Kyobu geka. The Japanese journal of thoracic surgery
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The feature of perioperative care for congenital heart surgery in newborn and infant is that the change of environment surrounding the baby should be considered. Especially the baby with anomaly of pulmonary artery, pulmonary vein, relation of the great vessels or patent ductus arteriosus (PDA) dependent heart defects is in a stable condition in the womb. Cardiopulmonary system changes immediately after birth, and symptoms of congenital heart disease will appear. In this part, we describe the pre- and post-operative care in newborn and infant with congenital heart defects.
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Venous thromboembolism (VTE) is the common condition of disease specified as deep vein thrombosis (DVT) or pulmonary embolism (PE), and PE is well known as one of the most important acute and chronic complications after thoracic surgery. Clinical guidelines recommend the use of low dose unfractionated heparins in the treatment and prevention of VTE, in addition to non-pharmacological interventions such as elastic stockings or intermittent sequential pneumatic compression (ISPC) aimed at reducing thrombotic risk. ⋯ In addition, use of inferior vena cava (IVC) filters or thrombolytic agents in patients with surgery also remains controversial. Prophylaxis in patients with VTE has received recommendations in many clinical guidelines, however, when the VTE is suspected, immediate and accurate diagnosis and appropriate treatment become important.
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High incidence of malnutrition is found in esophageal cancer patients. It is well known that to maintain good nutritional preoperative condition is very important to prevent postoperative morbidity and mortality. Hence, preoperative oral or nasogastric feeding is recommended when the patient is malnourished, at a total dose of 30 kcal/kg/day. ⋯ When total parenteral nutrition is used, blood glucose level should be controlled less than 150 mg/dl by pertinently administering insulin or limiting glycemic intake. Immunonutrition is promising nutritional management for critical surgical patients such as those performed esophageal cancer surgery. Continuing immune-enhancing diet at a dose of 750 to 1,000 ml/day for 5 to 7 days before surgery is necessary to bring good postoperative outcome.
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A respiratory morbidity such as atelectasis or pneumonia is possible to be predicted by calculated postoperative pulmonary function. The predicted postoperative 1 second forced expiratory volume (FEV1.0) is exclusively useful for predicting morbidity, but not for predicting mortality. ⋯ Thus, both parameters are helpful to make strategies for perioperative management. A prophylactic tracheostomy, a timely traheostomy and a timely bronchoscopy are applied by these parameters to treat postopeartive respiratory complications such as atelectasis or pneumonia.
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We experienced 2 patients who admitted to our hospital becaus of acute onset of dyspnea and chest pain. Chest X-ray and chest computed tomography showed severe atelectasisi of hemilateral lung. After intathoracic drainage under local anesthesia, we diagnosed a emphysematous giant bulla. We resected the giant bulla.