The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 1977
Kindness pays dividends: the medical benefits of intercostal nerve block following thoracotomy.
Postoperative pain is an important factor in the management of children undergoing thoracotomy. Intercostal nerve block has been used in adult patients, but its applicability in the pediatric age group has not been previously evaluated. Eighty-nine children (85 girls and 31 boys) aged 6 months to 16 years (mean age 4.7 years) underwent ligation of a patent ductus arteriosus (PDA) through a left thoracotomy. ⋯ The mean hospital stay was shortened in the patients with nerve block, 5.1 days versus 7.3 days for the control group. No ill effects of bupivacaine were noted. We conclude that intercostal nerve block is a valuable procedure reducing the need for postoperative analgesia and shortening hospital stay.
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The lung, like other viable organs, requires the adequate supply of oxygen and metabolic substrates for its functional and structural integrity. Therefore, we studied the metabolic and ultrastructural consequences in the canine lung following bronchial and/or pulmonary arterial occlusions. ⋯ When both the ventilation and perfusion were interrupted, rapid biochemical and structural deteriorations occurred, whereas the combinations of alveolar obliteration and hypoxemia, induced with low F102, produced intermediate damage. The implications of these findings on the pathogenesis and evolution of acute respiratory distress syndrome, on the lung preservation for transplantation, and on the rationale for membrane oxygenator support are discussed.