Is it possible to alleviate thoracic surgery? chest tube removal before the extubation

Background: The ambulatory surgery (AS), is an operative management that does not require an overnight hospital stay. But, the application of AS still limited in the thoracic surgery due to the necessity of air leaking management. The aim of this study is to review our AS institutional experience by a chest drain removal before the extubation, in thoracic sympathectomy surgery.Methods: We have carried out a retrospective analysis of patients who underwent thoracic sympathectomy between November 2012 and July 2016 in the Thoracic Surgery Department of Abderrahmen MAMI University Hospital.Results: During the study period, 17 patients underwent thoracic bilateral sympathectomy. Twelve (12) females were operated versus 5 males. The mean age was 24.47 (range:17-33) years. There is no chest X-ray disorder detected during all frame times. No patient had developed a respiratory distress during the postoperative period. In addition to that, no postoperative morbidities had been detected during the follow up. All patients were satisfied about the procedure at the end of the follow up.Conclusions: The ambulatory thoracic surgery procedures can safely, and efficiency be applied if the patient is well selected. The progression on operative mini invasive techniques will increase the number of patients who can profit from an "alleviated thoracic surgery".

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Effect of lidocaine cream analgesia for chest drain tube removal after video-assisted thoracoscopic surgery for lung cancer: a randomized clinical trial

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-100760 ◽

2019 ◽

Vol 45 (1) ◽

pp. 16-21

Author(s):

Shin-nosuke Watanabe ◽

Kazuhiro Imai ◽

Tetsu Kimura ◽

Yoshitaro Saito ◽

Shinogu Takashima ◽

...

Keyword(s):

Lung Cancer ◽

Clinical Trial ◽

Chest Tube ◽

Thoracoscopic Surgery ◽

Chest Drain ◽

Drain Removal ◽

Tube Removal ◽

Vas Scores ◽

Chest Tube Removal ◽

Video Assisted Thoracoscopic Surgery

Background and objectivesPain management makes an important contribution to good respiratory care and early recovery after thoracic surgery. Although the development of video-assisted thoracoscopic surgery (VATS) has led to improved patient outcomes, chest tube removal could be distressful experience for many patients. The aim of this trial was to test whether the addition of lidocaine cream would have a signiﬁcant impact on the pain treatment during chest tube removal from patients who had undergone VATS for lung cancer.MethodsThis clinical trial was a double-blind randomized study. Forty patients with histologically confirmed lung cancer amenable to lobectomy/segmentectomy were enrolled. All patients had standard perioperative care. Patients were randomly assigned to receive either epidural anesthesia plus placebo cream (placebo, Group P) or epidural anesthesia plus 7% lidocaine cream cutaneously around the chest tube insertion site and on the skin over the tube’s course 20 min (Group L) before chest drain removal.ResultsVisual analog scale (VAS) scores were higher in Group P (median 5, IQR, 3.25-8) than in Group L (median 2, IQR, 1-3). Pain intensities measured using a PainVision system were also higher in Group P (median 296.7, IQR, 216.9–563.5) than Group L (median 41.2, IQR, 11.8–97.0). VAS scores and the pain intensity associated with chest drain removal were significantly lower in Group L than Group P (p=0.0002 vs p<0.0001).ConclusionAnalgesia using lidocaine cream is a very simple way to reduce the pain of chest tube removal after VATS.Trial registration numberUMIN000013824.

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The Causative Organisms of Bacterial Meningitis and their Antimicrobial Resistance Profiles in Iranian Children in 2011-2016

Infectious Disorders - Drug Targets ◽

10.2174/1871526519666181123130101 ◽

2020 ◽

Vol 20 (2) ◽

pp. 229-236

Author(s):

Sepideh Keshavarz Valian ◽

Shima Mahmoudi ◽

Babak Pourakbari ◽

Maryam Banar ◽

Mohammad Taghi Haghi Ashtiani ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Bacterial Meningitis ◽

