Journal of thoracic disease
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Review
Influence of apnoeic oxygenation in respiratory and circulatory system under general anaesthesia.
Apnoeic oxygenation is an alternative technique of oxygenation which is recommended in the consecutive oxygen administration with varying flows (2-10 lt/min) through a catheter which is positioned over the keel of the trachea. Apnoeic oxygenation maintains for a significant period of time the oxygenation of blood in breathless conditions. ⋯ Recently they have begun to arise some studies which deal with the application of this technique in several conditions such as difficult tracheal intubation, ventilation of guinea pigs in campaign conditions where the oxygen supply is limited and calculable, the application of this technique in combination with the use of extracorporeal removal of carbon dioxide (CO2). All the above indicate, the clinical use of this technique.
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Transthoracic needle biopsy (TTNB) is done with imaging guidance and most frequently by a radiologist, for the aim is to diagnose a defined mass. It is integral in the diagnosis and treatment of many thoracic diseases, and is an important alternative to more invasive surgical procedures. FNAC is a method of aspiration cytopathology, which with transthoracic biopsy ("core biopsy") is a group of percutaneous minimally invasive diagnostic procedures for exploration of lung lesions. ⋯ On the contrary, gender, age, and the number of pleural passes have not been shown to correlate with the incidence of pneumothorax. The problem most responsible for complicating outpatient management, after needle biopsy was performed, is not the presence of the pneumothorax per se, but an increase in the size of the pneumothorax that requires chest tube placement and patient hospitalization. Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications.
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Cerebral oximetry based on near-infrared spectroscopy (NIRS) is increasingly used during the perioperative period of cardiovascular operations. It is a noninvasive technology that can monitor the regional oxygen saturation of the frontal cortex. ⋯ Intraoperatively, it provides continuous information about brain oxygenation and allows the use of brain as sentinel organ indexing overall organ perfusion and injury. This review focuses on the clinical validity and applicability of this monitor for cardiac surgical patients.
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The establishment of Extracorporeal Circulation (EC) significantly contributed to improvement of cardiac surgery, but this is accompanied by harmful side-effects. The most important of them is systemic inflammatory response syndrome. Many efforts have been undertaken to minimize this problem but unfortunately without satisfied solution to date. ⋯ Hemodynamics and respiratory parameters were improved compared to control group, but these differences was not statistical significant. Eosinofil adhesion and sequestration in intermediate tissue of lung parenchyma were significantly lower compared to control group. Also, alveolar edema was not noted in lornoxicam's group. Lornoxicam reduce the inflammatory response in patients undergone coronary artery bypass grafting with extracorporeal circulation. This calculated from levels reduction of IL-6, ICAM-1 και p-Selectin, and from lung pathologoanatomic examination (absence of alveolar edema, reduce in eosinofil adhesion and sequestration in intermediate tissues). Despite the favorable effect of lornoxicam on the hemodinamics and respiratory parameters these improvement did not seem to be statistical significant.
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Video-assisted thoracoscopic surgery (VATS) has become a common and globally accepted surgical approach for a variety of thoracic diseases. Conventionally, it is performed under tracheal intubation with double lumen tube or bronchial blocker to achieve single lung ventilation. Recently, VATS without tracheal intubation were reported to be feasible and safe in a series of VATS procedures, including management of pneumothorax, wedge resection of pulmonary tumors, excision of mediastinal tumors, lung volume reduction surgery, segmentectomy, and lobectomy. ⋯ The early outcomes of nonintubated VATS include a faster postoperative recovery and less complication rate comparing with its counterpart of intubated general anesthesia, by which may translate into a fast track VATS program. The future directions of nonintubated VATS should focus on its long-term outcomes, especially on oncological perspectives of survival in lung cancer patients. For now, it is still early to conclude the benefits of this technique, however, an educating and training program may be needed to enable both thoracic surgeons and anesthesiologists providing an alternative surgical option in their caring patients.