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1.
Khirurgiia (Mosk) ; (10): 11-22, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047581

RESUMO

OBJECTIVE: To summarize our experience in transsternal occlusion of main bronchus fistula. MATERIAL AND METHODS: We have performed 146 transsternal occlusions of the main bronchi for the period from 1979 to 2018. There were 123 (84.2%) men and 23 (15.7%) women. Mean age of patients was 63 years. Lung tuberculosis was diagnosed in 36 (24.7%) patients, lung cancer - 91 (62.3%) patients, non-specific suppurative lung diseases - 14 (9.6%) patients, trauma - 5 (3.4%) patients. All patients underwent transsternal occlusion of the main bronchi fistulae with or without pericardial cavity dissection. Wedge-shaped bronchial resection or tracheal bifurcation resection were carried out for a short stump fistula. RESULTS: Perioperative complications occurred in 28 (19.2%) out of 146 patients. Intraoperative complications developed in 4 (2.6%) patients. Postoperative complications were observed in 25 (17.1%) patients. Intraoperative mortality rate was 1.4% (n=2), postoperative mortality - 6.2% (n=9). Thus, overall mortality rate was 7.6% (n=11 It should be noted that intraoperative complications were absent if dissection of the pericardium and pulmonary artery stump ligation were not performed. CONCLUSION: Transsternal occlusion of the main bronchi fistulae was successful in 80.8% of patients. In these cases, healing of fistulae was not associated with any complications. Thus, we believe that transsternal occlusion of the main bronchial stump fistula should be considered as preferable surgical strategy.


Assuntos
Brônquios/cirurgia , Fístula Brônquica/cirurgia , Pneumopatias/cirurgia , Pneumonectomia/efeitos adversos , Procedimentos Cirúrgicos Torácicos/métodos , Brônquios/lesões , Fístula Brônquica/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esterno/cirurgia , Procedimentos Cirúrgicos Torácicos/efeitos adversos
2.
PLoS One ; 15(10): e0237363, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33017425

RESUMO

OBJECTIVE: To evaluate the analgesic efficacy and safety of paravertebral block (PVB) versus intercostal nerve block (INB) in thoracic surgery and breast surgery. METHODS: The PubMed, Web of Science, Embase and the Cochrane Library were searched up to February 2020 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy and safety of PVB compared with INB after thoracic surgery and breast surgery. For binary variables, odds ratio (OR) and 95% confidence interval (CI) was used. For continuous variables, weighted mean difference (WMD) and 95% confidence interval (CI) were used. RevMan5. 3 and Stata/MP 14.0 were used for performing the meta-analysis. RESULTS: A total of 9 trials including 440 patients (PVB block:222 patients; INB: 218 patients) met the inclusion criteria. In the primary outcome, there was no significant differences between the two groups with respect to postoperative visual analogue scale (VAS) at 1h (Std. MD = -0. 20; 95% CI = -1. 11to 0. 71; P = 0. 66), 2h (Std. MD = -0. 71; 95% CI = -2. 32to 0. 91; P = 0. 39), 24h (Std. MD = -0. 36; 95% CI = -0. 73 to -0. 00; P = 0. 05) and 48h (Std. MD = -0. 04; 95% CI = -0. 20 to 0. 11; P = 0. 57). However, there was significant difference in VAS of non Chinese subgroup at 1h (Std. MD = 0. 33; 95% CI = 0. 25to 0. 41; P<0. 00001) and VAS of Chinese subgroup at 24h (Std. MD = -0.32; 95% CI = -0.49 to-0.14; P = 0.0003). In the secondary outcome, the analysis also showed no significant difference between the groups according to the rates of postoperative nausea and vomit (OR = 0. 63; 95% CI = 0. 38 to 1. 03; P = 0. 06) and the rates of postoperative additional analgesia (OR = 0. 57; 95% CI = 0. 21 to 1. 55; P = 0. 27). There was significant difference in postoperative consumption of morphine (Std. MD = -14. 57; 95% CI = -26. 63 to -0.25; P = 0. 02). CONCLUSION: Compared with INB, PVB can provide better analgesia efficacy and cause lower consumption of morphine after thoracic surgery and breast surgery.


