good conditions for operative microscopy. Arterial blood-gas analysis showed excellent oxygenation and significant improvement in hypercapnia resulting from deep inhalational induction (p<0.05), but pre-induction carbon dioxide levels were not achieved.In traoperative monitoring revealed no serious cardiovascular problems and postoperative recovery was without serious complications, however, it is recommended that the technique is unsuitable for patients in whom mild hypercapnia for up to 20 minutes is undesirable.

Abstract 138: Wooden Chest Syndrome Complicated by Cardiopulmonary Arrest: A Rare Case of Fentanyl Toxicity

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Ifeoma C Ogbuka ◽  
Obiora Egbuche ◽  
Marshaleen H King
Keyword(s):  
Mechanical Ventilation ◽  
Chest Wall ◽  
Rare Case ◽  
Cardiopulmonary Arrest ◽  
Spontaneous Breathing Trial ◽  
Respiratory Acidosis ◽  
Rapid Sequence Intubation ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Breath Sounds

Background: Wooden chest syndrome (WCS) is a known manifestation of fentanyl toxicity, especially with high doses used for anesthetic induction in rapid sequence intubation (RSI). We present a rare case of WCS leading to cardiopulmonary arrest (CPA) following administration of low dose fentanyl. Case Report: A 37-year-old woman with no past medical history was admitted for management of septic abortion complicated by respiratory failure requiring mechanical ventilation. With clinical improvement, a spontaneous breathing trial (SBT) was attempted. Given respiratory acidosis during SBT, mechanical ventilation was continued. 25 micrograms (mcg) IV fentanyl bolus was given for analgesia. A few minutes later, she developed abdominal and chest wall rigidity with agonal breathing, culminating in CPA. Telemetry rhythm strip revealed asystole. Cardiopulmonary resuscitation (CPR) was initiated. She had absent breath sounds and high airway resistance causing difficulty with bag-mask ventilation. Arterial blood gas revealed hypoxia and hypercapnia. She achieved return of spontaneous circulation within a few minutes of CPR. CXR ruled out pneumothorax. She received 25mcg IV fentanyl bolus for sedation while undergoing CT chest and had another episode of chest wall rigidity. Cisatracurium was started. Her chest wall rigidity resolved and she was extubated the next day. Discussion: Our patient likely had WCS from fentanyl toxicity demonstrated by recurrence of chest wall rigidity with fentanyl doses. WCS should be suspected in patients who develop chest wall rigidity following fentanyl administration. It should be managed with ventilator support and reversal with naloxone or a short acting neuromuscular blocker. Conclusion: CPA is a rare but fatal complication of WCS. WCS can occur with low doses of fentanyl even in patients who have previously tolerated higher doses.

scholarly journals Application of colloidal-hyperosmolar solution in the early postoperative period in patients after cardiosurgery

2020 ◽  
pp. 45-46
Author(s):  
B.O. Kondratskyi ◽  
V.L. Novak ◽  
Ya.B. Kondratskyi ◽  
L.Ya. Solovey ◽  
S.V. Prymak
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Period ◽  
Surgical Stress ◽  
Early Postoperative Period ◽  
Blood Gas ◽  
Acid Base ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
The Mean ◽  
Polyelectrolyte Solutions

Objective. To substantiate the safety of the infusion drug Hecoton in the early postoperative period in patients after cardiac surgery. Materials and methods. The study involved 60 patients receiving infusions of 200 ml colloid-hyperosmolar solution Gecotone. The solution contains: hydroxyethyl starch 130/0.42 – 5 %, polyatomic alcohol xylitol – 5 %, sodium lactate – 1.5 % and electrolytes Na+, K+, Ca++, Mg++, Cl-. The total amount of sodium in the solution is 270 mmol/l, which is 2 times higher than its concentration in blood plasma. The amount of lactate is 133 mmol/l, which is 4 times higher than in isotonic polyelectrolyte solutions. The total osmolarity of the drug is 890 mOsm/l. Vital signs, hemodynamics, glucose, arterial blood gas and acid-base status was evaluated before, during and infusion of medication. Results and discussion. Gecoton infusions had no adverse effect on hemodynamic parameters. All changes were not statistically significant. The mean values of the patient’s body temperature were within the normal range. There was no case of temperature increase above 36.9 °C in all patients after administration of the drug. There was a slight, statistically unreliable increase in the mean glucose level (from 8.57±0.42 to 9.53±0.48 mmol/l), which was most likely due to response to the surgical stress. Dynamics of arterial blood gas and acid-base state shows that pH and PaCO2 practically did not change, decrease of PaO2 from 115.69±5.52 mm Hg to 110,79±4,83 mm Hg after the infusion of Gecotone, was statistically unreliable, the base excess showed little dynamics to increase (from -1.84±0.35 to -1.29±0.23 mmol/l) after administration of Gecotone. Conclusions. The use of the complex colloid-hyperosmolar infusion solution Gecotone in patients after cardiac surgery in the early postoperative period is safe.

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