Comparative evaluation of thoracoscopy versus thoracotomy in the management of lung hydatid disease.

BACKGROUND: Lung hydatid disease is an endemic problem in Mediterranean countries, and the ideal surgical management for it is still debated. In this prospective study, we aimed to evaluate the feasibility and safety of thoracoscopy in patients with lung hydatid disease. We studied the advantages of thoracoscopic procedure over posterolateral thoracotomy. METHODS: A total of 32 patients with an uncomplicated, unilateral lung hydatid cyst were subjected to surgical treatment over a period of 5 years. Of the 32 patients, 18 were treated with thoracotomy and 14 with thoracoscopy. Observations were made with regard to duration and ease of operation, complications, hospital stay, return to activity, and recurrence. RESULTS: The mean operative duration in the thoracoscopy group was 95.21 min compared to 137.77 min in thoracotomy group (P < 0.0001). Postoperative analgesia requirement was less in the thoracoscopic group (mean 4.92 days) compared to that in the thoracotomy group (mean 13.94 days; P < 0.0001). The intercostal drain was removed earlier in the thoracoscopic group (mean 5 days) than in the thoracotomy group (mean 8.83 days; P < 0.0001). The postoperative hospital stay was 8.35 days (mean) in thoracoscopic group and 18.77 days in the thoracotomy group (P < 0.0001). The most serious morbidity was wound infection, with three cases (16.66%) in the thoracotomy group and one (7.11%) in the thoracoscopy group. There was no operative mortality and no recurrence during the follow-up period. CONCLUSIONS: We strongly recommend the use of thoracoscopy as a primary tool for the management of uncomplicated, unilateral lung hydatid disease. Thoracoscopy offers a great advantage over open thoracotomy in terms of very low morbidity.

Effect of nalbuphine on haemodynamic response to orotracheal intubation.

BACKGROUND: Laryngoscopy and intubation are associated with increase in heart rate and mean blood pressure which are deleterious for patients especially with hypertension, ischaemic heart disease, raised intraocular and intracranial pressure. This study was undertaken with an objective to determine the efficacy of nalbuphine in preventing increase in heart rate and mean arterial pressure in response to laryngoscopy and orotracheal intubation. PATIENTS #ENTITYSTARTX00026; METHODS: A randomized controlled, prospective, double blinded study was undertaken on 60 patients ASA grade I and II posted for elective laparoscopy surgery to receive either saline (group I, control group, n=30) or Nalbuphine 0.2mg kg(-1)(group II, study group, n=30 ) as a bolus dose, 5 minutes before laryngoscopy. Heart rate and mean arterial pressure were taken 3 minute after study drug (T-1), just after intubation (T-2), then after every minute till 5 min (T3-7) and after 10 min of intubation (T-8). Twenty percent rise in heart rate and mean arterial pressure was considered as significant. Students 't' test was used for the analysis of data by using statistical software Medcal version 11.1.1.0. and P < 0.05 was considered significant. RESULTS: There was significant rise in heart rate(20.4%) in group I after intubation at T-2 compared with baseline at T-1 as compared to group II (16.66%). Mean arterial pressure showed rise of 12.35% in group I and 4.39% in group II at T-2 but was not significant. Heart rate and mean arterial pressure then gradually decreased from T3-8 but remained slightly higher than group II at 8th minute. CONCLUSION: We thus conclude that Nalbuphine 0.2 mg kg (-1)prevented a marked rise in heart rate and mean arterial pressure associated with laryngoscopy and orotracheal intubation.