Assuntos
Mama/cirurgia , Bloqueio Nervoso/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Analgesia/métodos , Feminino , Humanos , Nervos Intercostais , Masculino , Mastectomia , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Segurança , Coluna Vertebral/inervação , Toracoscopia , Toracotomia , Resultado do Tratamento
3.
Adv Respir Med ; 88(4): 366-368, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32869274

RESUMO

We discuss the hypothesis that common Chest Drain Systems collected to a COVID-19 patient, could be a possible source of contamination for health care staff in a Thoracic Surgery ward and we propose an alternative way to minimize this further risk of transmission.


Assuntos
Tubos Torácicos/efeitos adversos , Infecções por Coronavirus/transmissão , Pneumonia Viral/transmissão , Procedimentos Cirúrgicos Torácicos/métodos , Competência Clínica , Infecções por Coronavirus/prevenção & controle , Drenagem/efeitos adversos , Humanos , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/métodos , Pneumonia Viral/prevenção & controle , Medição de Risco , Toracostomia/métodos
4.
Asian Cardiovasc Thorac Ann ; 28(6): 322-329, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32609557

RESUMO

OBJECTIVES: Healthcare resources have been mobilized to combat the COVID-19 pandemic of 2020. The Thoracic Domain of the Asian Society for Cardiovascular and Thoracic Surgery reports a consensus statement on the provision of thoracic cancer surgery during this pandemic. METHODS: A Thoracic Experts Panel was convened by the Society. A consensus on the provision, safety, and setting of thoracic cancer surgery during the pandemic was obtained through a Delphi process. RESULTS: Responses were received from 26 panel members (96% response rate) from 10 regions across Asia. The Society recommended that elective thoracic cancer surgery services may need to be reduced or postponed if medical resources were needed for COVID-19 patients, especially intensive care unit beds and ventilators. However, thoracic cancer surgery should proceed as normal for all solid tumors, without restrictions based on disease stage, availability of non-surgical treatment options, or patient condition (unless there is a high likelihood of postoperative intensive care unit stay). Aerosol-forming procedures should be avoided intra- and perioperatively. The surgical approach does not make a difference in terms of safety. Services for thoracic cancer patients should be offered only in hospitals that maintain isolation wards for patients with confirmed or suspected COVID-19. CONCLUSIONS: Services for patients with thoracic cancer should be maintained during the COVID-19 pandemic. The position of the Society is that thoracic surgeons have a responsibility to perform good surgical management of thoracic cancer during the pandemic, to advocate for patients' rights to receive it, and to safeguard patients and staff from infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Neoplasias Torácicas/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Ásia , Humanos , Sociedades Médicas
5.
Br J Anaesth ; 125(5): 802-810, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32660716

RESUMO

BACKGROUND: Minimally invasive thoracic surgery causes significant postoperative pain. Erector spinae plane (ESP) block and serratus anterior plane (SAP) block promise effective thoracic analgesia compared with systemically administered opioids, but have never been compared in terms of terms of quality of recovery and overall morbidity after minimally invasive thoracic surgery. METHODS: Sixty adult patients undergoing minimally invasive thoracic surgery were randomly assigned to receive either single-shot ESP or SAP block before surgery using levobupivacaine 0.25%, 30 ml. The primary outcome was quality of patient recovery at 24 h, using the Quality of Recovery-15 (QoR-15) scale. Secondary outcomes included area under the curve (AUC) of pain verbal rating scale (VRS) over time, time to first opioid analgesia, postoperative 24 h opioid consumption, in-hospital comprehensive complication index (CCI) score and hospital stay. RESULTS: The QoR-15 score was higher among ESP patients compared with those in the SAP group, mean (standard deviation): 114 (16) vs 102 (22) (P=0.02). Time (min) to first i.v. opioid analgesia in recovery was 32.6 (20.6) in ESP vs 12.7 (9.5) in SAP (P=0.003). AUC at rest was 92 (31) mm h-1vs 112 (35) in ESP and SAP (P=0.03), respectively, whereas AUC on deep inspiration was 107 mm h-1 (32) vs 129 (32) in ESP and SAP (P=0.01), respectively. VRS pain on movement in ESP and SAP at 24 h was, median (25-75% range): 4 (2-4) vs 5 (3-6) (P=0.04), respectively. Opioid consumption at 24 h postoperatively was 29 (31) vs 39 (34) (P=0.37). Median (25-75%) CCI in ESP and SAP was 1 (0-2) vs 4 (0-26) (P=0.03), whereas hospital stay was 3 (2-6) vs 6 (3-9) days (P=0.17), respectively. CONCLUSION: Compared with SAP, ESP provides superior quality of recovery at 24 h, lower morbidity, and better analgesia after minimally invasive thoracic surgery. CLINICAL TRIAL REGISTRATION: NCT03862612.


