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Chapkanov A, Todorova M, Chirlova A, Marinov B. Factors affecting prediction accuracy of postoperative FEV1 and D L,CO in patients undergoing lung resection. Folia Med (Plovdiv) 2024; 66:171-178. [PMID: 38690811 DOI: 10.3897/folmed.66.e121799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/25/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION Despite significant development in systemic therapy and radiotherapy, surgery is still the cornerstone for curative lung cancer treatment. Although predicted postoperative function (ppo) somewhat exactly correlates with actual postoperative function bigger differences may be a cause of serious clinical outcome.
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Kaminski MF, Ermer T, Canavan M, Li AX, Maduka RC, Zhan P, Boffa DJ, Case MD. Evaluation of gastroesophageal reflux disease and hiatal hernia as risk factors for lobectomy complications. JTCVS OPEN 2022; 11:327-345. [PMID: 36172441 PMCID: PMC9510864 DOI: 10.1016/j.xjon.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
Objective Up to 40% of lobectomies are complicated by adverse events. Gastroesophageal reflux disease (GERD) and hiatal hernia have been associated with morbidity across a range of clinical scenarios, yet their relation to recovery from pulmonary resection is understudied. We evaluated GERD and hiatal hernia as predictors of complications after lobectomy for lung cancer. Methods Lobectomy patients at Yale-New Haven Hospital between January 2014 and April 2021 were evaluated for predictors of 30-day postoperative complications, pneumonia, atrial arrhythmia, readmission, and mortality. Multivariable regression models included sociodemographic characteristics, body mass index, surgical approach, cardiopulmonary comorbidities, hiatal hernia, GERD, and preoperative acid-suppressive therapy as predictors. Results Overall, 824 patients underwent lobectomy, including 50.5% with a hiatal hernia and 38.7% with GERD. The median age was 68 [interquartile range, 61-74] years, and the majority were female (58.4%). At least 1 postoperative complication developed in 39.6% of patients, including atrial arrhythmia (11.7%) and pneumonia (4.1%). Male sex (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.11-2.06, P = .01), age ≥70 years (OR, 1.55; 95% CI, 1.13-2.11, P = .01), hiatal hernia (OR, 1.40; 95% CI, 1.03-1.90, P = .03), and intraoperative packed red blood cells (OR, 4.80; 95% CI, 1.51-15.20, P = .01) were significant risk factors for developing at least 1 postoperative complication. Hiatal hernia was also a significant predictor of atrial arrhythmia (OR, 1.64; 95% CI, 1.02-2.62, P = .04) but was not associated with other adverse events. Conclusions Our findings indicate that hiatal hernia may be a novel risk factor for complications, especially atrial arrhythmia, following lobectomy that should be considered in the preoperative evaluation of lung cancer patients.
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Affiliation(s)
- Michael F. Kaminski
- Division of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Theresa Ermer
- Division of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
- London School of Hygiene & Tropical Medicine, University of London, London, United Kingdom
| | - Maureen Canavan
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Conn
| | - Andrew X. Li
- Division of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Richard C. Maduka
- Division of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Peter Zhan
- Division of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Daniel J. Boffa
- Division of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Meaghan Dendy Case
- Division of Interventional Radiology, Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Conn
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Gil MG, Rubio-Haro R, Morales-Sarabia J, Perez EB, Petrini G, Guijarro R, De Andrés J. A new strategy in lung/lobe isolation in patients with a lung abscess or a previous lung resection using double lumen tubes combined with bronchial blockers. Ann Card Anaesth 2022; 25:343-345. [PMID: 35799564 PMCID: PMC9387630 DOI: 10.4103/aca.aca_16_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/25/2021] [Accepted: 08/08/2021] [Indexed: 11/18/2022] Open
Abstract
The combined use of a double-lumen tube and a bronchial blocker can be very helpful in two different clinical scenarios: (1) in isolating not only the contralateral lung, but also the lobe/s of the same lung in which the infected lobe must be resected, (2) in preventing/treating hypoxemia because of the presence of a contralateral lobectomy. A cardiothoracic anesthesiologist must expertise this technique to avoid complications during surgery.
