Pre-emptive active drainage of reflux (PARD) in Ivor-Lewis oesophagectomy with negative pressure and simultaneous enteral nutrition using a double-lumen open-pore film drain (dOFD)

Background Postoperative reflux can compromise anastomotic healing after Ivor-Lewis oesophagectomy (ILE). We report on Pre-emptive Active Reflux Drainage (PARD) using a new double-lumen open-pore film drain (dOFD) with negative pressure to protect the anastomosis. Methods To prepare a dOFD, the gastric channel of a triluminal tube (Freka®Trelumina, Fresenius) is coated with a double-layered open-pore film (Suprasorb®CNP drainage film, Lohmann & Rauscher) over 25 cm. The ventilation channel is blocked. The filmcoated segment is placed in the stomach and the intestinal feeding tube in the duodenum. Negative pressure is applied with an electronic vacuum pump (− 125 mmHg, continuous suction) to the gastric channel. Depending on the findings in the endoscopic control, PARD will either be continued or terminated. Results PARD was used in 24 patients with ILE and started intraoperatively. Healing was observed in all the anastomoses. The median duration of PARD was 8 days (range 4–21). In 10 of 24 patients (40%) there were issues with anastomotic healing which we defined as “at-risk anastomosis”. No additional endoscopic procedures or surgical revisions to the anastomoses were required. Conclusions PARD with dOFD contributes to the protection of anastomosis after ILE. Negative pressure applied to the dOFD (a nasogastric tube) enables enteral nutrition to be delivered simultaneously with permanent evacuation and decompression.

Strategies for appropriate positioning and repositioning the Avalon ECMO cannula in a 17-year-old with left hepatic vein malposition

Introduction Extracorporeal membrane oxygenation (ECMO) is a well-recognized therapy in children with refractory hypoxia. Different cannulas have been used with reported complications with placement, such as cardiac perforation, and multiple reports focusing on avoiding this. However, strategies to avoid hepatic vein cannulation and reposition when it occurs are not well described. Case report Here, we report a case where a 27-Fr Avalon bicaval double lumen cannula in the left hepatic vein was successfully repositioning using serial chest X-rays (CXR) and transthoracic echocardiography (TTE) in a 17-year-old female. Discussion While venovenous (VV) ECMO is preferred by many, placement of the Avalon catheter, a cannula available for VV ECMO, may be challenging due to migration or positioning issues. Specific techniques of wire and catheter advancement as well as confirming wire position in the infra-hepatic inferior vena cava can help ensure appropriate positioning while avoiding hepatic vein cannulation and enabling successful repositioning when it occurs. Conclusion Wire position in the infra-hepatic inferior vena cava helps ensure safe and appropriate Avalon cannula position and placement. The Avalon cannula can be successfully repositioned from the left hepatic vein by retracting the cannula, reinserting the wire and introducer together, and then manipulation techniques using serial CXR and TTE.

Risk Factors of Catheter-Related Infection in Patients Undergoing Hemodialysis Using Double Lumen Catheter at Dr. M. Djamil Hospital Padang

Background. Chronic kidney disease (CKD) is a terminal disease requiring hemodialysis. Hemodialysis requires vascular access using a double lumen catheter (DLC). However, the use of DLC may increase complications mainly infection, either infection of exit site or bloodstream. This study is aimed to seek risk factors contributing to the incidence of central catheter-related infections in CKD patients with DLC undergoing HD at Dr. M. Djamil Hospital, Padang. Methods. This study is a prospective study on patients undergoing HD at Dr. M. Djamil Hospital, Padang. This study using consecutive sampling technique. Data were analyzed using SPSS version 25.0. Results. This study involved 40 CKD patients undergoing HD. Majority of the samples had bloodstream infections (67.5%). Clinical manifestations of purulent secretion, duration of catheter used, and hypoalbuminemia had significant differences in the incidence of DLC infection based on bloodstream infection and exit site infection (p<0.05). The most common bacterial found was Pseudomonas aeruginosa (22.5%) which was sensitive to ceftazidime, cefepime, meropenem, amikacin, gentamicin, ciprofloxacin. Conclusion. Factors contributing to the incidence of DLC-related infections at Dr. M. Djamil Hospital are duration of catheter use and hypoalbuminemia. Pseudomonas aeruginosa is the most common cause of DLC-related infections.

Case Report: Discontinuous Spontaneous Ventilating Anesthesia for McKeown Esophagectomy by Laryngeal Mask: A Case Series—A Novel Approach of Discontinuous Spontaneous Ventilating Anesthesia for Esophagectomy

Double lumen endobronchial ventilation in McKeown esophagectomy is common for esophageal cancer. In spite of most patients could be extubated immediately after surgery under adequate multimodal analgesia, still some patients require extended mechanical ventilation or airway support post-surgery because of pain or difficult respiration. The present study reported a novel challenge for McKeown esophagectomy with discontinuous spontaneous ventilating anesthesia by the laryngeal mask. Three esophageal cancer patients underwent McKeown esophagectomy under discontinuous spontaneous ventilating anesthesia with local and regional analgesia and appropriate sedation. Two of them were accomplished under non-intubated video-assisted thoracoscopic surgery (NIVATS), and then, the abdominal and neck surgery was managed under laryngeal mask airway with appropriate muscle relaxation. One patient was endured high PetCO2 level, and converted to regular double lumen endobronchial intubation for safety. However, from the two successful cases, we still proved that the discontinuous spontaneous ventilating anesthesia achieved the same anesthetic effect as bronchial intubation under general anesthesia for McKeown esophagectomy, which reduced the postoperative pharyngeal discomfort, might be beneficial to the patients for enhanced recovery after surgery (ERAS).

Unexpected difficult extubation of double lumen bronchial intubation: a case report

Background The anesthetist and other members of the perioperative team need to be extremely cautious for successful completion of any surgery. If the final step of any general anesthetic-extubation is not sufficiently well planned, it can lead to critical airway incidents during the extubation and hinder transportation of the patient to the post-anesthesia care unit. Case presentation A 48-year-old female underwent video-assisted thoracoscopic surgery (VATS) combined with left lower lobectomy. The distal end of the left branch of the tracheal tube was lodged by surgical sutures. In this case, the respiratory physician burned the sutures using an argon electrode, after discussion with the thoracic surgery experts. Conclusions Teamwork is essential when caring for a patient with a shared airway. The anesthetist and surgeon must communicate well with each other to achieve optimal surgical outcomes. Importantly, testing the patency of the ETT prior to extubation should be a regular procedure, which is practical significance to guide safe extubation.