Medical Center ◽

Blood Cultures ◽

Gram Positive ◽

Gram Negative ◽

Number Of Patients ◽

Resistance Patterns ◽

Iranian Children ◽

Surgery Department

Objective: The study aimed to describe the identity and antimicrobial resistance patterns of the causative agents of bacterial meningitis in children referred to Children’s Medical Center (CMC) Hospital, Tehran, Iran. Methods: This retrospective study was performed at CMC Hospital during a six-year period from 2011 to 2016. The microbiological information of the patients with a diagnosis of bacterial meningitis was collected and the following data were obtained: patients’ age, sex, hospital ward, the results of CSF and blood cultures, and antibiotic susceptibility profiles of isolated organisms. Results: A total of 118 patients with bacterial meningitis were admitted to CMC hospital. Sixty-two percent (n=73) of the patients were male. The median age of the patients was ten months (interquartile range [IQR]: 2 months-2 years) and the majority of them (n=92, 80%) were younger than two years of age. The highest number of patients (n=47, 40%) were admitted to the surgery department. Streptococcus epidermidis was the most frequent isolated bacterium (n=27/127, 21%), followed by Klebsiella pneumoniae (n=20/127, 16%), and Staphylococcus aureus (n=16/127, 12.5%). Blood culture was positive in 28% (n=33/118) of patients. Ampicillin-sulbactam and imipenem were the most effective antibiotics against Gram-negative bacteria isolated from CSF cultures. In the case of Gram-positive organisms, ampicillinsulbactam, vancomycin, and linezolid were the best choices. Imipenem was the most active drug against Gram-negative blood pathogens. Also, ampicillin and vancomycin had the best effect on Gram-positive bacteria isolated from blood cultures. Conclusion: Results of this study provide valuable information about the antibiotic resistance profiles of the etiologic agents of childhood meningitis, which can be used for prescription of more effective empirical therapies.

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Post-Traumatic Pyothorax: Epidemiology, Management and Prognosis in the Thoracic Surgery Department of the Donka National Hospital

Open Journal of Thoracic Surgery ◽

10.4236/ojts.2021.114011 ◽

2021 ◽

Vol 11 (04) ◽

pp. 83-88

Author(s):

Camara Alpha Kabinet ◽

Camara Soriba Naby ◽

Balde Oumar Taibata ◽

Diallo Amadou Sarah ◽

Camara Mama Aissata ◽

...

Keyword(s):

Thoracic Surgery ◽

National Hospital ◽

Post Traumatic ◽

Surgery Department

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Results of early versus standard silicone stent removal following external dacryocystorhinostomy under local anesthesia

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v17i3.800 ◽

2020 ◽

Vol 17 (3) ◽

pp. 263-272

Author(s):

Ben Limbu ◽

Benjamin Sim ◽

Mohan K. Shrestha ◽

Geoffrey Tabin ◽

Rohit Saiju

Keyword(s):

Statistical Difference ◽

Financial Burden ◽

Controlled Trial ◽

Silicone Tube ◽

Number Of Patients ◽

Tube Removal ◽

Silicone Stent ◽

External Dacryocystorhinostomy ◽

Lost To Follow Up

Introduction: Many patients in Nepal travel vast distances to have their surgeries in Kathmandu. They often remain close by until their follow-up visit for their silicone tube removal, which contributes to a large financial burden on them and their families. Hence, reducing the time for which silicone tubes remain in situ following external dacryocystorhinostomy (DCR) provides significant benefits to patients. Furthermore, this is the first comparative study which has successfully demonstrated the earliest timeframe for which silicone tubes can be removed following DCR in the medical literature. Methods: A randomized controlled trial consisting of 144 patients was designed to compare patient outcomes after early (2 weeks postoperatively) versus standard (6 weeks postoperatively) removal of silicone stents. The success of their procedures was determined when patients were assessed both symptomatically and anatomically at their 6-month follow-up. Results: The surgical success in both groups was high at 97.8% collectively in both groups and there were only a small number of patients who were lost to follow-up (5 patients) at 6 months. There was no statistical difference at removing silicone stents at 2 or 6 weeks postoperatively. Conclusion: These results were consistent with our pilot study, which showed no statistical difference in long-term success following silicone tube removal at 2 and 6 weeks.

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1018 Did COVID Compromise the Care of Closed Paediatric Hand Fractures?

