[Combined inflating lung and insufflating calf pulmonary surfactant under general anesthesia in the treatment of postoperative intractable atelectasis].

OBJECTIVE: To explore the efficacy and safety of combined inflating lung and insufflating calf pulmonary surfactant under general anesthesia for treating postoperative intractable atelectasis. METHODS: From August 2006 to January 2013, 15 patients with obstinate postoperative atelectasis receiving pressure control lung expansion were enrolled. The bronchial cannula was intubated into the affected side to assist the expanding of the lung, and the calf pulmonary surfactant was insufflated selectively. The chest auscultation and computed tomography (CT) scan was performed at 1 d and 5 d after the procedure respectively, to evaluation the effect. The airway pressure, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and oxygen saturation (SpO2) were recorded before the treatment, during the treatment and after the treatment.Monitoring arterial blood gas before and after treatment. RESULTS: After the expansion of the lung and insufflation of calf pulmonary surfactants, the iconographic scan showed that collapsed alveolar was reinflated in 12 (80.0%) patients at 1 d after the treatment and in 14 patients(93.3%) at 5 d after the procedure.There were not notable vital sign change and complications during the treatment.At after the treatment, 1, 3, 5 and 7 d after the treatment, PaO2 was higher (P < 0.05), and there were not significantly difference in the PaCO2 and pH (P > 0.05) . CONCLUSION: Combined pressure control lung expansion with selectively insufflating calf pulmonary surfactant under general anesthesia may be an effective therapy for postoperative intractable atelectasis.

Continuous Rhomboid Intercostal Block for Thoracoscopic Postoperative Analgesia.

BACKGROUND: Rhomboid intercostal block is a type of plane block used for postoperative analgesia after video-assisted thoracoscopic surgery. This prospective randomized controlled trial was conducted to investigate the effects of ultrasound-guided continuous rhomboid intercostal block (CRIB) on the global Quality of Recovery (QoR-40) scores and postoperative analgesia after video-assisted thoracoscopic surgery. METHODS: A total of 66 adult patients scheduled for elective unilateral video-assisted thoracoscopic surgery were randomly allocated to group C and group CRIB. In group C, patients were administered patient-controlled intravenous analgesia with sufentanil after operation. Patients in group CRIB received patient-controlled analgesia with ropivacaine CRIB. All patients completed the QoR-40 test during the preoperative evaluation and again 24 hours after the operation. Information on 48-hour postoperative pain and adverse events was recorded. RESULTS: The QoR-40 scores of group C were significantly lower than the scores of group CRIB (155.4 ± 6.1 vs 172.6 ± 6.3; P < .001), with a mean difference of -17.2 (95% CI, -20.4 to -13.9) 24 hours after operation. The postoperative numeric rating scale scores in group CRIB at 6, 12, 18, and 24 hours after the surgical procedure, when patients were at rest, were significantly lower than the scores in group C (all P < .05). The postoperative numeric rating scale scores in group CRIB at 1, 3, 6, 12, 18, 24, and 36 hours after surgical procedure, when patients were moving, were significantly lower than the scores in group C (all P < .05). CONCLUSIONS: In patients who underwent video-assisted thoracoscopic surgery, CRIB led to improved quality of recovery and postoperative analgesia.

[Effect of bronchial intubation for constant-pressure expanding ipsilateral lung on postoperatively intractable atelectasis in hypo-analgesia and muscle relaxation].

OBJECTIVE: To investigate the effect of bronchial intubation for constant-pressure expanding ipsilateral lung on postoperative intractable atelectasis. METHODS: For this prospective study, we recruited 18 patients with pulmonary atelectasis who could not been relieved by bronchoscopic suctioning, closed thoracic drainage, backslap, blowing hall and other routine treatments for over a week. After bronchial intubation, ipsilateral lung was expanded with a constant pressure. And the therapeutic effect was evaluated by chest radiographic examination and auscultation at the following day. RESULTS: Collapsed lung tissue were examined in 15 patients (83.3%) after the first treatment and in 2 patients (11.1%) after twice inflation. And another case failed even after three times treatment. During the procedure, the vital signs of all patients were stable and no complication occurred. CONCLUSION: Constant-pressure expanding of ipsilateral lung during bronchial intubation is a safe and effective treatment for postoperative intractable atelectasis.