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Affiliation(s)
- Manuel Granell Gil
- Department of Anesthesia Critical Care and Pain Management, Valencia University General Hospital, Tres Creus Avenue; Department of Surgery, Valencia University Medical School, Blasco Ibáñez Av, Valencia, Spain
| | - Ruben Rubio-Haro
- Department of Anesthesia Critical Care and Pain Management, Valencia University General Hospital, Tres Creus Avenue, Valencia, Spain
| | - Javier Morales-Sarabia
- Department of Anesthesia Critical Care and Pain Management, Valencia University General Hospital, Tres Creus Avenue, Valencia, Spain
| | - Elena Biosca Perez
- Department of Anesthesia Critical Care and Pain Management, Valencia University General Hospital, Tres Creus Avenue, Valencia, Spain
| | - Giulia Petrini
- Department of Anesthesia and Critical Care, Cardinal Massaia Hospital, Asti, Italy
| | - Ricardo Guijarro
- Department of Thoracic Surgery, Valencia University General Hospital, Tres Creus Avenue, Valencia, Spain
| | - Jose De Andrés
- Department of Anesthesia Critical Care and Pain Management, Valencia University General Hospital, Tres Creus Avenue; Department of Surgery, Valencia University Medical School, Blasco Ibáñez Av, Valencia, Spain
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Pang H, Wu Y, Qi S, Li C, Shen J, Yue Y, Qian W, Wu J. A fully automatic segmentation pipeline of pulmonary lobes before and after lobectomy from computed tomography images. Comput Biol Med 2022; 147:105792. [PMID: 35780601 DOI: 10.1016/j.compbiomed.2022.105792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/18/2022] [Accepted: 06/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Lobectomy is a curative treatment for localized lung cancer. The study aims to construct an automatic pipeline for segmenting pulmonary lobes before and after lobectomy from CT images. MATERIALS AND METHODS Six datasets (D1 to D6) of 865 CT scans were collected from two hospitals and public resources. Four nnU-Net-based segmentation models were trained. A lobectomy classification was proposed to automatically recognize the category of the input CT images: before lobectomy or one of five types after lobectomy. Finally, the lobe segmentation before and after lobectomy was realized by integrating the four models and lobectomy classification. The dice similarity coefficient (DSC), 95% Hausdorff distance (HD95) and average symmetric surface distance (ASSD) were used to evaluate the segmentations. RESULTS The pre-operative model achieved an average DSC of 0.964, 0.929, 0.934, and 0.891 in the four datasets. In D1 and D2, the average HD95 was 4.18 and 7.74 mm and the average ASSD was 0.86 and 1.32 mm, respectively. The lobectomy classification achieved an accuracy of 100%. After lobectomy, an average DSC of 0.973 and 0.936, an average HD95 of 2.70 and 6.92 mm, an average ASSD of 0.57 and 1.78 mm were obtained in D1 and D2, respectively. The postoperative segmentation pipeline outperformed other counterparts and training strategies. CONCLUSIONS The proposed pipeline can automatically segment pulmonary lobes before and after lobectomy from CT images and be applied to manage patients with lung cancer after lobectomy.
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Affiliation(s)
- Haowen Pang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Yanan Wu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Shouliang Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Chen Li
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Jing Shen
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
| | - Yong Yue
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Wei Qian
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Jianlin Wu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
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An Analysis of Respiration with the Smart Sensor SENSIRIB in Patients Undergoing Thoracic Surgery. SENSORS 2022; 22:s22041561. [PMID: 35214460 PMCID: PMC8879853 DOI: 10.3390/s22041561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022]
Abstract
The paper examines the problem of respiration monitoring with easily wearable instrumentation by using a smart device that is properly designed and implemented with small and light components. The practical implementation is presented both in practical aspects and from experimental results by following a properly defined method with a medical-like protocol and specific procedure of testing. The results of a statistically significant campaign of experimental tests are reported with the characteristic data from the angles and acceleration components of a sensed rib both to validate the smart device and the procedure for respiration monitoring.
