scholarly journals Differential lung ventilation for increased oxygenation during one lung ventilation for video assisted lung surgery

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Ran Kremer ◽  
Wisam Aboud ◽  
Ori Haberfeld ◽  
Maruan Armali ◽  
Michal Barak
Keyword(s):  
Lung Ventilation ◽  
Lung Surgery ◽  
One Lung Ventilation ◽  
Differential Lung Ventilation ◽  
Video Assisted

scholarly journals Effect of Thoracic Epidural Anesthesia with Different Concentrations of Ropivacaine on Arterial Oxygenation during One-lung Ventilation

2010 ◽  
Vol 112 (5) ◽  
pp. 1146-1154 ◽  
Author(s):  
Yajun Xu ◽  
Zhiming Tan ◽  
Shilai Wang ◽  
Haijun Shao ◽  
Xuqin Zhu
Keyword(s):  
Epidural Anesthesia ◽  
Arterial Oxygen Tension ◽  
Lung Ventilation ◽  
Saline Group ◽  
Lung Surgery ◽  
Thoracic Epidural Anesthesia ◽  
Arterial Oxygen ◽  
One Lung Ventilation ◽  
Thoracic Epidural ◽  
Double Blinded

Background Thoracic epidural anesthesia can contribute to facilitate the fast-track approach in lung surgery. However, data regarding the effects of thoracic epidural anesthesia on oxygenation during one-lung ventilation (OLV) are scarce and contradictory. Therefore, the authors conducted a prospective, randomized, double-blinded trial in patients undergoing lung surgery under spectral entropy-guided intravenous anesthesia to evaluate the effects of thoracic epidural anesthesia with different concentrations of ropivacaine on oxygenation, shunt fraction (Qs/Qt) during OLV, and maintenance doses of propofol. Methods One hundred twenty patients scheduled for lung surgery were randomly divided into four groups to epidurally receive saline (Group S), 0.25% (Group R0.25), 0.50% (Group R0.50), and 0.75% (Group R0.75) ropivacaine. Ropivacaine was administered intraoperatively (6-8 ml of first bolus + 5 ml/h infusion). Arterial oxygen tension (Pao2) and Qs/Qt were measured before, during, and after OLV. Results Pao2 was significantly lower in Group R0.75 compared with that in Group S and Group R0.25 10 min (170 +/- 61 vs. 229 +/- 68 mmHg, P = 0.01; 170 +/- 61 vs. 223 +/- 70 mmHg, P = 0.03) and 20 min after OLV (146 +/- 52 vs. 199 +/- 68 mmHg, P = 0.009; 146 +/- 52 vs. 192 +/- 67 mmHg, P = 0.03). During OLV, Qs/Qt was significantly higher in Group R0.75 compared with that in Group S and Group R0.25 (P < 0.05). Maintenance doses of propofol were significantly lower in Group R0.75. Vasopressor requirements were higher in Group R0.75. Conclusion A decrease in oxygenation during OLV occurred only at the highest dose of epidural local anesthetic and not at lower doses. Higher doses of epidural medication required less propofol and more vasopressors.

scholarly journals May awake video-assisted thoracoscopic surgery with thoracic epidural anesthesia use routinely for minimaly invasive thoracic surgery procedures in the future?

2018 ◽  
Vol 5 (5) ◽  
pp. 1602
Author(s):  
Gonul Sagiroglu ◽  
Fazli Yanik ◽  
Yekta A. Karamusfaoglu ◽  
Elif Copuroglu
Keyword(s):  
Thoracic Surgery ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Thoracoscopic Surgery ◽  
Lung Ventilation ◽  
Thoracic Epidural Anesthesia ◽  
One Lung Ventilation ◽  
Thoracic Epidural ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Background: In the last years thoracic surgery developed in greater extent with equipments and techniques in one lung ventilation. Still general anesthesia in one lung ventilation approved as gold standard. In thoracic surgery most performed surgeries are plerural decortication and lung biopsy. Avoidance of intubation in Video Assisted Thoracoscopic Surgery (VATS) procedures gains us some advantages in postoperative period; a better respiratory parameters, survival and morbidity mortality rates, reduced hospitalization time and costs, reduced early stress hormone and immune response.  Methods: In this study, we reported our experience of 24 consecutive patients undergoing VATS with Thoracic Epidural Anesthesia (TEA) between December 2015 through July 2016 to evaluate the feasibility, safety and indication of this innovative technique whether it will be a gold standart in thoracic surgeries or not in the future.Results: Operation procedures included wedge resection in 11 (46%) patients (eight of them for pneumothorax, three of them for diagnosis), in 10 (42%) patients pleural biopsy (eight of them used talc pleurodesis), in two (8%) patients air leak control with fibrin glue and in one (4%) patient bilateral thoracal sympathectomy for hyperhidrosis.  We used T4-5 TEA space for 17 (72%) of patients, while we used T4-6 TEA space for 7 (28%) of patients. TEA block reached the desired level after the mean 26.4±4.3 minutes (range 21-34 min). There was no occurrence of hypotension and bradycardia during and after TEA. One (4%) patient required conversion to general anesthesia and tracheal intubation because of significant diaphragmatic contractions and hyperpne. Conversion to thoracotomy was not needed in any patient.Conclusions: We conclude that nVATS procedure with aid of TEA is feasibile and safety with minimal adverse events. The procedure can have such advantages as early mobilization, opening of early oral intake, early discharge, patient satisfaction, low pain level. Nevertheless, there is a need for randomized controlled trials involving wider case series on the subject.

