-
Journal of Clinical Anesthesia Aug 2022
PubMed: 35393179
DOI: 10.1016/j.jclinane.2022.110755 -
Pediatric Pulmonology May 2014Viral croup is a frequent disease in early childhood. Although it is usually self-limited, it may occasionally become life-threatening. Mild croup is characterized by... (Review)
Review
Viral croup is a frequent disease in early childhood. Although it is usually self-limited, it may occasionally become life-threatening. Mild croup is characterized by the presence of stridor without intercostal retractions, whereas moderate-to-severe croup is accompanied by increased work of breathing. A single dose of orally administered dexamethasone (0.15-0.6 mg/kg) is the mainstay of treatment with addition of nebulized epinephrine only in cases of moderate-to-severe croup. Nebulized budesonide (2 mg) can be given alternatively to children who do not tolerate oral dexamethasone. Exposure to cold air or administration of cool mist are treatment interventions for viral croup that are not supported by published evidence, but breathing heliox can potentially reduce the work of breathing related to upper airway obstruction. In summary, corticosteroids may decrease the intensity of viral croup symptoms irrespective to their severity on presentation to the emergency department.
Topics: Administration, Inhalation; Administration, Oral; Algorithms; Anti-Inflammatory Agents; Bronchodilator Agents; Budesonide; Child; Child, Preschool; Croup; Dexamethasone; Helium; Humans; Infant; Oxygen; Racepinephrine; Severity of Illness Index
PubMed: 24596395
DOI: 10.1002/ppul.22993 -
European Journal of Anaesthesiology Sep 2021Peripheral local anaesthetic blockade has an important role in multimodal postoperative analgesia after video-assisted thoracic surgery. Intercostal nerve block has an...
BACKGROUND
Peripheral local anaesthetic blockade has an important role in multimodal postoperative analgesia after video-assisted thoracic surgery. Intercostal nerve block has an opioid-sparing effect after thoracoscopic surgery, but there is little information about an intra-operative opioid-sparing effect.
OBJECTIVE
This prospective randomised trial was designed to evaluate the feasibility of a modified intercostal nerve block and its potential opioid-sparing effect during single-port thoracoscopic lobectomy.
DESIGN
This was a randomised controlled study.
SETTING
The First Affiliated Hospital of Anhui Medical University, Hefei, China, from January 2020 to April 2020.
PATIENTS
Fifty patients scheduled for single-port thoracoscopic lobectomy were enrolled.
INTERVENTION
Patients were randomised to receive the intercostal nerve block using 10 ml 0.35% ropivacaine (group MINB) or conventional general anaesthesia (group CGA). Following a bolus of 0.5 to 1.0 μg kg-1 remifentanil, it was then infused at 0.2 to 0.5 μg kg-1 min-1 during surgery to keep mean arterial pressure or heart rate values around 20% below baseline values.
MAIN OUTCOME MEASURES
The primary outcome was intra-operative remifentanil consumption.
RESULTS
Median [IQR] remifentanil consumption was reduced in the MINB group [0 μg (0 to 0 μg)] compared with the CGA group [1650.0 μg (870.0 to 1892.5 μg)]. The median difference was 1650.0 μg (95%CI 1200.0 to 1770.0 μg; P = 0.00). The total number of analgesic demands during the first 24 and 48 h in the MINB group was significantly less than in the CGA group (difference = 1; 95% CI 1 to 3; P = 0.00 and difference = 4; 95% CI 3 to 5; P = 0.00; respectively). The difference in time to first demand for analgesia was significant [difference = 728 min (95% CI 344 to 1381 min), P = 0.00] and also in the number of patients requiring additional tramadol (P = 0.03).
CONCLUSION
We have shown intra-operative opioid-sparing with a modified intercostal nerve block during single-port thoracoscopic lobectomy, with opioid-sparing extending 48 h after surgery. However, the opioid-sparing effect was not associated with a reduction in opioid side effects.
TRIAL REGISTRATION
http://www.chictr.org.cn, ChiCTR2000029337.
PubMed: 33186308
DOI: 10.1097/EJA.0000000000001394 -
Journal of Clinical Medicine Apr 2023The journal retracts the article, 'Is Increasing Age Associated with Higher Rates of Intercostal Arteries Vulnerable to Laceration [...].
Retraction: Salame et al. Is Increasing Age Associated with Higher Rates of Intercostal Arteries Vulnerable to Laceration? A Point of Care Ultrasound Study. 2022, , 5788.