Assuntos
Raquianestesia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Bloqueio Nervoso/métodos , Cirurgia Torácica Vídeoassistida/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Adulto , Idoso , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Período de Recuperação da Anestesia , Anestésicos Locais , Feminino , Humanos , Tempo de Internação , Levobupivacaína , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/métodos
6.
J Card Surg ; 35(8): 2047-2049, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652625

RESUMO

Mediastinal paragangliomas are very uncommon neuroendocrine neoplasms. Due to their tissue of origin (sympathetic ganglia of the great vessels), they tend to arise deep within pericardial space and, more importantly, intimately attached to great vessels, which makes surgical resection, even with cardiopulmonary bypass, very challenging. This commentary accompanies the case report describing complex surgical management of a paraganglioma located in the anterior mediastinum that was initially thought to be a thymoma.


Assuntos
Neoplasias do Mediastino/cirurgia , Paraganglioma/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Ponte Cardiopulmonar , Diagnóstico Diferencial , Diagnóstico por Imagem , Galactosamina/análogos & derivados , Humanos , Imino Piranoses , Neoplasias do Mediastino/diagnóstico , Mediastino/cirurgia , Paraganglioma/diagnóstico , Timoma , Neoplasias do Timo
7.
J Card Surg ; 35(8): 2064-2066, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652795

RESUMO

A flail chest can occur when cardiopulmonary resuscitation causes extensive rib fractures. Despite successful cardiopulmonary resuscitation, if the flail chest is not treated, the patient may not survive regardless of the correction of the primary condition that caused the cardiac arrest. Therefore, if flail chest persists despite the appropriate conservative management to correct the flail chest, active surgical management is essential. We present a successful surgical treatment with a pectus bar for a patient with flail chest, caused by extensive segmental rib fractures sustained during cardiopulmonary resuscitation for a massive pulmonary thromboembolism.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Tórax Fundido/etiologia , Tórax Fundido/cirurgia , Fixação Interna de Fraturas/métodos , Fixadores Internos , Procedimentos Cirúrgicos Torácicos/métodos , Idoso , Feminino , Tórax Fundido/diagnóstico por imagem , Parada Cardíaca/terapia , Humanos , Radiografia Torácica , Fraturas das Costelas/diagnóstico por imagem , Fraturas das Costelas/etiologia , Fraturas das Costelas/cirurgia , Costelas/cirurgia , Tomografia Computadorizada por Raios X
9.
Rev. cir. (Impr.) ; 72(3): 195-202, jun. 2020. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1115542

RESUMO

Resumen Introducción: Uno de los mayores avances de las últimas décadas en la cirugía de tórax ha sido el desarrollo de la cirugía mínimamente invasiva. Objetivos: Describir la experiencia en videotoracoscopía (VATS) Uniportal de miembros del equipo de Cirugía de Tórax de la Universidad de Chile en 2 campos clínicos, (Clínica Las Condes y Hospital Clínico de la Universidad de Chile). Materiales y Método: Se estudiaron 105 pacientes sometidos a VATS uniportal entre enero de 2016 y enero de 2019. Los datos se analizaron de manera retrospectiva considerando variables demográficas (edad, sexo) y clínicas (diagnóstico, cirugía, estadía hospitalaria, días de pleurostomía, conversión y complicaciones). Resultados: De las 105 cirugías realizadas, 28 (26,6%) correspondieron a cirugías mayores complejas lobectomías y segmentectomías anatómicas. En 4 pacientes se agregó un 2° puerto, uno se convirtió a minitoracotomía y uno a toracotomía (5,7% conversión global). La estadía hospitalaria fue en promedio 3,07 ± 3,1 días y el promedio de mantención de pleurostomía de 2,67 ± 1,61 días. Siete pacientes (6,6%) presentaron complicaciones postoperatorias. Un paciente falleció por progresión de su enfermedad, no hubo mortalidad relacionada a la cirugía. Discusión: Las contraindicaciones de la VATS uniportal son las mismas que en la VATS multipuerto. En manos experimentadas, las complicaciones en cirugía por puerto único son bajas. Impresiona tener menos dolor postoperatorio, menor estadía hospitalaria y reintegración precoz a las actividades diarias comparado con la VATS tradicional. Conclusiones: Se presenta la primera serie de VATS uniportal publicada en Chile. Los resultados obtenidos son comparables a los observados en la literatura. Su implementación y desarrollo requiere de una curva de aprendizaje similar a cualquier nueva técnica quirúrgica.


