Italian survey on non-intubated thoracic surgery: results from INFINITY group

Background Non-Intubated Thoracic Surgery (NITS) is becoming increasingly adopted all over the world. Although it is mainly used for pleural operations,, non-intubated parenchymal lung surgery has been less frequently reported. Recently, NITS utilization seems to be increased also in Italy, albeit there are no multi-center studies confirming this finding. The objective of this survey is to assess quantitatively and qualitatively the performance of NITS in Italy. Methods In 2018 a web-based national survey on Non-Intubated management including both thoracic surgeons and anesthesiologists was carried out. Reference centers have been asked to answer 32 questions. Replies were collected from June 26 to November 31, 2019. Results We raised feedbacks from 95% (55/58) of Italian centers. Seventy-eight percent of the respondents perform NITS but only 38% of them used this strategy for parenchymal surgery. These procedures are more frequently carried out in patients with severe comorbidities and/or with poor lung function. Several issues as obesity, previous non-invasive ventilation and/or oxygen therapy are considered contraindications to NITS. The regional anesthesia technique most used to provide intra- and postoperative analgesia was the paravertebral block (37%). Conversion to general anesthesia is not anecdotal (31% of answerers). More than half of the centers believed that NITS may reduce postoperative intensive care unit admissions. Approximately a quarter of the centers are conducting trials on NITS and, three quarters of the respondent suppose that the number of these procedures will increase in the future. Conclusions There is a growing interest in Italy for NITS and this survey provides a clear view of the national management framework of these procedures.

Regional Anesthesia for Abdominal Surgery in a Patient with Severe Chronic Respiratory Failure: A Case Report

General anesthesia is associated with a risk for postoperative pulmonary complications. The risk is even higher in patients with chronic respiratory failure, and postoperative mortality rates are high. Proper perioperative anesthetic management is important in such patients. Therefore, it is essential to optimize the patient’s physical status before anesthesia and to determine the optimal anesthesia technique based on the pre-anesthesia evaluation of the patient’s pulmonary function. We successfully performed abdominal surgery under spinal anesthesia in a patient with severe chronic respiratory failure.

Anesthesia Techniques and Long-Term Oncological Outcomes

Despite advances in cancer treatments, surgery remains one of the most important therapies for solid tumors. Unfortunately, surgery promotes angiogenesis, shedding of cancer cells into the circulation and suppresses anti-tumor immunity. Together this increases the risk of tumor metastasis, accelerated growth of pre-existing micro-metastasis and cancer recurrence. It was theorized that regional anesthesia could influence long-term outcomes after cancer surgery, however new clinical evidence demonstrates that the anesthesia technique has little influence in oncologic outcomes. Several randomized controlled trials are in progress and may provide a better understanding on how volatile and intravenous hypnotics impact cancer progression. The purpose of this review is to summarize the effect of the anesthesia techniques on the immune system and tumor microenvironment (TME) as well as to summarize the clinical evidence of anesthesia techniques on cancer outcomes.

Simplified paravertebral anesthesia technique and its application

C. Fervers (Zentralbl. F. Chir. No. 37, 1929), in order to avoid complications, inserts the needle with paravertebral anesthesia one finger away from the spinous processes towards the angle formed by the transverse process and the edge of the vertebral body (the outer end of the needle with the midline forms an angle of 20 -30 ). The designated angle is located normally in the thoracic part of the spine near the upper edge of the spinous process, in the lumbar part, in the middle of the lower edge of the spinous process. In this way, the needle easily reaches the vertebral wall, and the injected fluid washes the ramus anter. ram. communicans. During operations, the author recommends using paravertebral anesthesia only for unilateral processes, such as appendicitis, cholelithiasis, kidneys and ureters and hernias. For the purposes of differential diagnosis and therapy, paravertebral anesthesia can be used.

Novel Regional Nerve Blocks in Clinical Practice: Evolving Techniques for Pain Management

: This review examines the use of novel US-guided nerve blocks in clinical practice. Erector spinae block is a regional anesthesia technique doing by injecting a local anesthetic among the erector spinae muscle group and transverse processes. The phrenic nerve is a branch of the cervical plexus, arising from the anterior rami of cervical nerves C3, C4, and C5. The quadratus lumborum muscle is located along the posterior abdominal wall. It originates from the transverse process of the L5 vertebral body, the iliolumbar ligament, and the iliac crest. US-guided peripheral nerve procedures have a considerable scope of use, including treating headaches and hiccups to abdominal surgical pain, cesarean sections, musculoskeletal pathologies. These nerve blocks have been an effective addition to clinical anesthesia practice. The use of peripheral nerve blocks has improved postoperative pain, lessened the use of opioids and their potential side effects, and decreased the incidence of sleep disturbance in patients. More research should be done to further delineate the potential benefits of these blocks.

Comparative Analysis of Memory and Alertness in the Perioperative Period of Operative Delivery in Pregnant Women With Preeclampsia and Without it With Different Kinds of Anesthesia

Relevance. The article investigates the choice of anesthesia technique during a caesarean section, which would minimally affect such components of cognitive functions as memory and alertness.The aim of the study is to increase the safety of anesthetic care in women of reproductive age by choosing the method of anesthesia.Material and methods. Two groups of maternity patients were examined: with a normal pregnancy and preeclampsia. They were tested according to a specially designed examination, which included: MoCA test, Benton’s test, Wechsler’s test, self-assessment questionnaire, hospital scale of anxiety and depression before and after surgical delivery.Results. According to the test results, it was found that memory and alertness in pregnant women were initially reduced (compared to the norm), especially with concomitant preeclampsia. When comparing the test results before and after abdominal delivery, it was found that the deterioration of memory and alertness parameters occurs less after the use of neuraxial methods (spinal and epidural anesthesia) compared to patients who underwent general combined anesthesia.

In Pursuit of Phrenic Nerve-Sparing Regional Anesthesia For Awake Shoulder Manipulation In Patients With Adhesive Capsulitis

Introduction. While interscalene brachial plexus block remains the gold standard of any shoulder procedure, including shoulder manipulation in patients with adhesive capsulitis, anesthesiologists are reluctant to face the risk of phrenic nerve paresis, especially in patients with preexisting pulmonary conditions. Hence, many studies have targeted specific regional anesthesia of the shoulder low enough by the blockade level, leaving phrenic nerve function intact but still providing satisfying anesthesia for shoulder procedures. Until recently, no comparison between these regional anesthesia techniques focusing on shoulder manipulation for adhesive capsulitis has been published. Case Report. We compared the profiles between suprascapular nerve block, shoulder interfascial plane block, and superior trunk block as the sole anesthesia technique in patients with adhesive capsulitis undergoing awake shoulder manipulation. Conclusion. This report descriptively signifies superior trunk block excellence among other regional anesthesia techniques in achieving complete anesthesia for awake shoulder manipulation in patients with adhesive capsulitis while sparing the phrenic-nerve function