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Yamagishi H, Chen-Yoshikawa TF, Oguma T, Hirai T, Date H. Morphological and functional reserves of the right middle lobe: Radiological analysis of changes after right lower lobectomy in healthy individuals. J Thorac Cardiovasc Surg 2021; 162:1417-1423.e2. [DOI: 10.1016/j.jtcvs.2020.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/09/2020] [Accepted: 08/02/2020] [Indexed: 11/30/2022]
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Wei S, Chen F, Liu R, Fu D, Wang Y, Zhang B, Ren D, Ren F, Song Z, Chen J, Xu S. Outcomes of lobectomy on pulmonary function for early stage non-small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD). Thorac Cancer 2020; 11:1784-1789. [PMID: 32374491 PMCID: PMC7592038 DOI: 10.1111/1759-7714.13445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Lung cancer is the first cause of cancer mortality worldwide. Chronic obstructive pulmonary disease (COPD) is an independent risk factor for lung cancer. An epidemiological survey discovered that the presence of COPD increases the risk of lung cancer by 4.5-fold. Lobectomy is considered to be the standard surgical method for early stage non-small cell lung cancer (NSCLC). However, the influence of lobectomy on the loss of pulmonary function has not been fully investigated in NSCLC patients with COPD. METHODS We searched the PubMed database using the following strategies: COPD and pulmonary function test (MeSH term) and lobectomy (MeSH term) from 01 January 1990 to 01 January 2019. We selected the articles of patients with COPD. A total of six studies, including 195 patients with COPD, provided lung function values before and after surgery. RESULTS Five out of six studies focused on the short-term change of pulmonary function (within 3-6 months) after lobectomy, and the average loss of FEV1 was 0.11 L (range: -0.33-0.09 L). One study investigated the long-term change of pulmonary function (within 1-2 years) after lobectomy, and the average loss of FEV1 was 0.15 L (range: -0.29-0.05 L). CONCLUSIONS A short-term (3-6 months) loss of pulmonary function after operation is acceptable for lung cancer patients with COPD. However, there may be a high risk of postoperative complications in NSCLC patients with COPD. Therefore, surgical treatment needs to be carefully considered for these patients.
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Affiliation(s)
- Sen Wei
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Feng Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Renwang Liu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Dianxun Fu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanye Wang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Bo Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Dian Ren
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Fan Ren
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zuoqing Song
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Song Xu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
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8
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Arai N, Kawachi R, Nakazato Y, Tachibana K, Nagashima Y, Tanaka R, Okamoto K, Kondo H. A rare post-lobectomy complication of right-to-left shunt via foramen ovale. Gen Thorac Cardiovasc Surg 2019; 68:1337-1340. [PMID: 31705454 DOI: 10.1007/s11748-019-01238-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Various complications can cause hypoxemia after pulmonary resection for lung cancer, but intracardiac shunt that becomes symptomatic and causes severe hypoxemia postoperatively is very rare. We report a case that presented platypnea-orthodeoxia syndrome (POS) due to right-to-left shunt via patent foramen ovale (PFO). CASE A 71-year-old man with a lung cancer in the left upper lobe was referred to our hospital. Left upper lobectomy was performed. Dyspnea developed postoperatively, which was worsened by sitting or standing and relieved in a recumbent position. Contrast transesophageal echocardiogram (TEE) and right intracardiac catheterization revealed a right-to-left shunt via PFO. Open-heart closure of PFO was performed and the patient was free from POS. CONCLUSIONS Postoperative intracardiac shunt via PFO can cause severe hypoxemia after lung resection. POS suggests the possibility of intracardiac shunt and careful observation is needed.
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Affiliation(s)
- Nobuaki Arai
- Department of General Thoracic Surgery, Kyorin University School of Medicine, 6-20-2 shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Riken Kawachi
- Department of Respiratory Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi, Tokyo, 173-8610, Japan.
| | - Yoko Nakazato
- Department of General Thoracic Surgery, Kyorin University School of Medicine, 6-20-2 shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Keisei Tachibana
- Department of General Thoracic Surgery, Kyorin University School of Medicine, 6-20-2 shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yasushi Nagashima
- Department of General Thoracic Surgery, Kyorin University School of Medicine, 6-20-2 shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Ryota Tanaka
- Department of General Thoracic Surgery, Kyorin University School of Medicine, 6-20-2 shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Kazuma Okamoto
- Department of Cardiovascular Surgery, Akashi Medical Center, 743-33 okubocho-yagi, Akashi, Hyogo, 674-0063, Japan
| | - Haruhiko Kondo
- Department of General Thoracic Surgery, Kyorin University School of Medicine, 6-20-2 shinkawa, Mitaka, Tokyo, 181-8611, Japan
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9
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Cohen JB, Hirschi MR, Patel SY, Liu J. Non-thoracic Source of Bleeding During Left-sided Thoracic Surgery. Cureus 2019; 11:e4593. [PMID: 31309018 PMCID: PMC6609276 DOI: 10.7759/cureus.4593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Hypotension during thoracic surgery is traditionally attributed to intrathoracic causes such as pulmonary bleeding, ventilation, causing decreased venous return, and a decrease in myocardial contractility. We present a case of unexplained hypotension presenting at the end of left-sided thoracic surgery. The cause of hypotension was ultimately found to be due to intra-abdominal bleeding from a splenic injury. This case reminds the anesthesiologist to be vigilant of non-thoracic causes of hypotension during left-sided lung surgery.