British Journal of Surgery ◽

10.1093/bjs/znab259.116 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

R Dbeis ◽

G Yim ◽

A Watts

Keyword(s):

Health Informatics ◽

Operative Management ◽

National Standards ◽

Post Injury ◽

Rapid Access ◽

Hand Fractures ◽

National Guidance ◽

A Prospective Study ◽

Surgery Department ◽

Mean Time

Abstract Aim To assess the effect of a ‘rapid-access’ musculoskeletal unit, established in March 2020, as part of the Royal Devon & Exeter hospital COVID response, with direct assessment of hand trauma by the Plastic Surgery department staff, on treatment timelines and national guidance compliance for closed paediatric hand fractures. Method This was a retrospective review from 1st January to 31st December 2019 and a prospective study from the 1st April to 15th June 2020. The retrospective cases were collated by health informatics. The prospective data was recorded on the department’s database. Exclusion criteria: nail bed injuries with tuft fractures, ligament injuries only, open fractures and patients aged 18 at time of surgery. Results In 2019 the majority (73%) of patients (n = 26) were referred within 48hrs but waited a median of 5 days to be seen in clinic by a hand surgeon resulting in significant delays in treatment. After service reconfiguration in 2020, all patients (n = 6) were operated on within 72 hours of the decision to operate - mean time to surgery 1.5 days (range 0-3 days). The mean time from referral to clinic was 1.33 days (range 0-6 days). 4 patients were operated on within 7 days of injury. Of the 2 patients operated on > 7 days, 1 was referred 32 days post injury and 1 failed conservative management. Conclusions The introduction of a ‘rapid-access’ musculoskeletal unit with early senior review and a dedicated theatre has created ‘gold-standard’ compliance with national standards for the operative management of closed paediatric fractures.

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Role of the pulmonologist in a thoracic surgery department

10.1183/13993003.congress-2021.pa3407 ◽

2021 ◽

Author(s):

Carla Suarez ◽

Nuria Toledo Pons ◽

Juan Antonio Torrecilla Medina ◽

Valerio Perna Perna ◽

Orlando Gigirey Castro ◽

...

Keyword(s):

Thoracic Surgery ◽

Surgery Department

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A randomised controlled trial of intrapleural balloon intercostal chest drains to prevent drain displacement

European Respiratory Journal ◽

10.1183/13993003.01753-2021 ◽

2021 ◽

pp. 2101753

Author(s):

Rachel M Mercer ◽

Eleanor Mishra ◽

Radhika Banka ◽

John P Corcoran ◽

Cyrus Daneshvar ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Adverse Events ◽

Standard Care ◽

Primary Outcome ◽

Controlled Trial ◽

Clinical Problem ◽

Outcome Data ◽

Chest Drain ◽

Drain Removal ◽

Randomised Controlled

BackgroundChest drain displacement is a common clinical problem, occurring in 9–42% of cases and results in treatment failure or additional pleural procedures conferring unnecessary risk. A novel chest drain with an integrated intrapleural balloon may reduce the risk of displacement.MethodsProspective randomised controlled trial comparing the balloon drain to standard care (12 F chest drain with no balloon) with the primary outcome of objectively-defined unintentional or accidental chest drain displacement.Results267 patients were randomised (primary outcome data available in 257, 96.2%). Displacement occurred less frequently using the balloon drain (displacement 5/128, 3.9%; standard care displacement 13/129, 10.1%) but this was not statistically significant (Odds Ratio (OR) for drain displacement 0.36, 95% CI 0.13 to 1.0, χ2 1df=2.87, p=0.09). Adjusted analysis to account for minimisation factors and use of drain sutures demonstrated balloon drains were independently associated with reduced drain fall out rate (adjusted OR 0.27, 95% CI 0.08 to 0.87, p=0.028). Adverse events were higher in the balloon arm than the standard care arm (balloon drain 59/131, 45.0%; standard care 18/132, 13.6%; χ2 1df=31.3, p<0.0001).ConclusionBalloon drains reduce displacement compared with standard drains independent of the use of sutures but are associated with increased adverse events specifically during drain removal. The potential benefits of the novel drain should be weighed against the risks, but may be considered in practices where sutures are not routinely used.

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Post thoracic surgery

Emergencies in Respiratory Medicine ◽

10.1093/med/9780199202447.003.0017 ◽

2007 ◽

pp. 103-106

Keyword(s):

Clinical Practice ◽

Thoracic Surgery ◽

Postoperative Mortality ◽

Operative Management ◽

Morbidity And Mortality ◽

Surgical Patient ◽

Current Clinical Practice ◽

Operative Morbidity ◽

Careful Assessment

Post thoracic surgery 104 Successful post-operative management of the thoracic surgical patient requires careful assessment. Potential complications should be recognized and managed early, as this will reduce post-operative morbidity and mortality. • In current clinical practice 30 day postoperative mortality following elective lobectomy is approximately 2–3% and minor morbidity is 40–50%....

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