Results of the Diaphragmatic Plication Database: 10 Years' Experience

2021 ◽  
Author(s):  
Nils Jurriaan Kosse ◽  
Thomas Galetin ◽  
Sarah Bettina Schwarz ◽  
Tim Mathes ◽  
Aris Koryllos ◽  
...  
Keyword(s):  
Surgical Therapy ◽  
Supine Position ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Blood Gas Analysis ◽  
Forced Expiratory Volume ◽  
Gas Analysis ◽  
Cervical Spine Surgery ◽  
Diaphragmatic Function ◽  
6Mwt Distance

Abstract Background Unilateral diaphragmatic paralysis or paresis (UDP) in adults is an often overlooked disease which relevantly impairs the patient's lung function and quality of life. Particularly in idiopathic UDP, there is no evidence for conservative therapy and only little evidence for surgical therapy. Methods The method involves retrospective single-center analysis of patients with UDP persistent for at least 1 year who were operated by diaphragmatic resection, plication, and augmentation with a polypropylene mesh. The patients were tested for lung and diaphragmatic function, six-minute walk test (6MWT), and blood gas analysis before, 3 and 12 months after surgery. Results In total, 85 patients received surgery for UDP. The most frequent reasons for UDP were idiopathic (67%), iatrogenic (mainly cardiac and cervical spine surgery; 24%), and trauma (9%). The mean operation time was 84 ± 24 minutes, the length of hospital stay 8.4 ± 3.9 days, chest tubes were removed after 11.7 ± 4.1 days. Overall morbidity was 42%, mortality 0%. Forced expiratory volume in one second (FEV1) in supine position improved by 12.4% absolute, vital capacity by 11.8% absolute, and sniff nasal inspiratory pressure by 1.4 kPa 12 months after surgery (p <0.001 each). Total lung capacity increased by 6.8% absolute at 12 months (p = 0.001) The 6MWT distance improved by 45.9 m at 3 months and 50.9 m at 12 months (p = 0.001, each). Conclusion Surgical therapy for UDP is highly effective in the long term. The superiority over conservative treatments needs to be evaluated prospectively with standardized physiotherapeutic protocols. FEV1 in supine position and 6MWT are easy to perform tests and represent statistically and patient-relevant outcomes.

Erector spine plane block as postoperative rescue analgesia in thoracic surgery

2020 ◽  
Vol 106 (5) ◽  
pp. 388-391
Author(s):  
Marco Rispoli ◽  
Roberta Tamburri ◽  
Moana Rossella Nespoli ◽  
Marianna Esposito ◽  
Dario Maria Mattiacci ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Rating Scale ◽  
Dynamic Assessment ◽  
Case Series ◽  
Blood Gas Analysis ◽  
Numeric Rating Scale ◽  
Forced Expiratory Volume ◽  
Gas Analysis ◽  
Rescue Analgesia ◽  
Surgical Ward

Objective: Erector spine plane block (ESPB) is a newly defined regional anesthesia technique performed by injection of local anesthetic beneath the erector spine muscle. We tested ESPB as a regional rescue analgesia bedside technique to be performed in the thoracic surgical ward, reporting a 7-patient case series. Methods: We report our experience in rescue analgesia after thoracic surgery. During the postoperative stay, numeric rating scale (NRS) score >3 and inability to perform physiotherapy or effective cough due to postoperative pain represented the criteria for proposing rescue analgesia with ESPB. NRS at rest and during movements was recorded; blood gas analysis and spirometry were performed to evaluate PaO2/FiO2 (P/F), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) before ESPB execution. After performing the ESPB, static and dynamic NRS, P/F, and FVC and FEV1 were recorded at 40 minutes and 80 minutes. Results: NRS had a reduction at rest and in dynamic assessment. The P/F did not improve but spirometric measures improved. FVC had a relevant improvement only after 80 minutes; FEV1 was increased after 40 minutes. Conclusion: The use of ESPB as postoperative rescue analgesia can offer several advantages due to effective rescue analgesia and safety that makes it easy to perform in the thoracic surgical ward or in an outpatient clinic setting.

scholarly journals Low pressure video endoscopic inguinal lymphadenectomy in the treatment of penile cancer: a historical control study

2020 ◽  
Author(s):  
Peng Xian ◽  
Gangjun Yuan ◽  
Junyong Dai ◽  
Xianli Tang ◽  
Fang Yuan ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Penile Cancer ◽  
Ph Value ◽  
Operation Time ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Inguinal Lymphadenectomy ◽  
Group 2 ◽  
Control Study

