Acute perioperative hyperlactatemia in oncoplastic reconstructive surgeries: What is the significance?

BACKGROUND AND AIMS: We aim to study the significance of intraoperative hyperlactatemia in reconstructive oncoplastic surgery. MATERIAL AND METHODS: A retrospective observational study was conducted on a cohort of patients who underwent reconstructive oncoplastic surgery with free flap for oral cancer over a 6-month period. The study population was divided into two groups based on peak lactate levels. Group N with peak lactate level less than 2 mmol/L and Group H peak lactate level more than 2 mmol/L. The various parameter studied were patient's comorbidities; intraoperative events (vasopressor requirement, blood transfusion, and duration of surgery); postoperative parameters including the need for re- exploration and duration of stay in hospital and intensive care unit. RESULTS: The study demonstrates that intraoperative rise of lactate was not influenced by comorbidities. None of the intraoperative parameters studied influenced the lactate levels. Baseline lactate level was found to correlate with peak lactate level intraoperatively. But it was observed that there was normalization of lactate level within 24 hours postoperatively in both the groups. There was no difference in outcome parameters in the two groups. CONCLUSION: Intraoperative hyperlactatemia is not a significant prognostic factor for outcome in oncoplastic reconstructive surgery.

Preoperative pulmonary evaluation for lung resection.

Preoperative assessment is a very crucial step in anesthesia management. Anatomical resection (lobectomy or pneumonectomy) offers best long-term prognosis to a lung cancer patient. At the same time, surgery cannot be offered to a patient who is expected to become ventilator dependent, postoperatively. Hence, it is very important to have an objective preoperative assessment for risk stratification. This review article provides a systematic approach for the prognostication of patients planned for pulmonary resection.

Aspergilloma of the Lung: Strategy to Prevent Endobronchial Spillage.

Aspergilloma of the lung eroding into the airway may lead to perioperative endobronchial spillage and contamination of the normal lung. Our aim in this group of patients who are undergoing robotic- or video-assisted thoracoscopic lobectomy is to protect the contralateral lung and, if possible, uninvolved lobes of ipsilateral lung. Double-lumen endobronchial tubes do provide lung protection to the contralateral lung intraoperatively, but there is no protection to the ipsilateral lung lobes not involved by the disease process. Moreover, there is no lung protection against endobronchial spillage during the period of induction of general anesthesia, when the cough reflex and gag reflex are absent. We have devised a technique to advance from side selection to lobe selection, that is, selective lobar isolation to prevent perioperative contamination of uninvolved lung lobes. This technique has two components viz positioning of the patient and securing the airway. The technique can also be used in other conditions such as hydatid cyst of the lung, lung abscess communicating with the airway and bleeding into the airway.

Robotic assisted thoracoscopic right upper lobectomy for post tuberculosis aspergilloma.

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.

Anesthesia for joint replacement surgery: Issues with coexisting diseases.

The first joint replacement surgery was performed in 1919. Since then, joint replacement surgery has undergone tremendous development in terms of surgical technique and anesthetic management. In this era of nuclear family and independent survival, physical mobility is of paramount importance. In recent years, with an increase in life expectancy, advances in geriatric medicine and better insurance coverage, the scenario of joint replacement surgery has changed significantly. Increasing number of young patients are undergoing joint replacement for pathologies like rheumatoid arthritis and ankylosing spondylitis. The diverse pathologies and wide range of patient population brings unique challenges for the anesthesiologist. This article deals with anesthetic issues in joint replacement surgery in patients with comorbidities.