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Affiliation(s)
- Jonathan B Cohen
- Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | | | - Sephalie Y Patel
- Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - Jinhong Liu
- Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
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Kumar A, Dhir U, Jain V, Yadav S, Purohit A. Off-pump coronary bypass grafting in a post-pneumonectomy patient: Challenges and management. Ann Card Anaesth 2019; 22:86-88. [PMID: 30648686 PMCID: PMC6350433 DOI: 10.4103/aca.aca_37_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pulmonary complications are common in cardiac surgical patients. Limited respiratory reserves along with the pain associated with sternotomy add to the morbidity. Patients undergoing cardiac surgery who have had a pneumonectomy done before can be even more challenging to manage perioperatively due to a single-functioning lung. We present a case of a postpneumonectomy patient who underwent off-pump coronary artery bypass grafting. Perioperative optimization of lung function tests was stressed upon including the chest physiotherapy and early mobilization. Preoperative thoracic epidural catheter was inserted for postoperative pain and other proven benefits of thoracic epidural in coronary artery disease patients. We could conclude from our experience that proper optimization of lung function tests and meticulous pain management along with fast-tracking are keys to the management of such patients.
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Affiliation(s)
- Anand Kumar
- Department of Cardiac Anaesthesia, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Udgeath Dhir
- Department of CTVS, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Vishal Jain
- Department of Cardiac Anaesthesia, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Surendra Yadav
- Department of CTVS, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Ankit Purohit
- Department of Cardiac Anaesthesia, Fortis Memorial Research Institute, Gurgaon, Haryana, India
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Kawagoe I, Hayashida M, Satoh D, Suzuki K, Inada E. Ventilation failure after lateral jackknife positioning for robot-assisted lung cancer surgery in a patient after lingula-sparing left upper lobectomy. JA Clin Rep 2018; 4:51. [PMID: 32025970 PMCID: PMC6966923 DOI: 10.1186/s40981-018-0188-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ventilation failure commonly occurs when a standard left-sided double-lumen tube is used in patients after left upper lobectomy having remarkable angulation of the left main bronchus. We present a female without remarkable angulation, in whom ventilation failure occurred after lateral jackknife positioning. CASE PRESENTATION A 73-year-old female after lingula-sparing left upper lobectomy without remarkable angulation was scheduled for robot-assisted right upper lobectomy. Ventilation failure with a standard left-sided double-lumen tube occurred when she was placed not in the lateral position but in the lateral jackknife position required for robotic surgery. After replacement by the Silbroncho® left-sided double-lumen tube, adequate one-lung ventilation became possible. CONCLUSIONS Ventilation failure with a standard tube may occur more easily when patients with bronchial angulation are placed in the lateral jackknife than lateral position due to posture-induced exacerbations of bronchial angulation. The Silbroncho® tube seems useful in such situations.
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Affiliation(s)
- Izumi Kawagoe
- Division of General Thoracic Anesthesia, Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan. .,, Tokyo, Japan.
