Efficacy of Dexmedetomidine as an Adjunct to Ropivacaine in Bilateral Dual-Transversus Abdominis Plane Blocks in Patients with Ovarian Cancer Underwent Cytoreductive Surgery

Objective: To evaluate the postoperative control of pain and recovery in patients with ovarian cancer underwent cytoreductive surgery by adding dexmedetomidine to ropivacaine in bilateral dual-transversus abdominis plane (Bd-TAP) blocks.Methods: We enrolled ninety ASA I-III patients undergoing open abdominal cytoreductive surgery in this study. Patients were randomized assigned into three groups (TAP-R, TAP-DR, and CON, n=30 in each). All patients received standardized general anesthesia and postoperative Bd-TAP blocks were performed. The TAP-R, TAP-DR and CON group received Bd-TAP blocks with 0.3% ropivacaine, 0.3% ropivacaine and dexmedetomidine 0.5µg/kg, and 0.9% normal saline, respectively. All patients received patient-controlled intravenous analgesia (PCIA). The first request time for PCIA bolus, the VAS scores at 0, 6, 12, 24, and 48 hours after operation, the cumulative sufentanil consumption in 24 and 48 hours were compared. Pulmonary function was evaluated pre-operation and 24h after operation. The use of rescue drugs, early recovery quality was recorded.Results: Median values of the first request time for PCIA in the TAP-DR was 13.5 (11.0-16.0) hours, which was significantly longer than those in the TAP-R and CON groups [7.0 (6.0-9.0) and 3.0 (1.0-4.5)]. The VAS scores at rest and on coughing of TAP-DR group at all time points after operation were significantly lower than those of CON group (P <0.05). Cumulative sufentanil consumption in TAP-DR group were the least at 48h after surgery. Postoperative FEV1 and FEV1/FVC in TAP-DR group was significantly higher than group CON. Less rescue analgesics was needed by the patients in TAP-DR group (P <0.05). There was no significantly difference in the early recovery quality between TAP-DR and CON group (P >0.05).Conclusion: Dexmedetomidine combined with ropivacaine for Bd-TAP blocks prolonged the first bolus time of PCIA for ovarian cancer surgery and decreased sufentanil consumption. The procedure provided better postoperative analgesia and improved postoperative pulmonary function without excessive sedation.

The Value of Residual Volume/Total Lung Capacity as an Indicator for Predicting Postoperative Lung Function in Non-Small Lung Cancer

Chronic obstructive pulmonary disease (COPD) is one of the most frequently occurring concomitant diseases in patients with non-small cell lung cancer (NSCLC). It is characterized by small airways and the hyperinflation of the lung. Patients with hyperinflated lung tend to have more reserved lung function than conventionally predicted after lung cancer surgery. The aim of this study was to identify other indicators in predicting postoperative lung function after lung resection for lung cancer. Patients with NSCLC who underwent curative lobectomy with mediastinal lymph node dissection from 2017 to 2019 were included. Predicted postoperative FEV1 (ppoFEV1) was calculated using the formula: preoperative FEV1 × (19 segments-the number of segments to be removed) ÷ 19. The difference between the measured postoperative FEV1 and ppoFEV1 was defined as an outcome. Patients were categorized into two groups: preserved FEV1 if the difference was positive and non-preserved FEV1, if otherwise. In total, 238 patients were included: 74 (31.1%) in the FEV1 non-preserved group and 164 (68.9%) in the FEV1 preserved group. The proportion of preoperative residual volume (RV)/total lung capacity (TLC) ≥ 40% in the FEV1 non-preserved group (21.4%) was lower than in the preserved group (36.1%) (p = 0.03). In logistic regression analysis, preoperative RV/TLC ≥ 40% was related to postoperative FEV1 preservation. (adjusted OR, 2.02, p = 0.041). Linear regression analysis suggested that preoperative RV/TLC was positively correlated with a significant difference. (p = 0.004) Preoperative RV/TLC ≥ 40% was an independent predictor of preserved lung function in patients undergoing curative lobectomy with mediastinal lymph node dissection. Preoperative RV/TLC is positively correlated with postoperative lung function.