Objective: To describe the initial results with uniportal Video-Thoracoscopic Surgery (VATS) performed in two campuses by members of the Section of Thoracic Surgery of the University of Chile ("Clínica Las Condes" and University of Chile Clinical Hospital). Materials and Method: Between January 2016 and January 2019, a total of 105 patients underwent uniportal VATS. Clinical data was collected retrospectively from digital records including demographic (age, sex) and clinical variables (diagnosis, surgery, duration of the chest tube, length of stay, conversion rate and postoperative complications). Results: Uniportal VATS was performed on 105 patients during the study period. Twenty-eight cases (26.6%) corresponded to lobectomy or anatomic segmentectomy. In 4 cases a 2nd port was required, 1 patient had to be converted to mini-thoracotomy and 1 to thoracotomy (5.8% global conversion). Overall, the median length of stay was 3.07 ± 3.1 days and the median duration of chest tube drainage was 2.67 ± 1.61 days. Seven patients (6.6%) presented complications. One patient died due to progression of his disease, there were no deaths related to the procedures. Discussion: Uniportal VATS has similar indications than multiportal VATS. On experienced hands, uniportal VATS has a low morbidity rate. Uniportal VATS appears to produce less post-operative pain, with shorter hospital stay and a faster return to normal life compared to standard VATS. Conclusion: We present the first uniportal VATS series in Chile. Results were similar to published series. Implementation and development of uniportal VATS requires a learning curve similar to any new surgical procedure.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Chile , Estudos Retrospectivos , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Torácicos/métodos , Cirurgia Torácica Vídeoassistida/instrumentação
10.
J Cardiothorac Surg ; 15(1): 112, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448351

RESUMO

Enhanced recovery after lobectomy surgery (ERAS) concept has been greatly developed between clinical implementation and minimally invasive surgery. In addition to the minimally invasive surgery, the management of the perioperative catheter has also attracted everyone's attention. Tubeless minimally invasive treatment includes no urinary catheter placement during the operation and no chest tube after the operation. Here, we summarized all the reports on no urinary catheterization and no chest tube in patients with thoracic surgery and the impact of postoperative length of stay (LOS) and postoperative complications. We find that avoiding chest drain and urinary catheter placement after the surgery appears to be safe and beneficial for patients.


Assuntos
Tubos Torácicos , Drenagem/instrumentação , Recuperação Pós-Cirúrgica Melhorada , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Torácicos/métodos , Feminino , Humanos , Tempo de Internação , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos
11.
Anaesthesia ; 75(11): 1509-1516, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32369611

RESUMO

Intra-operative aerosol-generating procedures are arguably unavoidable in the routine provision of thoracic anaesthesia. Airway management for such patients during the COVID-19 pandemic including tracheal intubation, lung isolation, one-lung ventilation and flexible bronchoscopy may pose a significant risk to healthcare professionals and patients. That said, there remains a need for timely thoracic surgery for patients with lung cancer or thoracic trauma. The thoracic anaesthetic community has been confronted with the need to modify existing techniques to maximise safety for patients and healthcare professionals. With appropriate modification, aerosol generation may be mitigated against in most circumstances. We developed a set of practice-based recommendations for airway management in thoracic surgical patients, which have been endorsed by the Association for Cardiothoracic Anaesthesia and Critical Care and the Society for Cardiothoracic Surgery in Great Britain and Ireland.


