Review of the Physiology and Anesthetic Considerations for Pleuroscopy/Medical Thoracoscopy

Respiration ◽  
2021 ◽  
pp. 1-15
Author(s):  
Andreas Kostroglou ◽  
Emmanouil I. Kapetanakis ◽  
Loizos Rougeris ◽  
Marios E. Froudarakis ◽  
Tatiana Sidiropoulou
Keyword(s):  
Emotional Stress ◽  
Anesthetic Techniques ◽  
Pleural Effusions ◽  
Interventional Pulmonology ◽  
Procedural Sedation And Analgesia ◽  
Main Application ◽  
Medical Thoracoscopy ◽  
Anesthetic Considerations ◽  
Sedation And Analgesia ◽  
Sedative Agents

Pleuroscopy or medical thoracoscopy is the second most common utilized procedure after bronchoscopy in the promising field of interventional pulmonology. Its main application is for the diagnosis and management of benign or malignant pleural effusions. Entry into the hemithorax is associated with pain and patient discomfort, whereas concurrently, notable pathophysiologic alterations occur. Therefore, frequently procedural sedation and analgesia is needed, not only to alleviate the patient’s emotional stress and discomfort by mitigating the anxiety and minimizing the pain but also for yielding better procedural conditions for the operator. The scope of this review is to present the physiologic derangements occurring in pleuroscopy and compare the various anesthetic techniques and sedative agents that are currently being used in this context.

scholarly journals Does the sedation regimen affect adverse events during procedural sedation and analgesia in injection drug users?

CJEM ◽  
2013 ◽  
Vol 15 (05) ◽  
pp. 279-288 ◽  
Author(s):  
Frank Xavier Scheuermeyer ◽  
Gary Andolfatto ◽  
Hong Qian ◽  
Eric Grafstein
Keyword(s):  
Adverse Events ◽  
Injection Drug Users ◽  
Drug Users ◽  
Vital Signs ◽  
Injection Drug ◽  
Procedural Sedation ◽  
Secondary Outcome ◽  
Procedural Sedation And Analgesia ◽  
Pearson Coefficient ◽  
Sedation And Analgesia

ABSTRACT Objectives: Injection drug users (IDUs) often undergo procedural sedation and analgesia (PSA) as part of emergency department (ED) treatment. We compared adverse events (AEs) using a variety of sedation regimens. Methods: This was a retrospective analysis of a PSA safety audit in two urban EDs. Consecutive self-reported IDUs were identified, and structured data describing comorbidities, vital signs, sedation regimens (propofol [P], propofol-fentanyl [PF], fentanyl-midazolam [FM], ketofol [1:1 ketamine:propofol, KF], and ketamine-propofol [KP]) and AEs were collected. The primary outcome was the proportion of patients in each sedation group having an AE; the secondary outcome was the proportion of patients having a cardiovascular or respiratory AE. Results: Data were collected on 276 IDUs (78 P, 82 PF, 65 FM, 25 KF, and 26 KP), and 18 patients had AEs (6.5%, 95% CI 4.0–10.3). The AE rates were 0.0%, 8.5%, 9.2%, 12.0%, and 7.6%, respectively, with propofol having a significantly lower rate (Pearson coefficient 14.9, p = 0.007). The cardiovascular/respiratory AE rates were significantly different as well, with P, KP, and KF having the lowest rates (Pearson coefficient 13.3, p = 0.01). Conclusions: For IDU PSA, the overall AE rate was 6.5%, and propofol appeared to have a significantly lower rate.

Unusual case of malignant pleural mesothelioma

2021 ◽  
Vol 14 (7) ◽  
pp. e243803
Author(s):  
Timothy Johanan Rajaratnam ◽  
Jurgen Herre
Keyword(s):  
Computed Tomography ◽  
Unusual Case ◽  
Ct Scans ◽  
Pleural Mesothelioma ◽  
Pleural Effusions ◽  
Multidisciplinary Team Meeting ◽  
Distal Oesophagus ◽  
Medical Thoracoscopy ◽  
Supportive Management ◽  
Progressive Dysphagia

We present the case of a 65-year-old woman who presented with progressive dysphagia and was diagnosed with achalasia. She subsequently developed bilateral chylous pleural effusions, with no cause identified despite extensive investigations (including computed tomography (CT) scans, gastroscopy and medical thoracoscopy (MT)) and review at a dedicated pleural multidisciplinary team meeting.Despite optimal supportive management she deteriorated and was admitted to the intensive care unit, where she passed away due to sepsis and respiratory failure 10 months after initial presentation. A postmortem returned a diagnosis of epithelioid mesothelioma, encasing the carina, distal oesophagus and coeliac axis.Mesothelioma only very rarely presents with either chylous effusions or achalasia. Additionally while MT normally conveys excellent sensitivity for pleural malignancy, it was insufficient here. This case highlights how an unusually located mesothelioma can produce an unusual clinical picture. It also suggests a role for early video-assisted thoracoscopy to aid diagnosis.

scholarly journals Procedural sedation and analgesia in children undergoing digestive endoscopic procedures – paediatrician or anaesthesiologist?

2014 ◽  
Vol 2 ◽  
pp. 77-81
Author(s):  
Alicja Bartkowska-Śniatkowska ◽  
Jowita Rosada-Kurasińska ◽  
Iwona Ignyś ◽  
Małgorzata Grześkowiak ◽  
Marzena Zielińska ◽  
...  
Keyword(s):  
Procedural Sedation ◽  
Procedural Sedation And Analgesia ◽  
Endoscopic Procedures ◽  
Sedation And Analgesia

scholarly journals Diagnostic value of medical thoracoscopy for undiagnosed pleural effusions

2018 ◽  
Author(s):  
Rui‑Lin Chen ◽  
Yong‑Qing Zhang ◽  
Jun Wang ◽  
Hua Wu ◽  
Shu‑Mei Yang
Keyword(s):  
Diagnostic Value ◽  
Pleural Effusions ◽  
Medical Thoracoscopy
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