Pectus Excavatum

2018 ◽  
Author(s):  
Priti G. Dalal ◽  
Meghan Whitley
Keyword(s):  
Epidural Analgesia ◽  
Surgical Procedures ◽  
Pectus Excavatum ◽  
Surgical Repair ◽  
Congenital Deformity ◽  
Shortness Of Breath ◽  
Thoracic Epidural ◽  
Breathing Exercises ◽  
Breath Management ◽  
Thoracoscopic Technique

Pectus excavatum is a funnel-shaped congenital deformity of the chest. Although the deformity can appear minimal at birth, it may be progressive. There may be cardiac or pulmonary compromise in addition to subjective complaints of pain and shortness of breath. Management ranges from breathing exercises to surgical repair with mobilization of the sternum and ribs. This can be performed using an open or thoracoscopic technique. Complications of surgical repair include atelectasis and pneumothorax. Significant pain is associated with the surgical procedures and multimodal analgesic therapy, including thoracic epidural analgesia and intravenous narcotics, are typically used. This chapter discusses the etiology and management of pectus excavatum.

scholarly journals Intercostal nerve cryoablation versus thoracic epidural for postoperative analgesia following pectus excavatum repair: a systematic review and meta-analysis

2020 ◽  
Vol 31 (4) ◽  
pp. 486-498
Author(s):  
Jean H T Daemen ◽  
Erik R de Loos ◽  
Yvonne L J Vissers ◽  
Maikel J A M Bakens ◽  
Jos G Maessen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Epidural Analgesia ◽  
Hospital Stay ◽  
Pectus Excavatum ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Intercostal Nerve ◽  
Nuss Procedure ◽  
Thoracic Epidural

Abstract OBJECTIVES Minimally invasive pectus excavatum repair via the Nuss procedure is associated with significant postoperative pain that is considered as the dominant factor affecting the duration of hospitalization. Postoperative pain after the Nuss procedures is commonly controlled by thoracic epidural analgesia. Recently, intercostal nerve cryoablation has been proposed as an alternative method with long-acting pain control and shortened hospitalization. The subsequent objective was to systematically review the outcomes of intercostal nerve cryoablation in comparison to thoracic epidural after the Nuss procedure. METHODS Six scientific databases were searched. Data concerning the length of hospital stay, operative time and postoperative opioid usage were extracted. If possible, data were submitted to meta-analysis using the mean of differences, random-effects model with inverse variance method and I2 test for heterogeneity. RESULTS Four observational and 1 randomized study were included, enrolling a total of 196 patients. Meta-analyses demonstrated a significantly shortened length of hospital stay [mean difference −2.91 days; 95% confidence interval (CI) −3.68 to −2.15; P < 0.001] and increased operative time (mean difference 40.91 min; 95% CI 14.42–67.40; P < 0.001) for cryoablation. Both analyses demonstrated significant heterogeneity (both I2 = 91%; P < 0.001). Qualitative analysis demonstrated the amount of postoperative opioid usage to be significantly lower for cryoablation in 3 out of 4 reporting studies. CONCLUSIONS Intercostal nerve cryoablation during the Nuss procedure may be an attractive alternative to thoracic epidural analgesia, resulting in shortened hospitalization. However, given the low quality and heterogeneity of studies, more randomized controlled trials are needed.

Intravenous Versus Epidural Analgesia After Surgical Repair of Pectus Excavatum

2009 ◽  
Vol 16 (5) ◽  
pp. 398-403 ◽  
Author(s):  
Iris E Soliman ◽  
Jesus S Apuya ◽  
Kathy M Fertal ◽  
Pippa M Simpson ◽  
Joseph D Tobias
Keyword(s):  
Epidural Analgesia ◽  
Pectus Excavatum ◽  
Surgical Repair

scholarly journals Intraoperative cardiac function assessment by transesophageal echocardiography versus FloTrac/Vigileo™ system during pectus excavatum surgical repair

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Silvia Fiorelli ◽  
Gelsomina Capua ◽  
Cecilia Menna ◽  
Claudio Andreetti ◽  
Elisabetta Giorni ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Function ◽  
Transesophageal Echocardiography ◽  
Pectus Excavatum ◽  
Surgical Repair ◽  
Linear Regression Analysis ◽  
Surgical Correction ◽  
Percentage Error ◽  
Congenital Deformity ◽  
Cardiac Output Monitoring

Abstract Background Pectus excavatum (PE), a congenital deformity of the chest wall, can lead to cardiac compression and related symptoms. PE surgical repair can improve cardiac function. Intraoperative transesophageal echocardiography (TEE) has been successfully employed to assess intraoperative hemodynamic variations in patients undergoing PE repair. FloTrac/Vigileo™ system (Edwards Life-sciences Irvine, CA) (FT/V) is a minimally invasive cardiac output monitoring system. This retrospective study aimed to assess hemodynamic changes in surgical repair of PE using FT/V and concordance with parameters measured by TEE. Results N=19 patients submitted to PE repair via Ravitch or Nuss technique were enrolled. Intraoperative cardiac assessments simultaneously obtained via TEE and FT/V system were investigated. The agreement between TEE-derived cardiac output (CO-TEE) and FT/V system parameter (COAP) was evaluated. The relationship between COTEE and COAP was analyzed for all data using linear regression analysis. A significant correlation between COAP and COTEE values (R = 0.65, p < 0.001) was found. Bland-Altman analysis of COAP and COTEE showed a bias of 0.13 L/min and a limit of agreement of − 2.33 to 2.58 L/min, with a percentage error of 48%. Intraoperative measurements by TEE and FT/V both showed a significant increase in CO after surgical correction of PE (p < 0.005). Conclusions FT/V system compared to TEE in hemodynamic monitoring during PE surgery yielded clinically unacceptable results due to a high percentage error. After surgical correction of PE, CO, measured by TEE and FT/V, significantly improved.

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