Thoracic surgery

This chapter discusses the anaesthetic management of thoracic surgery. It begins with general principles of thoracic surgery, including isolation of the lungs, one-lung ventilation, and providing analgesia for thoracic surgery. Surgical procedures covered include rigid bronchoscopy and bronchial stent insertion; mediastinoscopy; wedge resection; lobectomy; pneumonectomy; thoracoscopy and video-assisted thoracoscopic surgery (VATS); drainage of empyema and decortications; lung volume reduction surgery and bullectomy; repair of bronchopleural fistula; pleurectomy and pleurodesis; oesophagectomy and surgical management of chest injuries.

A Parametric Tool for Studying a New Tracheobronchial Silicone Stent Prototype: Toward a Customized 3D Printable Prosthesis

The management of complex airway disorders is challenging, as the airway stent placement usually results in several complications. Tissue reaction to the foreign body, poor mechanical properties and inadequate fit of the stent in the airway are some of the reported problems. For this reason, the design of customized biomedical devices to improve the accuracy of the clinical results has recently gained interest. The aim of the present study is to introduce a parametric tool for the design of a new tracheo-bronchial stent that could be capable of improving some of the performances of the commercial devices. The proposed methodology is based on the computer aided design software and on the finite element modeling. The computational results are validated by a parallel experimental work that includes the production of selected stent configurations using the 3D printing technology and their compressive test.

Clinical Characteristics and Outcome of Lung Transplant Recipients with Respiratory Isolation ofCorynebacteriumspp.

ABSTRACTAlthough chronic respiratory disease and immunosuppression are risk factors forCorynebacteriumspecies respiratory infection, data are scarce regarding this disease in lung transplantation. Our aim was to describe the clinical characteristics and outcomes of lung transplant recipients (LTR) with respiratory isolation ofCorynebacteriumspp. This was a retrospective observational study performed at a referral center in Barcelona, Spain (2014 to 2016). We included all LTR in whomCorynebacteriumspp. were isolated in at least one good-quality lower respiratory tract specimen. Overall, 24 of 527 (4.6%) LTR at risk during the study period were included. The main epidemiological, clinical, and microbiological data were analyzed. The most frequently isolated species wereC. striatum(11/24),C. pseudodiphtheriticum(3/24), andC. amycolatum(3/24). All 19 (76%) patients who underwent bronchoscopy showed abnormalities, mainly mucosal plaques at the bronchial suture and purulent secretions. Clinical cure was achieved in 8/12 (67%) patients who fulfilled the CDC definition of lower respiratory tract infection (LRTI). To assess the clinical relevance ofCorynebacteriumspp., only patients with monomicrobial isolation (n= 18) were evaluated. LRTI was diagnosed in 9, and a nonsignificant association was found with a significant number ofCorynebacteriumsp. CFU/ml (7/9 LRTI versus 2/9 non-LRTI,P= 0.057). Persistent infection was associated with metallic bronchial stent implantation (4/4 versus 2/14,P= 0.005). The isolation ofCorynebacteriumspp. in respiratory specimens of lung transplant recipients may herald a respiratory tract infection or bronchial suture damage. Bronchial stent implantation is a risk factor for the persistence ofCorynebacteriumspecies infection.