European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Oct 2011
Is flexible bronchoscopy necessary to confirm the position of double-lumen tubes before thoracic surgery?
Flexible bronchoscopy is recommended to confirm correct placement of double-lumen tubes used for thoracic anesthesia. However, there is still controversy over routine bronchoscopic confirmation of their position. This study aimed to verify the usefulness of flexible bronchoscopy for confirming the position of double-lumen tubes after blind intubation. ⋯ After blind intubation, 37% of double-lumen tubes required repositioning by means of flexible bronchoscopy, despite positive evaluation made by the anesthesiologist. Our data suggests that initial bronchoscopic assessment should be made with the patient still in the supine position, and confirms that flexible bronchoscopy is useful in verifying the correct position of double-lumen tubes or adjusting possible misplacements, before starting thoracic surgery.
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Eur J Cardiothorac Surg · Oct 2011
Awake coronary artery bypass grafting under thoracic epidural anesthesia: great impact on off-pump coronary revascularization and fast-track recovery.
The ultimate goal of minimally invasive coronary artery bypass grafting (CABG) is day surgery. We evaluated the potential of a new awake CABG protocol using only epidural anesthesia in realizing day surgery. ⋯ Despite the presence of severe preoperative comorbidities in this series, good surgical outcome was obtained. Almost all the patients were able to drink water and walk very soon after surgery, suggesting the potential of this protocol as one-day or day surgery. Awake OPCAB is a promising modality of ultra-minimally invasive cardiac surgery.
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Eur J Cardiothorac Surg · Oct 2011
Review Randomized Controlled TrialIntra-operative paravertebral block for postoperative analgesia in thoracotomy patients: a randomized, double-blind, placebo-controlled study.
Epidural analgesia is the gold standard for post-thoracotomy pain relief but is contraindicated in certain patients. An alternative is paravertebral block. We investigated whether ropivacaine, administered through a paravertebral catheter placed by the surgeon, reduced postoperative pain. ⋯ Paravertebral block using a catheter placed by the thoracic surgeon was ineffective on postoperative pain after thoracotomy and did not confirm the analgesic effect that has been observed after percutaneous catheter placement. A direct comparison of these two placement methods is required.