| | - Masakazu Hayashida
- Division of Cardiovascular Anesthesia, Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Daizoh Satoh
- Division of Intensive Care Medicine, Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Eiichi Inada
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
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12
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Kawagoe I, Hayashida M, Suzuki K, Kitamura Y, Oh S, Satoh D, Inada E. Anesthetic Management of Patients Undergoing Right Lung Surgery After Left Upper Lobectomy: Selection of Tubes for One-Lung Ventilation (OLV) and Oxygenation During OLV. J Cardiothorac Vasc Anesth 2016; 30:961-6. [DOI: 10.1053/j.jvca.2015.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Indexed: 11/11/2022]
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13
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Acharya MN, George RS, Loubani M. A rare case of occult splenic rupture after left pneumonectomy. J Surg Case Rep 2016; 2016:rjw091. [PMID: 27190201 PMCID: PMC4869514 DOI: 10.1093/jscr/rjw091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Cardiopulmonary resuscitation (CPR) techniques are now well-established and play a crucial role in improving survival in cardiac arrest. Recognized complications associated with CPR include injury to the upper abdominal viscera, including the liver, stomach and spleen. We present a rare case of occult splenic rupture following cardiac arrest in a 63-year-old male immediately after left pneumonectomy. We discuss potential mechanisms predisposing the spleen to injury in this case, and highlight the difficulty of promptly identifying such a traumatic injury within the confines of a cardiac arrest scenario. Clinicians should be aware that anatomical changes following thoracic surgery may render the intra-abdominal viscera at increased risk of injury following CPR.
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Affiliation(s)
- Metesh N Acharya
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull HU16 5JQ, UK
| | - Robert S George
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull HU16 5JQ, UK
| | - Mahmoud Loubani
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull HU16 5JQ, UK
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14
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Ataya A, Alnuaimat H. Cardiac Dextroversion after Right Lower Lobe Lobectomy. Am J Respir Crit Care Med 2016; 192:e55-6. [PMID: 26266397 DOI: 10.1164/rccm.201505-1049im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ali Ataya
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, Florida
| | - Hassan Alnuaimat
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, Florida
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15
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Seok Y, Yi E, Cho S, Jheon S, Kim K. Perioperative outcomes of upper lobectomy according to preservation or division of the inferior pulmonary ligament. J Thorac Dis 2015; 7:2033-40. [PMID: 26716043 DOI: 10.3978/j.issn.2072-1439.2015.11.41] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The aim of this study was to investigate the relationship between inferior pulmonary ligament division and postoperative complications. METHODS Medical records of 72 non-small cell lung cancer (NSCLC) patients who underwent video-assisted thoracic surgery (VATS) upper lobectomy between March 2012 and November 2013 performed by a single thoracic surgeon at our center were reviewed retrospectively. Patients were categorized into two groups: the division group, who underwent division of the inferior pulmonary ligament, and the preservation group, who did not. The division group included 43 patients (27 right, 16 left), while the preservation group included 29 (11 right, 18 left). Postoperative outcomes such as the presence of pleural effusion, chest tube duration, and changes in the angle and diameter of remnant bronchus were compared; bronchial diameter and angle were measured on three-dimensional (3D) reconstruction chest CT images. RESULTS Chest tube duration, duration of chest tube drainage >200 mL, and the presence of pleural effusion on chest X-rays taken 1 month after surgery were not significantly different between the two groups (P=0.07, 0.33, and 1.00, respectively). There were also no significant differences between groups in the presence of apical dead space or in change in bronchial angle (P=0.22 and 0.74, respectively). In 3D reconstruction images, changes in the diameter of the right middle, right lower, and left lower lobar (LLL) bronchi were similar between groups (P=0.72, 0.12 and 0.29, respectively). Change in the angle between the right bronchus intermedius (RBI) and the right middle lobar (RML) bronchus and between the RBI and the right lower lobar (RLL) bronchus were significantly different between the division and preservation groups (P=0.02 and 0.05, respectively). CONCLUSIONS Inferior pulmonary ligament division had no clear benefits. Complications related to excessive dislocation of remnant bronchi might be associated with inferior pulmonary ligament division, but further research is needed to elucidate this relationship.