The journal retracts the article, 'Is Increasing Age Associated with Higher Rates of Intercostal Arteries Vulnerable to Laceration [...].
PubMed: 37109383
DOI: 10.3390/jcm12082905 -
European Journal of Anaesthesiology Jun 2021
PubMed: 33967264
DOI: 10.1097/EJA.0000000000001529 -
Asian Journal of Endoscopic Surgery Apr 2019Recently, single-incision laparoscopic cholecystectomy has been accepted as an alternative to conventional laparoscopic cholecystectomy. The aim of this study was to...
INTRODUCTION
Recently, single-incision laparoscopic cholecystectomy has been accepted as an alternative to conventional laparoscopic cholecystectomy. The aim of this study was to retrospectively evaluate the safety and feasibility of unique gallbladder retraction methods using an ENDOLOOP® (Ethicon, Tokyo, Japan) and Lapaherclosure™ (Hakko Medical, Tokyo, Japan).
MATERIALS AND SURGICAL TECHNIQUE
From May 2013 to April 2015, 77 patients underwent single-incision laparoscopic cholecystectomy with this retraction technique. During the same period, conventional laparoscopic cholecystectomy was performed in 85 patients; these patients were the control group. The patients' data, including the operative time, total blood loss, conversion rate to laparotomy, and perioperative complications, were compared. Alexis® Wound Retractor XS (Applied Medical, Tokyo, Japan) was inserted through a 25-30-mm vertical transumbilical incision to prevent bile contamination. Next, a SILS Port (Covidien, Tokyo, Japan) was inserted. A flexible 5-mm laparoscope was inserted through the port with a grasper (SILS Clinch, Covidien) and a normal 5-mm scalpel. The fundus of the gallbladder was tied by the ENDOLOOP. The Lapaherclosure was then directly inserted through a right lower intercostal space to capture and pull the Lapaherclosure out. After the cystic artery and duct were cut, the resected gallbladder was directly extracted from the umbilical incision.
DISCUSSION
Several methods and devices have been developed to perform single-incision laparoscopic cholecystectomy, including the suturing method, the Mini Loop Retractor II (Covidien), and the EndoGrab (Virtual Ports, Caesarea, Israel). However, considering medical costs and safety, our retraction method seems to be feasible and comparable to existing methods.
Topics: Cholecystectomy, Laparoscopic; Female; Gallbladder; Humans; Male; Middle Aged; Retrospective Studies; Surgical Instruments
PubMed: 30549252
DOI: 10.1111/ases.12614 -
Anesthesiology and Pain Medicine Jun 2022Robotic surgery is becoming the most common approach in minimally invasive urologic procedures. Robotic surgery offers less pain to patients because of smaller keyhole... (Review)
Review
CONTEXT
Robotic surgery is becoming the most common approach in minimally invasive urologic procedures. Robotic surgery offers less pain to patients because of smaller keyhole incisions and less tissue retraction and stretching of fascia and muscular fibers. Tailored pain regimens have also evolved and allowed patients to feel minimal to no discomfort after robotic urologic surgery, allowing in parallel better surgical outcomes. This study aims to analyze the most current pain regimens in robotic urologic surgery and to evaluate the most current pain protocols and corresponding outcomes.
EVIDENCE ACQUISITION
A literature review was performed of published manuscripts utilizing Pubmed and Google Scholar on pain protocols for patients undergoing robotic urologic surgery.
RESULTS
Multimodal analgesia is gaining ground in robotic urologic surgery. Regional analgesia includes four major modalities: Neuroaxial analgesia, intercostal blocks, tranvsersus abdominis plane blocks, and paravertebral blocks. Each approach has a different injection site, region of analgesia coverage, and duration of coverage depending upon local anesthesia and/or adjuvant utilized with advantages and disadvantages that make each modality unique and efficacious.
CONCLUSIONS
Robotic urologic surgery has offered the advantage of smaller incisions, faster recovery, less postoperative opioid consumption, and better surgical outcomes. Neuraxial, intercostal, transversus abdominis plane, and quadratus lumborum blocks are the best and most adopted approaches which offer optimal outcomes to patients.
PubMed: 36818482
DOI: 10.5812/aapm-127911 -
Journal of Cardiac Surgery 2000In recent years, the field of minimally invasive cardiac surgery has grown rapidly beginning with the MIDCAB operation and evolving toward totally endoscopic coronary...
