Minerva anestesiologica
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Minerva anestesiologica · May 1999
ReviewOne lung ventilation: prospective from an interested observer.
The improvements in video endoscopic surgical equipment and a growing enthusiasm for minimally invasive surgical approaches, brought video assisted thoracoscopy (VAT) to the practice of surgery for diagnostic and therapeutic procedures. Most of these procedure required a well collapse lung and should be included in the absolute indication for one lung ventilation (OLV) category. The univent tube, is a novel means of achieving bronchial blockade. ⋯ Finally, one of the most interesting future concept to keep adequate oxygenation during OLV, is the ability to modulate the lung circulation. In fact inhaled nitric oxide (NO) and intravenous Almitrine have been combined with additive effects on gas exchange. In case of OLV using that combination will maximize the HPV of the non-dependent lung while dilate the dependent lung to practically eliminate the transpulmonary shunt.
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Traditionally, anaesthetists evaluate the effect of neuromuscular blocking agents clinically. We observe the fasciculations following injection of succinylcholine, the movements of the reservoir bag, the spontaneous movements of the patient, headlift etc. However, with the advent of new fast acting neuromuscular blocking agents and the increasing awareness of the problems of postoperative residual neuromuscular block there is an mounting understanding of the importance of a more objective assessment of the neuromuscular function during anaesthesia. ⋯ In this lecture I shall give my personal bias on whether or not routine monitoring of neuromuscular function during anaesthesia is essential. Also, I shall try to answer the question "why, how and when should we monitor neuromuscular function during clinical anaesthesia?"
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Post-thoracotomy pain is the most severe form of pain after surgery and is continuously exacerbated by ventilatory function. Due to the multiplicity of nociceptive inputs from the chest wall, thoracic viscera, diaphragm and postoperative chest tubes, postoperative pain may be difficult to control with single modalities. The aim is excellent analgesia with function i.e. normal ventilation and rapid mobilisation. ⋯ The most popular and probably most effective technique at the present time is thoracic epidural analgesia using a combination of different local anesthetic agents and opioids. There are few data indicating any influence on outcome of different postthoracotomy analgesic techniques. Improvement in outcome requires a co-ordinated approach from all caregivers using the best possible analgesic techniques.