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Affiliation(s)
- Yangki Seok
- 1 Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Medical Center, Seoul, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul, Republic of Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eunjue Yi
- 1 Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Medical Center, Seoul, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul, Republic of Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sukki Cho
- 1 Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Medical Center, Seoul, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul, Republic of Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sanghoon Jheon
- 1 Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Medical Center, Seoul, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul, Republic of Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwhanmien Kim
- 1 Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Medical Center, Seoul, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul, Republic of Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Chhabra L, Bajaj R, Chaubey VK, Kothagundla C, Spodick DH. Electrocardiographic impacts of lung resection. J Electrocardiol 2013; 46:697.e1-8. [DOI: 10.1016/j.jelectrocard.2013.05.140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Indexed: 11/28/2022]
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Nishimura T, Fukamizu S, Matsushita N, Hojo R, Hayashi T, Abe T, Komiyama K, Tanabe Y, Tejima T, Sakurada H, Nishizaki M, Hiraoka M. High-risk transseptal puncture in a patient with a “pancake” deformity in the left atrium caused by descending aorta displacement. J Arrhythm 2012. [DOI: 10.1016/j.joa.2012.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Kim CW, Godelman A, Jain VR, Merav A, Haramati LB. Postlobectomy Chest Radiographic Changes: A Quantitative Analysis. Can Assoc Radiol J 2011; 62:280-7. [DOI: 10.1016/j.carj.2010.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Revised: 12/22/2010] [Accepted: 12/30/2010] [Indexed: 10/17/2022] Open
Abstract
Purpose To provide a quantative analysis of postlobectomy chest radiographic changes and to evaluate whether the scarring from prior sternotomy affects the size of the hemithorax and the duration of air leak in patients with subsequent lobectomy. Methods In this retrospective case-controlled series, 10 consecutive patients who had a lobectomy after a prior sternotomy and 30 controls, 3 for each case, matched for lobectomy site were identified. Pre- and postoperative chest radiographs were quantitatively analysed for diaphragmic elevation, size of each hemithorax, mediastinal shift, and the presence of pneumothorax. Charts were reviewed for air-leak duration, surgical complications, and duration of hospitalization. Results There was no difference between patients with lobectomy and with and without prior sternotomy for the following variables expressed as mean (SD): hemidiaphragm elevation (1.5 ± 2.5 vs 0.5 ± 2.0 cm; P = .2), change of hemithorax size (mean transverse, 0.99 ± 0.05 vs 0.97 ± 0.07; P = .5; craniocaudal, 0.93 ± 0.08 vs 0.91 ± 0.08; P = .4) and mediastinal shift (upper, 1.2 ± 0.4 vs 1.3 ± 0.6; P = .5; lower, 1.2 ± 0.4 vs 1.2 ± 0.3; P = .8), the latter 2 were expressed as the ratio of post- to preoperative measurements. These postlobectomy radiographic findings varied, depending on the resected lobe, and became progressively more pronounced during the first 12 months after surgery. There was no difference in pneumothorax duration (mean [SD]) (9.5 ± 21 days vs 6.4 ± 7.5 days; P = .5), air leak duration (mean [SD]) (0.7 ± 0.8 days vs 1.3 ± 3.9 days; P = .6), complication rate (20% vs 30%; P = .5), or hospital stay (mean [SD]) (6.0 ± 1.7 days vs 6.9 ± 4.7 days; P = .6). Conclusion There are specific patterns of volume loss, mediastinal shift, and hemidiaphragm displacement that can be quantified on postlobectomy chest radiographs. Prior sternotomy did not affect postlobectomy radiographic changes or patient outcome.
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Affiliation(s)
- Choo-Won Kim
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Alla Godelman
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Vineet R. Jain
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Avraham Merav
- Department of Cardiothoracic Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Linda B. Haramati
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
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Goneppanavar U, George M, Kaur J. Electrocardiographic Changes Simulating Myocardial Ischemia Possibly Because of Previous Lung Surgery. J Cardiothorac Vasc Anesth 2009; 23:440-2. [PMID: 18834834 DOI: 10.1053/j.jvca.2008.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Indexed: 11/11/2022]
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Ghotkar SV, Aerra V, Mediratta N. Cardiac surgery in patients with previous pneumonectomy. J Cardiothorac Surg 2008; 3:11. [PMID: 18312686 PMCID: PMC2270840 DOI: 10.1186/1749-8090-3-11] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 03/01/2008] [Indexed: 11/26/2022] Open
Abstract
Severe pulmonary dysfunction is a commonly occurring postoperative complication following cardiac surgery. Resection of a lung causes major anatomical and physiological changes. Shift of the mediastinum and reduction in respiratory function following pneumonectomy makes cardiac surgery challenging not only for the surgeon but also for the anaesthetist. With improvement in life expectancy and better results following cardiac and pulmonary operations increasing number of patients are likely to be subjected to both of these operations during their lifetime. There is paucity of data in the literature on the subject of cardiac surgery subsequent to previous pneumonectomy. We report our experience on performing cardiac surgery following pneumonectomy to highlight certain important features that we think are important while managing these patients.