A Modified Calculation Improves the Accuracy of Predicted Postoperative Lung Function Values in Lung Cancer Patients

Purpose Preoperative pulmonary function testing is mandatory for non-small cell lung cancer (NSCLC) surgery. The predicted postoperative FEV1 (ppoFEV1) is used for further risk stratification. We compared the ppoFEV1 with the postoperative FEV1 (postFEV1) in order to improve the calculation of the ppoFEV1. Methods 87 patients voluntarily received an FEV1 assessment 1 year after surgery. ppoFEV1 was calculated according to the Brunelli calculation. Baseline characteristics and surgical procedure were compared in a uni- and multivariate analysis between different accuracy levels of the ppoFEV1. Parameters which remained significant in the multinominal regression analysis were evaluated for a modification of the ppoFEV1 calculation. Results Independent factors for a more inaccurate ppoFEV1 were preoperative active smoking (odds ratio (OR) 4.1, confidence interval (CI) 3.6–6.41; p = 0.01), packyears (OR 4.1, CI 3.6–6.41; p = 0.008), younger age (OR 1.1, CI 1.01–1.12; p = 0.03), and patients undergoing pneumectomy (OR 5.55, CI 1.35–23.6; p = 0.01). For the customized ppoFEV1 we excluded pneumonectomies. For patients < 60 years, an additional lung segment was added to the calculation. ppoFEV1 = preFEV1 × $$1-\left(\frac{\text{Lung segments resected} + 1}{\text{Total number of segments}}\right)$$ 1 - Lung segments resected + 1 Total number of segments . For actively smoking patients with more than 30 packyears we subtracted one lung segment from the calculation ppoFEV1 = PreFEV1 × $$1-\left(\frac{\text{Lung segments resected} - 1}{\text{Total number of segments}}\right)$$ 1 - Lung segments resected - 1 Total number of segments . Conclusion We were able to enhance the predictability of the ppoFEV1 with modifications. The modified ppoFEV1 (1.828 l ± 0.479 l) closely approximates the postFEV1 of 1.823 l ± 0.476 l, (0.27%) while the original ppoFEV1 calculation is at 1.78 l ± 0.53 (2.19%). However, if patients require pneumectomy, more complex techniques to determine the ppoFEV1 should be included to stratify risk.

The efficacy of diaphragmatic plication in patients with unilateral diaphragmatic paralysis; a two-centre experience

Background and objective: Diaphragm is not an uncommon problem. is the most presenting in most of the cases. In this study, we used diaphragm (DUS) and to evaluate the outcome of post-surgical diaphragmatic plication (SDP) in adults with unilateral diaphragmatic paralysis (UDP). To our knowledge, no large reports about the efficacy of and the utilization of DUS for these patients were done. Methods: A retrospective analysis of all patients who underwent SDP at two (2014 - 2018) was done. Data of all patients were patients' characteristics, preoperative (chest X-ray, chest computed tomography, DUS, and ) , two years postoperative follow up. Results: Among 47 (UDP) patients. 40 patients underwent SDP. 30 (75%) males (mean age 45±14 years). Left-sided SDP was found in 57% of cases (n=23). Most of the patients were suffering from Dyspnea (n=38). Minor complications occurred in 12% (n=5). Excellent results in 90% (n=36), good results in 7,5% and unsatisfactory in one patient (2,5%). Patients up at one month and 6 months and two years showed a significant increase in FEV1 up to 20% (range 15-40%), P=0.011 and FVC up to 30% (range 10%45%) P=0.024. There was a significant postoperative improvement in (P<0.005). There was a significant correlation between postoperative FEV1 and the height of the copula on CXR and DUS (P<0.001 and P<0.005 respectively). Conclusion: SDP is an effective and safe procedure which can be performed to treat UDP in adult patients suffering from chronic . is a significant improvement in the patient’s functional is correlated to the assessment. Keywords: Diaphragm Diaphragmatic Eventration Diaphragmatic Eventration/surgery diaphragm/ultrasonography, fluoroscopy, Recovery of Function Thoracic Surgical Procedures/methods

Comparison of Three Methods of Predictive Postoperative FEV1 and DLCO Calculations in Relation to Their Observed Postoperative Values in Lung Resection

