Serratus anterior plane block for cardiothoracic surgeries: a meta-analysis of randomized trials

Background Comparison of serratus anterior plane block to different analgesic methods for anterolateral thoracic wall incisions. Meta-analysis was used to address this concern. Authors systemically searched the MEDLINE, EMBASE, PubMed, and Cochrane databases to identify all published randomized and prospective clinical trials, comparing the SAPB with other methods that used for analgesia in different thoracic surgical procedures and trauma. Results Ten studies were identified for inclusion in this study, involving a total of 735 patients. Meta-analysis showed that, compared with thoracic wall analgesia and PCA methods, the SAPB group resulted in a significant decrease in pain scores, significant decrease in consumption of analgesic drugs, and a significant decrease in the incidence of nausea and vomiting with no difference in the rate of hypotension. Conclusions The use of SAPB in cardiothoracic surgery and trauma is a safe and effective option for thoracic analgesia.

Anesthetic Management of Pulmonary Metastatectomy in a Patient Infected with Novel Corona Virus SARS-CoV-2

Prioritization of individual patients for thoracic surgeries gained importance during the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic to ensure optimal utilization of resources. We report the successful anesthesia management of an urgent pulmonary metastasectomy in an elderly patient despite him testing positive for real-time reverse transcription–polymerase chain reaction [rRT-PCR] on two occasions. The rationale behind acceptance of the case for surgery and the precautions taken for reducing aerosol generation during the various stages of anesthesia are highlighted. Keywords: COVID-19; SARS-CoV-2; Coronavirus Infections; One-Lung Ventilation; Personal Protective Equipment; Aerosols; Thoracic Surgical Procedures

Requirement of artificial intelligence technology awareness for thoracic surgeons

Background We have recently witnessed incredible interest in computer-based, internet web-dependent mechanisms and artificial intelligence (AI)-dependent technique emergence in our day-to-day lives. In the recent era of COVID-19 pandemic, this nonhuman, machine-based technology has gained a lot of momentum. Main body of the abstract The supercomputers and robotics with AI technology have shown the potential to equal or even surpass human experts’ accuracy in some tasks in the future. Artificial intelligence (AI) is prompting massive data interweaving with elements from many digital sources such as medical imaging sorting, electronic health records, and transforming healthcare delivery. But in thoracic surgical and our counterpart pulmonary medical field, AI’s main applications are still for interpretation of thoracic imaging, lung histopathological slide evaluation, physiological data interpretation, and biosignal testing only. The query arises whether AI-enabled technology-based or autonomous robots could ever do or provide better thoracic surgical procedures than current surgeons but it seems like an impossibility now. Short conclusion This review article aims to provide information pertinent to the use of AI to thoracic surgical specialists. In this review article, we described AI and related terminologies, current utilisation, challenges, potential, and current need for awareness of this technology.

Conducting Dermatological Operations in Patients Who Have Previously Undergone Cardiac Surgery

Thoracic surgical procedures and the use of cardiac devices such as pacemakers are becoming increasingly common in the population. Therefore, dermatologists may be more likely to encounter previously implanted or discarded surgical material during a dermatological operation on the chest wall. A basic understanding of the types of wires and tunneling paths used in such procedures is essential to accurately predict the presence of these wires and effectively manage any chance encounters. Dermatologists should be aware that temporary epicardial pacemaker electrodes and pacemaker electrodes often remain in the chest wall of many patients. All patients with a history of cardiac surgery should be asked about the possible presence of temporary epicardial electrodes in their body, and if such materials are found during the operation, it is necessary to immediately stop the procedure and do not undertake further manipulations with them until the material from which it is made is determined. Specialists in cardiology and cardiothoracic surgery need to document any abandoned wire in the patient's list of problems and inform the patient about the abandoned wire so that he or she can be an important source of clinical information. Trying to pull out the remaining pacemaker electrodes is a serious risk, so dermatologist surgeons should not attempt it under any circumstances. When detecting wire material, it is necessary to determine the type and location of the material before any manipulation or pulling attempts. Once it is established that this is a non-functional, abandoned wire, it is necessary to apply the correct technique for removing it, which consists in gently pulling and securing the wire at the exit point. Accurate identification of the material is required in order not to interfere with the operation of the active device and not to abandon the operation unnecessarily. The aim of the work is to consider the implementation of dermatological operations in patients who have previously undergone cardiac surgery.

