Mert Şentürk

The effects of three different analgesia techniques on long-term postthoracotomy pain.

In this clinical, randomized, prospective study, we compared the effects of three different analgesia techniques (thoracic epidural analgesia [TEA] with and without preoperative initiation and IV patient-controlled analgesia [IV-PCA]) on postthoracotomy pain in 69 patients. In two groups, a thoracic epidural catheter was inserted preoperatively. Group Pre-TEA had bupivacaine and morphine solution preoperatively and intraoperatively. Postoperative analgesia was maintained with epidural PCA with a similar solution. Group Post-TEA, with no intraoperative medication, had the same postoperative analgesia as Group Pre-TEA plus the bolus dose. Group IV-PCA received only IV-PCA with morphine for postoperative analgesia. Pain was evaluated every 4 h during the first 48 h at rest, cough, and movement. Pre-TEA was associated with decreased pain compared with the other groups. Six months later, the patients were asked about their pain. The incidence and the intensity of pain were most frequent in Group IV-PCA (78%) and were the least in Group Pre-TEA (45%) (Group Pre-TEA versus Group IV-PCA, P = 0.0233; Group Pre-TEA versus Group IV-PCA, P = 0.014). Patients having pain on the second postoperative day had 83% chronic pain. TEA with preoperative initiation is a preferable method in preventing acute and long-term thoracotomy pain.

Effects of thoracic epidural anaesthesia on pulmonary venous admixture and oxygenation during one-lung ventilation

Background:  In this clinical randomized study, the effects of four anaesthesia techniques during one‐lung ventilation [total intravenous anesthesia (TIVA) with or without thoracic epidural anaesthesia (TEA) (G‐TIVA‐TEA and G‐TIVA), isoflurane anaesthesia with or without TEA (G‐ISO‐TEA and G‐ISO)] on pulmonary venous admixture (Qs/Qt) and oxygenation (OLV) were investigated.

Intraoperative mechanical ventilation strategies for one-lung ventilation

One-lung ventilation (OLV) has two major challenges: oxygenation and lung protection. The former is mainly because the ventilation of one lung is stopped while the perfusion continues; the latter is mainly because the whole ventilation is applied to only one lung. Recommendations for maintaining the oxygenation and methods of lung protection can contradict each other (such as high vs. low inspiratory oxygen fraction (FiO2), high vs. low tidal volume (TV), etc.). In light of the (very few) randomized clinical trials, this review focuses on a recent strategy for OLV, which includes a possible decrease in FiO2, lower TVs, positive end-expiratory pressure (PEEP) to the dependent lung, continuous positive airway pressure (CPAP) to the non-dependent lung and recruitment manoeuvres. Other applications such as anaesthetic choice and fluid management can affect the success of ventilatory strategy; new developments have changed the classical approach in this respect.

Efeitos das alterações no oxigênio cerebral durante cirurgia de revascularização do miocárdio sobre a disfunção cognitiva no pós‐operatório em pacientes idosos: estudo piloto

BACKGROUND AND OBJECTIVES Postoperative cognitive dysfunction is common after cardiac surgery. Adequate cerebral perfusion is essential and near infrared spectroscopy (NIRS) can measure cerebral oxygenation. Aim of this study is to compare incidence of early and late postoperative cognitive dysfunction in elderly patients treated with conventional or near infrared spectroscopy monitoring. METHODS Patients undergoing coronary surgery above 60 years, were included and randomized to 2 groups; control and NIRS groups. Peroperative management was NIRS guided in GN; and with conventional approach in control group. Test battery was performed before surgery, at first week and 3 rd month postoperatively. The battery comprised clock drawing, memory, word list generation, digit spam and visuospatial skills subtests. Postoperative cognitive dysfunction was defined as drop of 1 SD (standard deviation) from baseline on two or more tests. Mann-Whitney U test was used for comparison of quantitative measurements; Chi-square exact test to compare quantitative data. RESULTS Twenty-one patients in control group and 19 in NIRS group completed study. Demographic and operative data were similar. At first week postoperative cognitive dysfunction were present in 9 (45%) and 7 (41%) of patients in control group and NIRS group respectively. At third month 10 patients (50%) were assessed as postoperative cognitive dysfunction; incidence was 4 (24%) in NIRS group (p:0.055). Early and late postoperative cognitive dysfunction group had significantly longer ICU stay (1.74+0.56 vs. 2.94+0.95; p<0.001; 1.91+0.7 vs. 2.79+1.05; p<0.01) and longer hospital stay (9.19+2.8 vs. 11.88+1.7; p<0.01; 9.48+2.6 vs. 11.36+2.4; p<0.05). CONCLUSION In this pilot study conventional monitoring and near infrared spectroscopy resulted in similar rates of early postoperative cognitive dysfunction. Late cognitive dysfunction tended to ameliorate with near infrared spectroscopy. Early and late cognitive declines were associated with prolonged ICU and hospital stays.

Postoperative Care in Thoracic Surgery

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Pain Management Following Thoracic Surgery

price are net prices, subject to local VAT. Prices indicated with * include VAT for books; the €(D) includes 7% for Germany, the €(A) includes 10% for Austria. Prices indicated with ** include VAT for electronic products; 19% for Germany, 20% for Austria. All prices exclusive of carriage charges. Prices and other details are subject to change without notice. All errors and omissions excepted. M. Şentürk, M. Orhan Sungur (Eds.) Postoperative Care in Thoracic Surgery

Should Every “Myasthenic Thymectomy” Be Sent to ICU?

Pain after thoracotomy is intense, and uncontrolled pain can have negative consequences such as impaired respiratory function, delayed recovery, and transition to chronic pain. The aim is to achieve efficient analgesia without further compromising respiratory system or increasing unwanted complication risks with a multimodal regimen. For this reason, thoracic epidural analgesia and recently paravertebral blocks have gained popularity. Proper preparation followed by comprehensive teamwork and meticulous follow-up can ensure patient comfort and safety.

What Are the Specific Challenges in the Postoperative Mechanical Ventilation After Thoracic Surgery

Myasthenia gravis (MG), an autoimmune disease of neuromuscular junction, is associated with an interaction with the muscle relaxants (MR). Thymectomy is often the method of choice for its treatment; anesthetic and also postoperative management require meticulous preoperative evaluation, careful monitoring, and adequate dose titration. The frequency of video-assisted thoracoscopic extended thymectomy (VATET) is also increasing, thus making the use of MR obligatory. Introduction of sugammadex into modern practice has provided a safe choice to the avoidance of prolonged action of MR also in patients with MG. Still, postoperative management of MG can be challenging, including the risks of prolonged mechanical ventilation, both cholinergic and myasthenic crisis, and drug interactions. This chapter aims to give information about some approaches to obtain a safe postoperative period in patients with MG. The general approach to MG and also other operations of myasthenic patients are not included within the range of this chapter.

Techniques and complications of one-lung ventilation in children with suppurative lung disease: Experience in 15 cases

Incidence of the requirement of prolonged mechanical ventilation after thoracic surgery appears to be decreasing. However, the importance of some severe and specific challenges remains the same. As an example, combination of prolonged air leakage and respiratory insufficiency can be considered as a double-edged sword. Besides the classical approach of “protective” ventilation, which should also be examined again and again, methods like “high-frequency jet ventilation” and “independent lung ventilation” should be considered in selected cases. Not at least, a physician dealing with the postthoracotomy patient should be familiar with the management of chest tubes in different cases.