In recent years, the field of minimally invasive cardiac surgery has grown rapidly beginning with the MIDCAB operation and evolving toward totally endoscopic coronary artery bypass grafting (CABG). It promotes the goal of decreasing surgical trauma while maintaining surgical efficacy. For MIDCAB, a limited anterior thoracotomy or mediastotomy have been proposed to harvest the internal mammary artery (IMA). However, complete graft harvesting of the IMA is difficult under direct vision in these circumstances and may necessitate costal resection and important chest wall retraction. Additionally, it carries the potential risk of kinking or coronary steal syndrome. Thoracoscopic harvesting of the IMA avoids these hazards. It permits complete dissection from the subclavian artery to the sixth inter-costal space (ICS) with section of all collateral branches issuing from the IMA without any traumatic retraction. The technique of IMA takedown described herein has been used regularly by us since 1995. Our current experience shows that it is safe and reproducible after a reasonable period of training. Furthermore, in the objective of performing a totally endoscopic and/or robotic CABG, thoracoscopic IMA takedown would be a prerequisite.
Topics: Coronary Artery Bypass; Humans; Mammary Arteries; Robotics; Surgical Instruments; Thoracic Surgery, Video-Assisted
PubMed: 11758064
DOI: 10.1111/j.1540-8191.2000.tb01290.x -
Current Health Sciences Journal 2022A male infant, one month old, weight 4000 g, breastfed only, no pathological history, was admitted to the 2 Pediatric Clinic, Clinical Emergency County Hospital in...
A male infant, one month old, weight 4000 g, breastfed only, no pathological history, was admitted to the 2 Pediatric Clinic, Clinical Emergency County Hospital in Craiova with fever and cough. Clinical findings when he was admitted: fever 38.7°C, perioral cyanosis, spastic cough, expiratory dyspnea, intercostal retraction, polypnea, subcrepitant rales in the right lung area. The chest x-ray revealed pneumonia aspect in the right middle perihilar region. He was administered antibiotic treatment, HHC, antithermics, with a favorable evolution. The control x-ray, when the infant was in a fair general state, with no disease symptomatology, pointed out a cystic formation at the level of the right middle lobe. The pulmonary CT revealed cavitary lesion, with a diameter of about 40mm in the right lung, and with the presence of septa to the interior and air content. The infant was urgently transferred to Marie Curie Hospital in Bucharest, where the cyst formation was removed through a surgical procedure. The anatomo-pathological examination revealed a bronchogenic cyst. The evolution was favorable after the surgical procedure.
PubMed: 35911936
DOI: 10.12865/CHSJ.48.01.20 -
The Journal of Thoracic and... Oct 2005Thoracotomy is associated with significant pain and morbidity. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Thoracotomy is associated with significant pain and morbidity.
METHODS
We performed a prospective randomized trial over 4 months. Patients were randomized to a standard posterior-lateral thoracotomy or an identical procedure, except an intercostal muscle was harvested from the lower rib (to protect the intercostal nerve) before chest retraction. To ensure an equal distribution among both groups, patients were stratified by race, sex, and type of pulmonary resection. All patients received similar pain management. Pain was assessed by using multiple pain scores during hospitalization and after discharge. Outcomes assessed were pain scores, spirometric values, analgesic use, and activity level.
RESULTS
There were 114 patients. The median time for intercostal muscle harvesting was 3.7 minutes. The numeric pain scores were lower for the intercostal muscle group on postoperative days 1 and 2 and at weeks 1, 2, 3, 4, 8, and 12 (P < .05 for all). In addition, patients in the intercostal muscle group had a smaller decrease in spirometric values, were less likely to be using analgesics, and were more likely to have returned to normal activity.
CONCLUSIONS
The harvesting of an intercostal muscle flap before chest retraction decreases the pain of thoracotomy and leads to a lower decrease in spirometry. In addition, patients have less pain at 1, 2, 3, 4, 8, and 12 weeks postoperatively and are less likely to be using narcotics. Finally, it offers a pedicled muscle flap that takes little time to harvest and is able to buttress all bronchi after lobectomy.
Topics: Aged; Female; Humans; Male; Pain, Postoperative; Prospective Studies; Surgical Flaps; Thoracotomy
PubMed: 16214509
DOI: 10.1016/j.jtcvs.2005.05.052