Introduction: Three ways of simple calculations (segmental based on 18 segments method, segmental based on 19 segments method and subsegmental method) of predictive postoperative values of FEV1 and DLCO are in use during the preoperative survey for patients planned for lung resection as treatment of lung carcinoma as a part of risk assessment. Hypothesis: Segmental calculation method based on 19 segments is better than subsegmental method and segmental calculation method based on 18 segments in prediction of postoperative values of both FEV1 and DLCO one month after lung lobectomy. Materials and methods: Expected postoperative calculated values of FEV1 and DLCO (two segmental and one subsegmental method) of 52 patients undergone lobectomy are related to real postoperative values for same patients one month after surgery. Results: According to univariate analysis, real values of postoperative DLCO correlate most significantly with ppoDLCO calculated by segmental method (18 segments), but real values of postoperative FEV1 correlate most significantly with ppoFEV1 calculated by 19 overall segments segmental method. Data analysis as well showed that preoperative calculated PpoFEV1 and PpoDLCO underestimate real postoperative values of FEV1 and DLCO one month after lobectomy, but it is not statistically significant. Discussion: Same as contemporary guidelines suggest, ppoFEV1 calculation by 19 segments segmental method seems to be the best choice. PpoDLCO is maybe better to calculate by 18 segments segmental method.

Prediction of postoperative lung function in lung cancer patients using perfusion scintigraphy

Background Predicting postoperative lung function is critical in lung cancer patients. Perfusion scintigraphy has been used to estimate postoperative function after lung resection. Purpose To evaluate the usefulness of the posterior oblique method in relation to other conventional processing methods for predicting postoperative lung function using lung perfusion scintigraphy. Material and Methods Fifty-five patients with non-small-cell lung cancer who underwent lobectomy were enrolled. Forced expiratory volume in 1 s (FEV1) values were obtained from preoperative and postoperative pulmonary function tests. After performing lung perfusion scintigraphy, predicted FEV1 values were calculated using the segment, conventional, posterior, and posterior oblique methods. Postoperative FEV1 values were compared with predicted FEV1 values. Results The mean value of the preoperative FEV1 was 2.29 L and that of the postoperative FEV1 was 1.89 L. The mean values of the predicted postoperative FEV1 values for the segment, conventional, posterior, and posterior oblique were 1.83 L, 1.94 L, 1.88 L, and 1.89 L, respectively. Between the observed and predicted FEV1 values, there was a strong correlation without significant difference except for conventional method. Bland–Altman analysis showed that segment and posterior methods underestimated the FEV1, whereas conventional and posterior oblique methods overestimated the FEV1. Conclusion Predictions with each processing method of lung perfusion scintigraphy showed nearly similar results to the actual postoperative lung function. The posterior oblique method of lung perfusion scintigraphy showed a very small difference to such an extent as to be equal to the observed FEV1, implying that this method may be applied for predicting postoperative lung function in lung cancer patients.

Role of quantitative CT in predicting postoperative FEV1 and chronic dyspnea in patients undergoing lung resection

Lung resection is the mainstay of treatment in patients with early stage non-small cell lung cancer. However, lung cancer patients often suffer from comorbidities and the respiratory reserve should be carefully evaluated preoperatively in order to avoid postoperative complications. Forced expiratory vol- ume in 1 second (FEV1) is considered to be an index that depicts the patient’s respiratory efficacy and its prediction has a key role in the preoperative evaluation of lung cancer patients with impaired lung function. Prediction of postoperative FEV1 is currently possible with the use of perfusion radionuclide lung scanning. Quantitative CT is the analysis of data acquired during nor- mal chest CT scan using the system’s software. By applying a dual threshold of -500 to -910 Hounsfield Units, functional lung volumes are estimated and postoperative FEV1 can be predicted by reducing the preoperative measurement by the fraction of the part to be resected. Studies have shown that preoperative predictions correlate well with the actual postoperative measurements. Additionally, quantitative CT results are in good agreement with perfusion scintigraphy predictions. Newer radiological techniques such as perfusion MRI and co-registered SPECT/CT have also been used in the preoperative evaluation with similar results. In conclusion, chest CT which is obligatory for staging, can be used for quantitative analysis of the already available data. It is technically simple, providing an accurate prediction of postoperative FEV1. Thus, quantitative CT appears to be a useful tool in the preoperative evaluation of lung cancer patients undergoing lung resection.