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Affiliation(s)
- Sanjay V Ghotkar
- Department of Cariothoracic Surgery, Cardiothoracic Centre, Thomas Drive, Liverpool, UK.
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Yosefy C, Levine RA, Picard MH, Vaturi M, Handschumacher MD, Isselbacher EM. Pseudodyskinesis of the inferior left ventricular wall: recognizing an echocardiographic mimic of myocardial infarction. J Am Soc Echocardiogr 2007; 20:1374-9. [PMID: 17764898 DOI: 10.1016/j.echo.2007.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Dyskinesis is diagnosed by outward systolic bulging, but a similar inferior wall (IW) motion is sometimes observed in patients without infarction. Such diastolic flattening of the IW is followed by systolic rounding and outward bulging, consistent with extrinsic diastolic compression that is overcome by systolic contraction. HYPOTHESIS Pseudodyskinesis (PD) (paradoxical IW motion) is associated with preserved systolic wall thickening and does not reflect ischemic dysfunction. METHODS We compared 100 consecutive patients having a pattern of PD on transthoracic echocardiography with control groups of 50 patients with documented inferior myocardial infarction and 50 healthy individuals. Percent systolic thickening of the inferior, anterior, septal, and lateral left ventricular (LV) walls was measured in a midventricular short-axis view, and LV cross-sectional shape was evaluated by the ratio of two perpendicular diameters. Diaphragmatic position was evaluated on chest radiograph. RESULTS Systolic IW thickening was not significantly different in PD from that of normal (58.2 +/- 6.2% vs 53.0 +/- 4.6%) and of non-IW in the same patients (50.4 +/- 6.8%). The LV was circular (diameter ratio = 1.0) in systole and diastole in healthy individuals; in PD, it was noncircular in diastole consistent with IW compression (P < .01), and circular in systole; in inferior myocardial infarction, it was circular in diastole and noncircular in systole (P < .01) consistent with decreased IW contraction. The left hemidiaphragm was more elevated in PD (78% vs 8.5%, P < .01). CONCLUSIONS In PD, the IW thickens normally to produce a circular LV cavity in systole. This motion, consistent with extrinsic compression, is important to distinguish from inferior myocardial infarction.
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Affiliation(s)
- Chaim Yosefy
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
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Sekine Y, Iwata T, Chiyo M, Yasufuku K, Motohashi S, Yoshida S, Suzuki M, Iizasa T, Saitoh Y, Fujisawa T. Minimal alteration of pulmonary function after lobectomy in lung cancer patients with chronic obstructive pulmonary disease. Ann Thorac Surg 2003; 76:356-61; discussion 362. [PMID: 12902063 DOI: 10.1016/s0003-4975(03)00489-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the influence of chronic obstructive pulmonary diseases (COPD) on postoperative pulmonary function and to elucidate the factors for decreasing the reduction of pulmonary function after lobectomy. METHODS We conducted a retrospective chart review of 521 patients who had undergone lobectomy for lung cancer at Chiba University Hospital between 1990 and 2000. Forty-eight patients were categorized as COPD, defined as percentage of predicted forced expiratory volume at 1 second (FEV1) less than or equal to 70% and percentage of FEV1 to forced vital capacity less than or equal to 70%. The remaining 473 patients were categorized as non-COPD. RESULTS Although all preoperative pulmonary function test data and arterial oxygen tension were significantly lower in the COPD group, postoperative arterial oxygen tension and FEV1 were equivalent between the two groups, and the ratio of actual postoperative to predicted postoperative FEV1 was significantly better in the COPD group (p < 0.001). With multivariable analysis, COPD and pulmonary resection of the lower portion of the lung (lower or middle-lower lobectomies) were identified as independent factors for the minimal deterioration of FEV1. Actual postoperative FEV1 was 15% lower and higher than predicted, respectively, in the non-COPD patients with upper portion lobectomy and the COPD patients with lower portion lobectomy. Finally, we created a new equation for predicting postoperative FEV1, and it produced a higher coefficient of determination (R(2)) than the conventional one. CONCLUSIONS The postoperative ventilatory function in patients with COPD who had lower or middle-lower lobectomies was better preserved than predicted.
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Affiliation(s)
- Yasuo Sekine
- Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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