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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Comparison of the Rate of Preoperative and Post-Operative Pain in VATS and Open Surgery of the Lungs

Backgrounds

Our presentation includes a brief definition of videothoracoscopy and thoracotomy and brief comparison of both with focus on rib spacing in thoracotomy. Mention is also made of study that compared a number of parameters (time of drainage, time of hospitalization, total number and number of pulmonary complications) between VATS and thoracotomy. Following a key question, how is with the pain in both cases.

Keywords: videothoracoscopy, thoracotomy, pain rate.

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Suspected chyle leak during complex spine surgery A unique case of propofol infusion resulting in lipid emulsion pooling in the surgical field

Abstract

The authors report a case of propofol infusion being mistaken for chyle during a two stage thoracic spinal fusion. Propofol is commonly used during spine surgery to facilitate neuromonitoring and there are no reported cases of these observations in the spine literature. We describe the positioning, timing, and treatment in a patient that required prolonged care to rule out a chylothorax.  Chyle and the pharmacologic and physiologic effects of propofol are discussed. This review outlines our reasoning and steps used to rule out a chyle leak in the setting of propofol-based anesthesia.

Key words: chest tube, chylothorax, motor evoked potential monitoring, neuromonitoring, propofol infusion syndrome, PRIS, thoracic duct, thoracotomy, total intravenous anesthesia, TIVA

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Haemodynamic changes after induction of anaesthesia with sevoflurane vs. propofol

Abstract

Inhalation induction with sevoflurane would appear to offer several objective advantages compared to  induction with propofol. In our study, the hemodynamic results of sevoflurane vs. propofol induction in patients undergoing thoracotomy were studied. In a prospective, randomized, blinded study 24  patients were randomly allocated to one of 2 groups: sevoflurane (S) and propofol (P) (n=12 each). For  hemodynamic monitoring the LIDCO plus system was used. Patients in  group S were induced into anaesthesia with sevofluran, remifentanil and vecuronium, whereas patients in group P with propofol, remifentanil and vecuronium. The anaesthesia was maintained with the same agents. Hemodynamic stability was guided using a special algorithm. The goal was oxygen delivery index (DO2I) > 500 mL min-1 m-2. According to the algorithm, patients received colloids or vasoactive drugs. Hemodynamic parameters were recorded before induction, 3 minutes after induction and 3 minutes after intubation and commencement of  one lung ventilation. The consumption of vasoactive drugs and colloids and the time from the beginning of  induction to intubation were documented. No statistically significant differences in measured hemodynamic parameters, remifentanil and colloid consumption between the S and P group were found. In group P, statistically more ephedrine was used (S: 4.2, P:20.8, p<0.05). Patients undergoing thoracotomy induced with sevoflurane are circulatory more stable than those induced with propofol.

Key words: thoracotomy, one lung ventilation, cardiac index,  Systemic Vascular Resistance Index (SVRI)

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Usage of central venous catheter for delayed traumatic pneumothorax

Abstract

Pneumothorax, whether spontaneous, iatrogenic or traumatic, frequently requires drainage, especially in the face of positive pressure ventilation or general anesthesia. The traditional approach with large-bore, rigid chest tube is associated with significant pain and various complications. Recently, less invasive modalities such as pigtail catheter or fine-needle aspiration have been used in selected patients. We report a case of delay-onset pneumothorax after trauma and the patient was treated successfully with the easily available central venous catheter for drainage.

Key words: thoracic injury, delayed traumatic pneumothorax, central venous catheter, thoracotomy

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