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1.
J Vis Surg ; 2: 96, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29399483

RESUMO

BACKGROUND: Intraoperative cardiorespiratory arrest secondary to lower airway obstruction is often difficult to manage. We describe the management of one such technically challenging case of three consecutive cardiorespiratory arrests during a right pneumonectomy in a young boy. METHODS: A 10 years boy with a large fleshy vascular endobronchial tumor (biopsy proven squamous papilloma), completely occluding the right main-stem bronchus with collapse-consolidation of underlying right lung, was posted for a right pneumonectomy. There were dense adhesions of lung to the parieties and the lung was completely damaged. Twenty-five minutes into the surgery, patient started desaturating and the anesthetist was having difficulty in ventilating him. Check bronchoscopy showed endobronchial bleeding and the double lumen tube abutting the tumor. He was turned supine and CPR performed along with suctioning of blood and repositioning of tube. Patient revived and surgery continued. One and a half hour into the surgery the boy had a second cardiorespiratory arrest due to similar airway obstruction and managed in similar fashion. Lower lobectomy was speedily done to gain access to the hilum followed by quick completion pneumonectomy. Immediately following specimen removal, the patient had the third cardiorespiratory arrest and anesthetist was unable to ventilate the patient even after suctioning and repositioning of tube. With patient in lateral position, through the thoracotomy, right bronchial stump was opened and a quick bronchial intubation performed by the surgeon in chief. On opening the bronchus a tumor ball was seen occluding the left main bronchus, which probably got detached from the main tumor during pneumonectomy. Residual tumor was delivered out and the bronchial stump closed. Patient was transferred to ICU on ventilatory support. RESULTS: Postoperatively he was extubated after 48 hours and was found to have no neurological deficit. Chest drain came out on POD2 and he was discharged on POD5. CONCLUSIONS: Promptly and methodically addressing this technical challenge helped us to prevent mortality. We also managed to avoid neurological sequelae of cardiorespiratory arrest. Learning point in this case is that when faced with a similar situation, it's important to stay calm and focused and to handle the challenge in a scientific and logical manner.

2.
J Vis Surg ; 2: 51, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29078479

RESUMO

BACKGROUND: Minimally invasive techniques for non-oncologic lung resections especially fungal infections are not widely employed. Through this video we share our experience of one such case of a robotic resection of pulmonary aspergilloma. METHODS: A 55-year-old male with recurrent hemoptysis underwent surgical resection of post tuberculosis aspergilloma of right upper lobe using a 4-arm DaVinci Robot. RESULTS: He received antituberculous drugs for 6 weeks pre-operatively. Systemic antifungals were given 2 weeks prior and continued for 3 months postoperatively. The operative time was 188 minutes and blood loss was 560 mL. Postoperative Chest X-rays showed complete lung expansion. CONCLUSIONS: Robotic resection of lung is technically possible with good clinical outcomes even in infective pathologies. Robotic technique allows excellent 3D visualisation and good dexterity for easier and safe dissection of adhesions, as well as effective and precise anatomical lung resections for pulmonary aspergilloma.

3.
Ann Card Anaesth ; 17(2): 164-6, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24732623

RESUMO

Endobronchial spillage of fungal material into normal lung can infect it and the spillage of fungal material should be prevented during surgery. We report our experience of a patient who presented for right upper lobectomy with bronchiectasis, tubercular destruction and subsequent aspergilloma. A 4F Fogarty catheter was introduced through the tracheal lumen of the left sided endobronchial double lumen tube (DLT) to occlude the bronchus intermedius to prevent spillage of aspergilloma into the non-infected lower and middle lobes of the right lung. The Fogarty catheter was pulled into the trachea just before stapling the bronchus; thereafter, right upper lobectomy was completed successfully. The patient was extubated uneventfully and transferred to post-operative recovery ward. The endobronchial blockage of the intermediate bronchus of the operative lung by the Fogarty catheter and isolation of the left lung by the DLT prevented spillage of aspergilloma in both the operative right lung and the left lung.


Assuntos
Brônquios/microbiologia , Complicações Intraoperatórias/prevenção & controle , Pneumopatias Fúngicas/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Antifúngicos , Aspergilose/tratamento farmacológico , Aspergilose/etiologia , Aspergilose/microbiologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/microbiologia , Feminino , Hemoptise/etiologia , Humanos , Complicações Intraoperatórias/microbiologia , Pulmão/microbiologia , Pneumopatias Fúngicas/etiologia , Pneumopatias Fúngicas/microbiologia , Complicações Pós-Operatórias/microbiologia , Tuberculose/complicações , Voriconazol/uso terapêutico
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