Assuntos
Manuseio das Vias Aéreas/métodos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Ventilação Monopulmonar/métodos , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Torácicos/métodos , Extubação , Anestesia em Procedimentos Cardíacos , Broncoscopia , Pressão Positiva Contínua nas Vias Aéreas , Cuidados Críticos , Humanos , Intubação Intratraqueal , Pandemias , Sociedades Médicas
12.
Surg Today ; 50(10): 1262-1271, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32372154

RESUMO

PURPOSE: Non-small cell lung cancer (NSCLC) involving the chest wall is usually treated with en bloc rib resection or parietal pleurectomy; however, the former causes chest wall deformity and the latter is associated with local recurrence. To prevent both these sequalae, we performed the "ribcage" procedure for tumors involving the chest wall after induction chemoradiotherapy. METHODS: This was a single center retrospective study conducted from 2012 to 2018. The "ribcage" procedure is designed to preserve the ribs of patients with lung tumors involving chest wall and involves peeling the intercostal muscles and periosteum from the ribs, resulting in a birdcage-like appearance. Seventeen patients with NSCLC clearly involving the chest wall, but not destroying the ribs, were treated with induction chemoradiotherapy, followed by the ribcage procedure. A negative margin at the ribs was confirmed by intraoperative frozen sections in 16 of these patients, who then underwent the ribcage procedure. RESULTS: Complete resection was achieved in all 16 patients, none of whom experienced major postoperative complications. After a median follow-up period of 37 months, there was no evidence of local recurrence in any of the patients. CONCLUSION: Our findings suggest that the ribcage procedure is the preferable surgical option as it can prevent chest wall deformities as well as local recurrence.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Quimiorradioterapia Adjuvante , Neoplasias Pulmonares/cirurgia , Terapia Neoadjuvante , Pleura/cirurgia , Costelas/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Parede Torácica , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento
13.
Surg Today ; 50(10): 1249-1254, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32458233

RESUMO

PURPOSE: To establish whether new indices on plain chest X-ray (CXR) can replace those on computed tomography (CT) for the follow-up of children who have undergone the Nuss procedure. METHODS: The subjects of this retrospective study were 45 children who underwent the Nuss procedure between 2000 and 2016. The Haller index (HI) was measured by preoperative CT. Preoperative and postoperative chest deformities were evaluated by two CXR measurements: the concave rate on the lateral view (CR; the depth of the concavity divided by the anterior-posterior diameter of the rib cage) and the tracheal bifurcation angle (TBA) on the anterior view. Data are expressed as the median with range. RESULTS: The median age and HI of the children, when they underwent the Nuss procedure, was 9.3 (3.8-17.3) years and 4.5 (3.2-10.1), respectively. The preoperative CR was correlated significantly with the HI. The postoperative CR was significantly lower than the preoperative CR [pre: 0.17 (0.08-0.37), post: 0.09 (0.01-0.18), p < 0.05], and the low value was sustained after bar removal. The TBA decreased significantly after the Nuss procedure from 74.2° (55-104) preoperatively to 65.0° (45-92) postoperatively (p < 0.05). CONCLUSIONS: These results suggest that CXR can replace CT for the follow-up of patients after the Nuss procedure, with lower radiation exposure.


Assuntos
Tórax em Funil/diagnóstico por imagem , Exposição à Radiação/prevenção & controle , Radiografia Torácica , Procedimentos Cirúrgicos Torácicos/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Tórax em Funil/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/efeitos adversos
16.
Ann Thorac Surg ; 110(2): 364-372, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32268139

RESUMO

The burgeoning demands for quality, safety, and value in cardiothoracic surgery, in combination with the advancement and acceleration of digital health solutions and information technology, provide a unique opportunity to improve efficiency and effectiveness simultaneously in cardiothoracic surgery. This primer on digital health explores and reviews data integration, data processing, complex modeling, telehealth with remote monitoring, and cybersecurity as they shape the future of cardiothoracic surgery.


Assuntos
Telemedicina , Cirurgia Torácica , Procedimentos Cirúrgicos Torácicos , Inteligência Artificial , Simulação por Computador , Humanos , Cirurgia Torácica/métodos , Cirurgia Torácica/normas , Procedimentos Cirúrgicos Torácicos/métodos , Procedimentos Cirúrgicos Torácicos/normas
17.
Tumori ; 106(5): 388-391, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32326829

