Bilateral tension pneumothoraces during minimally invasive parathyroidectomy: A case report.

Minimally invasive parathyroidectomy, a new technique for the surgical management of parathyroid disease, is gaining popularity. The smaller incision in the neck results in better cosmetic results and patient satisfaction. Despite a low incidence of complications, the anesthesiologist should be aware and prepared to manage life saving situations. We describe a case of bilateral tension pneumothoraces during minimally invasive parathyroidectomy.

Robotic fourth-arm enucleation of an esophageal leiomyoma and review of literature.

Esophageal leiomyomas are resected in symptomatic and/or malignancy-suspicious cases. Traditionally, they have been removed by laparotomy or thoracotomy and more recently by thoracoscopy and laparoscopy. Mucosal injury is reported as high as 7% of cases but may be higher in unreported general practice. Robotic technology seems to offer advantages. We describe a robotic approach that seems to minimize mobilization of the esophagus, potentially decreasing the likelihood of mucosal injury and postoperative recovery time. We review the literature to evaluate the reports of mucosal injury with the open, minimally invasive, and robotic techniques and describe our own method. To improve efficiency, we use a four-arm technique.

Treatment of chylothorax by robotic thoracic duct ligation.

This is the first report describing the use of robotic technology for the treatment of chylothorax. We present a 22-year-old with mixed embryonal cell and seminoma germ cell cancer refractory to medical and surgical treatment. The patient had rising markers and a growing left lower lung lobe metastasis. After left lower lobectomy, left-sided chylothorax developed. Conservative management failed, and a robotic right-sided thoracic duct ligation was performed. Other treatment options are reviewed.

Oncologic emergencies: the anesthesiologist's perspective.

Cancer is the second leading cause of death in the United States. During the course of treatment, a cancer patient may present emergently to the hospital because of either the cancer itself or a manifestation of cancer therapy. Rarely, patients with cancer can present to the operating room with several emergent conditions that require the services of an anesthesiologist. The main oncologic emergencies affecting anesthesiologists relate to airway obstruction and cardiac-, neurologic-, gastrointestinal-, and endocrine-related conditions. Mismanagement of these crises can increase morbidity and mortality. This article addresses emergencies in patients with cancer and how they relate to anesthetic care.

Cardiac function during steep Trendelenburg position and CO2 pneumoperitoneum for robotic-assisted prostatectomy: a trans-oesophageal Doppler probe study.

BACKGROUND: Haemodynamic changes associated with pneumoperitoneum and steep Trendelenburg position were investigated in non-obese, ASA I-II males, using general anaesthesia (sevoflurane in air/O2, 40%) undergoing robotic-assisted laparoscopic prostatectomy. METHODS: A trans-oesophageal echo-Doppler probe (Arrow International) measured cardiovascular changes in heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR), stroke volume (SV) and aortic diameter (AoD) in 35 of 37 males. Assessments were conducted after induction of general anaesthesia in: the supine position; at 45 degrees Trendelenburg; Trendelenburg + pnuemoperitoneum (intra-abdominal 15 mmHg); and at the end of surgery in the supine position. RESULTS: The Trendelenburg position increased stroke volume. Trendelenburg position + pneumoperitoneum increased MAP and SVR and decreased AoD. CONCLUSIONS: Pneumoperitoneum and steep Trendelenburg position significantly increase MAP and SVR. Trendelenburg position increased stroke volume. Pneumoperitoneum decreases aortic diameter. No significant changes in cardiac output or stroke volume were noted.

Management of pain and nausea in outpatient surgery.

The cost associated with surgical procedures has been dramatically decreased by the ability to perform these procedures on an outpatient basis. Pain and nausea, two common symptoms after anesthesia and surgical procedures, are among the greatest concerns for patients and their family members. As a result of the distress and sequelae associated with these symptoms, clinicians have attempted to determine the optimal intraoperative and postoperative symptom management for patients. The purpose of this quality improvement project was to describe the incidence of these symptoms and their management in patients who underwent planned outpatient surgical procedures in a cancer center. A sample of 39 patients were accrued at a comprehensive cancer center over a 3-month period. Data were collected at three specific time points (i.e., preoperatively, at 24 hours and at 7 days postoperatively). Postoperative pain and nausea were generally well managed, but improvement was needed in preoperative patient teaching, including the topics of drug and nondrug interventions. The methods used in this project have potential application for the measurement of other clinical outcomes after outpatient surgical procedures.