The effect of hypercapnia and hypertension on cerebral oxygen balance during one-lung ventilation for lung surgery during propofol anesthesia

2010 ◽  
Vol 22 (8) ◽  
pp. 608-613 ◽  
Author(s):  
Masato Iwata ◽  
Satoki Inoue ◽  
Masahiko Kawaguchi ◽  
Michitaka Kimura ◽  
Takashi Tojo ◽  
...  
Keyword(s):  
Lung Ventilation ◽  
Lung Surgery ◽  
Cerebral Oxygen ◽  
Oxygen Balance ◽  
One Lung Ventilation ◽  
Cerebral Oxygen Balance

Iatrogenic rupture of the trachea caused by double Lumen tube intubation

Open Medicine ◽  
2010 ◽  
Vol 5 (6) ◽  
pp. 737-741 ◽  
Author(s):  
Iztok Potocnik ◽  
Andreas Kupsch ◽  
Vesna Jankovic
Keyword(s):  
Fiber Optic ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Tracheal Rupture ◽  
Lumen Tube ◽  
Video Assisted ◽  
Tracheobronchial System ◽  
Hazardous Procedure

AbstractAcute injuries of the tracheobronchial system are rare and life-threatening situations. Tracheal rupture most commonly occurs after blunt trauma to the chest. It is a rare but most concerning immediate complication of intubation. One-lung ventilation is required in lung surgery. Video assisted thoracoscopic procedures are an absolute indication for one-lung intubation. The double-lumen tube is the mainstay of one lung ventilation. Due to their larger size and rigidity, double lumen tubes are more difficult to insert, and complications are more common than with single lumen tubes. Opinions about the need for checking routinely the position of a double lumen tube by fiber optic bronchoscopy directly after intubation are divided. A 69-year-old woman with epidermoid lung carcinoma was scheduled for video assisted thoracoscopic left upper pulmonary lobectomy under general anaesthesia. The patient was prepared for the operation and itubated with the Carlens double lumen tube as usual. On introducing the camera into the thoracic cavity, the surgeon noted that the lungs were not completely collapsed. During blind adjustment the position of the tube the trachea was ruptured. The right-sided thoracotomy was performed and closed the greater part of the tracheal laceration. Only its upper 1.5-cm segment was surgically inaccessible because of the anatomical situation and thus remained unsutured. The patient received antibiotics, continuous airway humidification, analgesia with piritramide, and chest physiotherapy. She had no complications. In the literature, opinions about checking routinely the position of a double lumen tube by fiber optic bronchoscopy are divided.. Possibly, the very serious complication encountered in our patient could have been avoided, had the tube position been checked by bronchoscopy. The treatment strategy for post-intubation tracheal rupture depends on the size and location of the rupture, its clinical presentation, and the overall condition of the patient). Early surgical repair is the treatment of choice for most patients when a transmural tear with a length exceeding 2 cm. In our the combination of surgical and conservative treatment was performed. The uppermost part of the tear could not be sutured because of the anatomical situation, and so about 1.5 cm of the trachea remained open. The case is interesting from many perspectives. It shows that intubation with a Carlens tube is a potentially hazardous procedure, which should be performed only by experienced anaesthesiologists. Furthermore, our case report underscores the importance of checking routinely the position of a double lumen tube by fiber optic bronchoscopy. It provides evidence that minor tracheal lacerations can be successfully managed by conservative measures.

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