Perioperative, protective use of extracorporeal membrane oxygenation in complex thoracic surgery

Background: Extracorporeal membrane oxygenation (ECMO) is increasingly used in patients undergoing complex thoracic surgical procedures. However, studies reporting the clinical outcomes of these patients are limited to case reports, without real consensus. Our aim was to evaluate the perioperative use of ECMO as respiratory and/or circulatory support in thoracic surgery: indications, benefits, and perioperative management. Methods: Between May 2013 and December 2018, we reviewed the clinical data of 15 patients (11 males and 4 females; mean age: 47 years old; range, 25–73 years) undergoing ECMO-assisted thoracic surgery in our hospital. Results: Of the 15 patients, 10 cases received peripheral veno-arterial (VA) ECMO and five cases received veno-venous (VV) ECMO. Indications for ECMO were pulmonary transplantation with hard-to-maintain oxygenation (n = 5), traumatic main bronchial rupture (n = 2), traumatic lung injury (n = 1), airway tumor leading to severe airway stenosis (n = 2), huge thoracic mass infiltrated vena cava (n = 5). The ECMO duration was 1–51 hours. All patients were successfully extubated and weaned from ECMO postoperatively. The main complications were hemorrhage (26.7%), infection (33.3%), acute hepatic dysfunction (33.3%), and venous thrombosis (26.7%). There was only one hospital death and postoperative one-year survival rate was 86%. Conclusion: Our experience indicates that ECMO is a feasible method for complex trachea-bronchial surgery, huge thoracic mass excision and lung transplantation, and the ECMO-related risks may be justified. With further accumulation of experience with ECMO, a more sophisticated protocol for management of critical airway or heart failure problems in thoracic surgeries can be derived.

Full endoscopic surgery for thoracic pathology: an assessment of supportive evidence

In the last five years, surgeons have applied endoscopic transforaminal surgical techniques mastered in the lumbar spine to the treatment of thoracic pathology. The aim of this systematic review was to collate the available literature to determine the place and efficacy of full endoscopic approaches used in the treatment of thoracic disc prolapse and stenosis. An electronic literature search of PubMed, Embase, the Cochrane database and Google Scholar was performed as suggested by the Preferred Reporting Items for Systematic Review and Meta-analysis statements. Included were any full-text articles referring to full endoscopic thoracic surgical procedures in any language. We identified 17 patient series, one cohort study and 13 case reports with single or of up to three patients. Although the majority included disc pathology, 11 papers related cord compression in a proportion of cases to ossification of the ligamentum flavum or posterior longitudinal ligament. Two studies described the treatment of discitis and one reported the use of endoscopy for tumour resection. Where reported, excellent or good outcomes were achieved for full endoscopic procedures in a mean of 81% of patients (range 46–100%) with a complication rate of 8% (range 0–15%), comparing favourably with rates reported after open discectomy (anterior, posterolateral and thoracoscopic) or by endoscopic tubular assisted approaches. Twenty-one of the 31 author groups reported use of local anaesthesia plus sedation rather than general anaesthesia, providing ‘self-neuromonitoring’ by allowing patients to respond to cord and/or nerve stimuli. Cite this article: EFORT Open Rev 2021;6:930-940. DOI: 10.1302/2058-5241.6.200080

The efficacy of diaphragmatic plication in patients with unilateral diaphragmatic paralysis; a two-centre experience

Background and objective: Diaphragm is not an uncommon problem. is the most presenting in most of the cases. In this study, we used diaphragm (DUS) and to evaluate the outcome of post-surgical diaphragmatic plication (SDP) in adults with unilateral diaphragmatic paralysis (UDP). To our knowledge, no large reports about the efficacy of and the utilization of DUS for these patients were done. Methods: A retrospective analysis of all patients who underwent SDP at two (2014 - 2018) was done. Data of all patients were patients' characteristics, preoperative (chest X-ray, chest computed tomography, DUS, and ) , two years postoperative follow up. Results: Among 47 (UDP) patients. 40 patients underwent SDP. 30 (75%) males (mean age 45±14 years). Left-sided SDP was found in 57% of cases (n=23). Most of the patients were suffering from Dyspnea (n=38). Minor complications occurred in 12% (n=5). Excellent results in 90% (n=36), good results in 7,5% and unsatisfactory in one patient (2,5%). Patients up at one month and 6 months and two years showed a significant increase in FEV1 up to 20% (range 15-40%), P=0.011 and FVC up to 30% (range 10%45%) P=0.024. There was a significant postoperative improvement in (P<0.005). There was a significant correlation between postoperative FEV1 and the height of the copula on CXR and DUS (P<0.001 and P<0.005 respectively). Conclusion: SDP is an effective and safe procedure which can be performed to treat UDP in adult patients suffering from chronic . is a significant improvement in the patient’s functional is correlated to the assessment. Keywords: Diaphragm Diaphragmatic Eventration Diaphragmatic Eventration/surgery diaphragm/ultrasonography, fluoroscopy, Recovery of Function Thoracic Surgical Procedures/methods