Abstract Background and ObjectiveTo decrease the risk of complications of inguinal lymphadenectomy by investigating the value of low CO2 pressure video endoscopic inguinal lymphadenectomy in the treatment of penile cancer.MethodsThe clinical data of a total of 44 patients who underwent video endoscopic inguinal lymphadenectomy (VEIL) were collected for statistical analysis.ResultsThe average operation time was ( 106.88 ± 17.93) min in low CO2 pressure (LP) group and ( 115.79 ± 20.29) min in normal CO2 pressure (NP) group. The average number of lymph nodes was (10.83 ± 2.14) in LP group and (11.16 ± 1.77) ml in NP group. The intraoperative PaCO2 value was (45.51 ± 4.57) mmHg in LP group and (50.77 ± 6.50) ml in NP group. The PH value of blood gas analysis was (7.35 ± 0.05) in LP group and (7.31 ± 0.04) ml in NP group. The incidence of emphysema was 2/25 in LP group while it was 9/19 in NP group. 2 cases of skin metastasis and 1 lung metastasis were observed in NP group, but not in LP group.ConclusionsDecrease of CO2 pressure during operation will not increase the difficulty of the surgery. LP VEIL can reduce the risk of complications including hypercapnia and the subcutaneous or lung recurrence.

scholarly journals Forced expiratory volume in 1-second and blood gas analysis in children during asthma attacks

2018 ◽  
Vol 58 (5) ◽  
pp. 221-6
Author(s):  
Dewa Ayu Dini Primashanti ◽  
Putu Siadi Purniti ◽  
I Gusti Ayu Trisna Windiani
Keyword(s):  
Blood Gas Analysis ◽  
Cross Sectional Study ◽  
Forced Expiratory Volume ◽  
Gas Analysis ◽  
Blood Gas ◽  
Cross Sectional ◽  
Common Chronic Disease ◽  
Asthma Attack ◽  
Children With Asthma ◽  
Blood Gas Analyses

Background Asthma is the most common chronic disease in the world, with a high incidence in children. Blood gas analysis and pulmonary function test using spirometry are recommended to evaluate the degree of asthma in children. Spirometry test is non-invasive and easier to implement compared to blood gas analysis. Objective To evaluate for a possible correlation between forced expiratory volume in 1 second (FEV1) measured by spirometry test and blood gas analysis (pO2 and pCO2 levels) in children during an asthma attack. Methods This cross-sectional study was done in children with asthma attacks who were admitted to Sanglah Hospital, Denpasar, Bali, between November 2016 and April 2017. Subjects underwent spirometry tests and blood gas analyses. Potential correlations between FEV1 and pO2 and pCO2 levels were analyzed by Spearman’s correlation test. Results A total of 50 subjects, consisting of children aged 6 to 12 years, were diagnosed with asthma attacks during the study period. Subjects’ mean FEV1 level was 43.6%, mean pCO2 was 38.36 mmHg, and mean pO2 was 121.92 mmHg. There were no significant correlations between FEV1 and pCO2 level (r=0.206; P=0.152) or FEV1 and pO2 (r=0.157; P=0.277) found in this study. Conclusion FEV1 does not correlate with pCO2 and pO2 level in children during asthma attacks.

scholarly journals Clinical Study on the Effects of Different Positions on Supine Hypotensive Syndrome in Cesarean Section after Lumbar Anesthesia

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Chunyan Zhao ◽  
Yi Tang ◽  
Cibo Chen ◽  
Bingchun Xia
Keyword(s):  
Blood Pressure ◽  
Cesarean Section ◽  
Supine Position ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Significant Difference ◽  
Group A ◽  
Hypotensive Syndrome ◽  
Group B

Aim: To explore the effects of different positions on supine hypotensive syndrome in cesarean section after lumbar anesthesia. Methods: 600 full-term parturient were randomly divided into 4 groups. The patented positioning pads (patent number: ZL 2017 2 0618886.5) in our department was used in the left-leaning position. The parturient lied in a supine position for anesthesia in, and then the group of positioning pads was placed after turning into the lateral position. The parturient were divided into group A (supine position), group B (left-leaning to 10 °), group C (left-leaning to 20 °), and group D (30 °). Observation index: Main index: Comparison of maternal blood pressure changes and neonatal blood gas analysis in the supine position without using a position pad and with the use of patent positioning pads in different tilt angles (10°, 20°, 30°). Minor index: 1) the use and frequency of vasoactive drugs, whether a left-leaning operating bed or uterine displacement is required; 2) the consciousness of the parturient; 3) newborn’s Apgar scores of 1 minute, 5 minutes, and 10 minutes after birth; 4) whether the obstetrician can perform the operation smoothly in the corresponding left leaning position. Results: The blood pressure at the supine position after anesthesia, the beginning of surgery and the time when the newborn was delivered in group A and group B were significantly different from those in group C (P<0.05). There were significant differences at different timings in group A and group B, and the decline was more significant at the supine position after anesthesia, the beginning of surgery and the time when the newborn was delivered (P<0.05). The pH value of blood gas analysis of newborns in group A, group B and group C was between 7.25 and 7.37, and there was no significant difference between the three groups (P?0.05). Conclusion: The use of positioning pads can prevent the adverse effects of supine hypotensive syndrome on parturient and newborns to a certain extent.