RESUMO

OBJECTIVE: Erector spine plane block (ESPB) is a newly defined regional anesthesia technique performed by injection of local anesthetic beneath the erector spine muscle. We tested ESPB as a regional rescue analgesia bedside technique to be performed in the thoracic surgical ward, reporting a 7-patient case series. METHODS: We report our experience in rescue analgesia after thoracic surgery. During the postoperative stay, numeric rating scale (NRS) score >3 and inability to perform physiotherapy or effective cough due to postoperative pain represented the criteria for proposing rescue analgesia with ESPB. NRS at rest and during movements was recorded; blood gas analysis and spirometry were performed to evaluate PaO2/FiO2 (P/F), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) before ESPB execution. After performing the ESPB, static and dynamic NRS, P/F, and FVC and FEV1 were recorded at 40 minutes and 80 minutes. RESULTS: NRS had a reduction at rest and in dynamic assessment. The P/F did not improve but spirometric measures improved. FVC had a relevant improvement only after 80 minutes; FEV1 was increased after 40 minutes. CONCLUSION: The use of ESPB as postoperative rescue analgesia can offer several advantages due to effective rescue analgesia and safety that makes it easy to perform in the thoracic surgical ward or in an outpatient clinic setting.


Assuntos
Anestésicos Locais/uso terapêutico , Músculo Esquelético/efeitos dos fármacos , Dor Pós-Operatória/tratamento farmacológico , Procedimentos Cirúrgicos Torácicos/métodos , Adulto , Idoso , Analgesia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/inervação , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/fisiopatologia , Coluna Vertebral/efeitos dos fármacos , Coluna Vertebral/fisiopatologia , Ultrassonografia de Intervenção
18.
Ann Thorac Surg ; 110(5): e417-e419, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32333850

RESUMO

Severe acute respiratory syndrome coronavirus 2 disease 2019 (COVID-19) has rapidly spread worldwide since December 2019. An acute respiratory distress syndrome develops in a relevant rate of patients, who require hospitalization. Among them, a nonnegligible rate of 9.8% to 15.2% of patients requires tracheal intubation for invasive ventilation. We report the case of a pneumomediastinum and subcutaneous emphysema developing in a COVID-19 patient secondary to postintubation tracheal injury. The management of COVID-19 patients can be challenging due to the risk of disease transmission to caregivers and epidemic spread. We performed a bedside tracheal injury surgical repair, after failure of conservative management, with resolution of pneumomediastinum and subcutaneous emphysema and improvement of the patient's conditions.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Intubação Intratraqueal/efeitos adversos , Enfisema Mediastínico/cirurgia , Pneumonia Viral/terapia , Enfisema Subcutâneo/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Traqueia/lesões , Idoso , Infecções por Coronavirus/epidemiologia , Humanos , Masculino , Enfisema Mediastínico/diagnóstico , Enfisema Mediastínico/etiologia , Pescoço , Pandemias , Pneumonia Viral/epidemiologia , Enfisema Subcutâneo/diagnóstico , Enfisema Subcutâneo/etiologia , Tomografia Computadorizada por Raios X
19.
Surg Clin North Am ; 100(2): 237-248, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32169178

RESUMO

Minimally invasive surgery for diseases of the chest offsets the morbidity of painful thoracic incisions while allowing for meticulous dissection of major anatomic structures. This benefit translates to improved outcomes and recovery following the surgical management of benign and malignant esophageal pathologic condition, mediastinal tumors, and lung resections. This anatomic region is particularly amenable to a robotic approach given the fixed space and need for complex intracorporeal dissection. As robotic platforms continue to evolve, more complex thoracic surgical interventions will be facilitated, translating to improved outcomes for our patients.


Assuntos
Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Esofagectomia , Humanos , Doenças do Mediastino/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Pneumonectomia , Cirurgia Torácica Vídeoassistida
20.
Ann Thorac Surg ; 110(1): e67-e69, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32114051

RESUMO

Sleeve resection and double-barreled reconstruction are very rarely adopted for peripheral bronchial tumors. This surgical procedure was used for a carcinoid tumor in the bifurcation of the left upper and lower lobe bronchi. Bronchoplasty was accomplished by suturing the upper and basal bronchi together and anastomosing them to the left main bronchus. The techniques for double-barreled reconstruction described in this report obtained a successful result. These manipulations may be applicable to resection of other bronchial and tracheal bifurcations.


Assuntos
Brônquios/cirurgia , Neoplasias Brônquicas/cirurgia , Tumor Carcinoide/cirurgia , Pneumonectomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Brônquios/diagnóstico por imagem , Neoplasias Brônquicas/diagnóstico , Broncoscopia , Tumor Carcinoide/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade
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