Olajire Idowu

Anesthetic management of pediatric patients undergoing thoracoscopy

ECENT IMPROVEMENTS in the instruments for R and the technique of video-assisted thoracoscopy in adults have resulted in increased use of thoracoscopy.l Reported advantages of thoracoscopy include smaller thoracic incisions, reduced postoperative pain, and faster postoperative recovery.2 The descriptions of anesthetic techniques used for thoracoscopy pertain only to adults.2-4 Because thoracoscopy is now used in the pediatric population,5,6 the detailed anesthetic management for thoracoscopy in nine pediatric patients, with emphasis on methods of one-lung ventilation in children, is reported.

Ectopic pancreas as the cause of gastric outlet obstruction in a newborn

Abstract This case of ectopic pancreas found in the pre-pyloric channel of a 2-day-old infant is unique. A review of the literature reveals no other cases of symptomatic ectopic pancreas in an infant of this age. In this patient, signs and symptoms were consistent with pyloric stenosis. Upper gastrointestinal study and esophagogastroduodenoscopy (EGD) revealed the diagnosis. This case is examined and the literature is reviewed.

Colonic atresia in monozygotic twins.

We describe monozygotic twins with colonic atresia and discuss genetic causes of colonic atresia.

Use of transthoracic cryoanalgesia during the Nuss procedure

From the Division of Pediatric Surgery, UCSF Benioff Children’s Hospitals, Oakland, Calif; the Department of Surgery, University of California, San Francisco–East Bay, Oakland, Calif; and the Department of Cardiothoracic Surgery, Regional Medical Center, San Jose, Calif. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Aug 15, 2015; revisions received Sept 17, 2015; accepted for publication Sept 27, 2015. Address for reprints: Sang H. Lee, MD, Department of Cardiothoracic Surgery, Regional Medical Center, 455 O’Connor Dr, Suite 280, San Jose, CA 95128 (E-mail: sangleemd@hotmail.com). J Thorac Cardiovasc Surg 2016;151:887-8 0022-5223/

Minimally invasive repair of symmetric pectus carinatum: bilateral thoracoscopic chondrotomies and suprasternal compression bar placement.

36.00 Copyright 2016 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2015.09.110

Use of intraoperative lateral pelvic X-ray to localize and ensure coccyx removal during sacrococcygeal teratoma resection

PURPOSE We previously reported a novel minimally invasive repair for unilateral pectus carinatum. We have now modified this approach for the repair of symmetric bilateral pectus carinatum. MATERIALS AND METHODS Using thoracoscopy, parasternal chondrotomies were performed at multiple rib levels at points of maximal sternal protrusion. The sternum was depressed to an appropriate position and maintained using a suprasternal metal compression bar. The bar was applied in a submuscular plane and anchored to the lateral ribs with sutures. Bars were removed after 6 months. RESULTS Three patients with severe symmetric pectus carinatum underwent the repair. The first patient returned to the operating room after 1 month for repeat fixation of the bar after suture breakage. No other complications occurred. Operative times were comparable to published series. Patient satisfaction after the repair was good. CONCLUSIONS Minimally invasive thoracoscopic repair of symmetric pectus carinatum using chondrotomies and suprasternal bar compression is a feasible alternative to open repair.

Intraoperative cryoanalgesia for managing pain after the Nuss procedure

En bloc removal of the coccyx during sacrococcygeal teratoma resection is necessary to decrease the risk of recurrence. However, variable anatomy often makes the border between the coccyx and sacrum difficult to identify. We describe the use of intraoperative lateral pelvic X-ray to localize this border and ensure complete coccygectomy.

Mechanics of a stuck central venous catheter removal

BACKGROUND Cryoanalgesia prevents pain by freezing the affected peripheral nerve. We report the use of intraoperative cryoanalgesia during the Nuss procedure for pectus excavatum and describe our initial experience, modifications of technique, and lessons learned. MATERIALS AND METHODS We retrospectively reviewed the medical records of patients who received cryoanalgesia during the Nuss procedure between June 1, 2015, and April 30, 2016, at our institutions and analyzed modifications in surgical technique during this early adoption period. RESULTS Eight male and two female patients underwent the Nuss procedure with cryoanalgesia. The mean postoperative length of stay (LOS) was 2days (range 1-3). Average inpatient pain scores were 3.4, 3.2, and 4.6 on postoperative days 1-3, respectively (N=10, 7, and 2). At a 1-week postoperative visit, mean pain score was 1.1 (N=6). Compared to the preceding 15 Nuss patients at our institution, who were treated with a thoracic epidural, postoperative LOS was significantly shorter with cryoanalgesia (2.0±0.82 vs. 6.3±1.3days, P<0.001). We modified our technique for patient habitus and adopted single-lung ventilation for improved visualization. CONCLUSIONS Cryoanalgesia may be the ideal pain management strategy for Nuss patients because it is effective and long lasting. Intraoperative application is easily integrated into the Nuss procedure. STUDY TYPE Treatment study: case series; Evidence level IV.

Modification of U-Stitch Laparoscopic Gastrostomy Technique to Minimize Suture Knot Abscess Formation.

Although a surgical removal of tunneled central venous catheter is usually simple, it can become complicated when the catheter is found to be stuck because of its adherence within a central vein. If a catheter is pulled too hard, it may fracture within a central vein in two pieces. In this report, we describe the mechanics of central venous catheter breakage and provide a solution that minimizes the possibility of catheter from breaking as it is pulled out from its stuck position within a central vein.

A method to accurately estimate the catheter length needed for a tunneled central catheter placement

Aim U-stitch laparoscopic gastrostomy is a commonly used technique for placement of balloon gastrostomy for pediatric patients. The U-stitch method was modified by others whereby the stay sutures are placed in a subcutaneous tissue. Although this modification has been reported to be superior, it has led to suture knot abscess formation which was not reported in the original method. We developed further modification whereby the stay-suture knots are positioned within the gastrostomy tract instead of the subcutaneous tissue which minimizes suture knot abscess formation. Methods Modified U-stitch technique was used to place the balloon gastrostomy. The U-stitch stay sutures are placed to hold the stomach to the abdominal wall. These sutures are subcutaneously tunneled toward the gastrostomy tract and tied to the opposing sutures with the resulting knots lying within the tract of the gastrostomy. Chart reviews of patients who underwent this modified U-stitch method were done. Results A total of 27 consecutive patients were evaluated. Minimal follow-up period was 6 months. No suture knot abscess complication was found. One patient for whom we used a polyglactin (Vicryl; Ethicon Inc., Cincinnati, Ohio, United States) suture developed cellulitis around the gastrostomy site which cleared with antibiotic. Remaining 10 patients for whom we used Vicryl suture and 16 patients for whom polydioxanone (PDS; Ethicon Inc.) suture was used did not develop any infections. Conclusion Subcutaneous placement of stay suture within the open gastrostomy tract rather than within closed subcutaneous tissue may minimize suture knot abscess formation.