Efficacy of Near-Infrared Spectrometry for Monitoring the Cerebral Effects of Severe Dilutional Anemia

2014 ◽  
Vol 17 (3) ◽  
pp. 154 ◽  
Author(s):  
Arıtürk Cem ◽  
Ustalar Serpil ◽  
Toraman Fevzi ◽  
Ökten Murat ◽  
Güllü Ümit ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Surgery ◽  
Blood Lactate ◽  
Near Infrared ◽  
Bypass Graft ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Infrared Spectrometry ◽  
Control Group ◽  
Near Infrared Spectrometry

<p><strong>Introduction:</strong> Clear guidelines for red cell transfusion during cardiac surgery have not yet been established. The current focus on blood conservation during cardiac surgery has increased the urgency to determine the minimum safe hematocrit for these patients. The aim of this study was to determine whether monitoring of cerebral regional oxygen saturation (rSO<sub>2</sub>) via near-infrared spectrometry (NIRS) is effective for assessing the cerebral effects of severe dilutional anemia during elective coronary arterial bypass graft surgery (CABG).</p><p><strong>Methods:</strong> The prospective observational study involved patients who underwent cerebral rSO<sub>2</sub> monitoring by NIRS during elective isolated first-time CABG: an anemic group (<em>N</em>=15) (minimum Hemoglobin (Hb) N=15) (Hb &gt;8 g/dL during CPB). Mean arterial pressure (MAP), pump blood flow, blood lactate level, pCO<sub>2</sub>, pO<sub>2</sub> at five time points and cross-clamp time, extracorporeal circulation time were recorded for each patient. Group results statistically were compared.</p><p><strong>Results:</strong> The anemic group had significantly lower mean preoperative Hb than the control group (10.3 mg/dL versus 14.2 mg/dL; <em>P</em> = .001). The lowest Hb levels were observed in the hypothermic period of CPB in the anemic group. None of the controls exhibited a &gt;20% decrease in cerebral rSO<sub>2</sub>. Eleven (73.3%) of the anemic patients required an increase in pump blood flow to raise their cerebral rSO<sub>2</sub>.</p><p><strong>Conclusions:</strong> In this study, the changes in cerebral rSO<sub>2</sub> in the patients with low Hb were within acceptable limits, and this was in concordance with the blood lactate levels and blood-gas analysis. It can be suggested that NIRS monitoring of cerebral rSO<sub>2</sub> can assist in decision making related to blood transfusion and dilutional anemia during CPB.</p>

Blood gas analysis in newborns with low cardiac output syndrome after cardiac surgery.

2018 ◽  
Vol 19 (5) ◽  
pp. 676-687
Author(s):  
G.G. Khubulava ◽  
A.B. Naumov ◽  
S.P. Marchenko ◽  
O.Yu. Chupaeva ◽  
A.A. Seliverstova ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output

Prognostic Value of Oxygenated Hemoglobin Assessed during Acute Exacerbations of Chronic Pulmonary Disease

Respiration ◽  
2021 ◽  
pp. 1-8
Author(s):  
Clemens F. Hinke ◽  
Rudolf A. Jörres ◽  
Peter Alter ◽  
Robert Bals ◽  
Florian Bornitz ◽  
...  
Keyword(s):  
Pulmonary Disease ◽  
Predictive Value ◽  
Hemoglobin Concentration ◽  
Blood Gas Analysis ◽  
Study Data ◽  
Gas Analysis ◽  
Chronic Obstructive ◽  
Acute Exacerbations ◽  
All Cause Mortality

<b><i>Background:</i></b> Oxygenated hemoglobin(OxyHem) is a simple-to-measure marker of oxygen content capable of predicting all-cause mortality in stable chronic obstructive pulmonary disease (COPD). <b><i>Objectives:</i></b> We aimed to analyze its predictive value during acute exacerbations of COPD (AECOPD). <b><i>Methods:</i></b> In this retrospective study, data from 227 patients discharged after severe AECOPD at RoMed Clinical Center Rosenheim, Germany, between January 2012 and March 2018, was analyzed. OxyHem (hemoglobin concentration [Hb] × fractional SpO<sub>2</sub>, g/dL) was calculated from oxygen saturation measured by pulse oximetry and hemoglobin assessed within 24 h after admission. The follow-up (1.7 ± 1.5 years) covered all-cause mortality, including readmissions for severe AECOPD. <b><i>Results:</i></b> During the follow-up period, 127 patients died, 56 due to AECOPD and 71 due to other reasons. Survivors and non-survivors showed differences in age, FVC % predicted, C-reactive protein, hemoglobin, Cr, Charlson Comorbidity Index (CCI), and OxyHem (<i>p</i> &#x3c; 0.05 each). Significant independent predictors of survival were BMI, Cr or CCI, FEV<sub>1</sub> % predicted or FVC % predicted, Hb, or OxyHem. The predictive value of OxyHem (<i>p</i> = 0.006) was superior to that of Hb or SpO<sub>2</sub> and independent of oxygen supply during blood gas analysis. OxyHem was also predictive when using a cutoff value of 12.1 g/dL identified via receiver operating characteristic curves in analyses including either the CCI (hazard ratio 1.85; 95% CI 1.20, 2.84; <i>p</i> = 0.005) or Cr (2.04; 95% CI 1.35, 3.10; <i>p</i> = 0.001) as covariates. <b><i>Conclusion:</i></b> The concentration of OxyHem provides independent, easy-to-assess information on long-term mortality risk in COPD, even if measured during acute exacerbations. It therefore seems worth to be considered for broader clinical use.

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