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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The surgical requirement for thoracoscopy is a good view of the contents of the thorax. This is achieved by capitalizing on natural consequences and the skills of anaesthesiologists to produce a pneumothorax and collapse the ipsilateral lung--a process that is commonly enhanced by insufflating carbon dioxide. Insufflating CO2 to actively promote lung collapse creates the dynamics of a tension pneumothorax. Complications are clinically insignificant if CO2 is used judiciously. There is a body of experience using ordinary endotracheal tubes and two-lung ventilation. Techniques of one-lung ventilation are more widely reported. All the factors known to contribute to the significant increase in shunt fraction associated with one-lung ventilation apply. The manoeuvre of collapsing a lung is no longer regarded as benign. Chemical attempts to produce a reversible post-pneumonectomy pulmonary circulation have not been shown to be an improvement. Post-operative pain can be severe. The mechanism is not defined but it differs from that associated with thoracotomy. Epidural analgesia and opioids may be required. Chronic pain syndromes have been described as complications.
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PMID:Anaesthesia for thoracoscopic surgery. 1249 43

Chronic obstructive pulmonary disease (COPD) and older age are known to be independent risk factors for severe perioperative adverse outcomes after surgery. A basic understanding of the disease, careful preoperative evaluation and preparation of the patient, as well as a tailored anaesthetic management plan might help to decrease complications in this patient population. Aging affects the pharmacokinetics and pharmacodynamics of almost all drugs and therefore the dosage must be adapted in older patients. The type of anaesthesia (general versus regional anaesthesia) has no substantial effect on perioperative morbidity and mortality. Most patients, even with severe COPD, tolerate general anaesthesia without major problems. One important goal of the anaesthetic management is to prevent reflex-induced bronchoconstriction, which can be accomplished by the use of volatile anaesthetics. Early recovery can be facilitated by the use of short-acting drugs, such as propofol and the new opioid remifentanil. Judicious use of neuromuscular blocking agents is necessary because of the risk of residual paralysis, and those agents associated with histamine liberation should be avoided. Ventilation requires long expiration times to avoid air trapping, and hyperinflation to avoid the possible threat of pneumothorax and a decrease in cardiac output. For postoperative analgesia, a balanced regimen consisting of regional analgesia with local anaesthetics and NSAIDs should be preferred. This will enhance analgesia and reduce opioid toxicity, which is important in patients with COPD, where respiratory depression is especially dangerous.
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PMID:Anaesthesia and postoperative analgesia in older patients with chronic obstructive pulmonary disease: special considerations. 1269 95

Assess the safety and evidence of efficacy of RFA for colorectal (CRC) lung metastases with follow up to 1 year. Twenty-three patients had percutaneous RFA for 52 colorectal pulmonary metastases under fluoro-CT. Patients received IV conscious sedation and local analgesia with routine hospitalisation/monitoring for 24 h post RFA. Patients had CT scanning at 1 month and then 3 monthly with serum CEA assessment monthly and 3 monthly. All ablations were technically successful. Tumor diameter ranged from 0.3 to 4.2 cm. Pneumothorax occurred in 43% (10 of 23) of patients. Six patients required intercostal chest drain placement. Six patients had a second RFA, 4 for new lesions and 2 patients had a previously treated lesion retreated. Median admission was 2.0 days (range 1-9). Median follow-up is 428 days (range 173-829), with data reported to 1 year in this paper. Five patients died at 5, 6, 8, 8 and 12 months post RFA from extra-pulmonary (1) or widespread (4) disease. One patient developed malignant pleural effusion at 6 months after RFA. Cavitation was seen in nine treated lesions (17%), all resolved with scar tissue contraction by 12 months. Eighteen patients with CT scan follow-up at one year have 40 lesions classified as: disappeared (17), decreased (5), stable/same size (4), increased (14). Percutaneous imaging-guided RFA of multiple CRC pulmonary metastases is a minimally invasive treatment option with modest morbidity. A significant proportion of patients show good evidence of successful local control at one year.
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PMID:[Radiofrequency ablation (RFA) of lung metastases from colorectal cancer (CRC)-one-year follow-up]. 1523 89

Few data are available on the medical aspects of fall accidents in mountainous terrain. Therefore, we report the severity and pattern of injury in 97 survivors of a major fall in Alpine terrain. Twenty-eight of 97 victims (29%) had severe or critical multisystem trauma, with an injury severity score >/=14, the incidence increasing to 23 out of 28 (82%) in individuals with falls exceeding 50 m. Fractures of the extremities and the sacropelvic region (n = 55) were the most common injuries. Seventeen of 21 spine fractures (81%) occurred in the thoracolumbar region. Rib fractures were found in 17 victims, in eight of them (47%) with an accompanying pneumothorax. Critical head trauma with a Glasgow Come Scale below 9 was rather uncommon (n = 6); abdominal visceral injuries were rare (n = 2). The pattern of injury observed in our study suggests a feet- or side-first body position at impact in the majority of individuals surviving Alpine fall accidents. Furthermore, it indicates a direct impact, rather than deceleration type mechanism of injury. Because of the high incidence of severe multisystem trauma, major fall in Alpine terrain should be used as triage criterion for the dispatch of an advanced trauma life support unit and direct transfer of the victim to a trauma center. Considering the high incidence of fractures, measures for adequate immobilization and analgesia will generally be necessary before the difficult evacuation from the site of the accident can be started.
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PMID:Severity and pattern of injury in survivors of alpine fall accidents. 1545 1

Since December 1999 to November 2003, we treated 68 patients with pectus excavatum using the Nuss minimally invasive procedure. Their ages were between 6 and 24 years old, with a mean of 12 years. Average Haller index was 4.1. Lateral stabilisers were used in all the cases, in 28% of them, two stabilisers were used. Mean operative time was 70 minutes (range 40 to 120). A thoracic epidural catheter was used for postoperative analgesia in 87% of the cases, with a mean duration of 3 days. The most frequent early complication was residual pneumothorax, which resolved spontaneously in 24% of the cases. The average hospital stay was 5.7 days. 93% of patients had excellent, very good or good results, in 5% of the cases the results were fair, and 2% had poor results due to thoracic asimetry and/or sternal rotation. The Nuss minimally invasive procedure is a useful method for treatment of pectus excavatum's patients.
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PMID:[Minimally invasive approach of Nuss for the correction of pectus excavatum]. 1604 41

This case report describes the delayed migration of an interscalene brachial plexus catheter that was inserted for postoperative analgesia and to facilitate physiotherapy after shoulder surgery. Approximately 18 h after surgery the catheter was found to have migrated into the interpleural space, which could have resulted in a serious complication, namely a pneumothorax.
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PMID:An unusual complication of interscalene brachial plexus catheterization: delayed catheter migration. 1646 25

This randomised study was designed to compare clinical outcomes for simple aspiration versus tube thoracostomy, in the treatment of the first primary spontaneous pneumothorax (PSP) attack. A randomised trial, comparing simple aspiration with tube thoracostomy, in 137 patients with a first episode of PSP was carried out. Immediate success was obtained in 40 out of the 65 patients (62%) randomly assigned to undergo simple aspiration and in 49 out of the 72 patients (68%) who had been randomly assigned to undergo tube thoracostomy. The 1-week success rates were: 58 (89%) patients in the intention-to-treat simple aspiration group and 63 (88%) patients in the tube thoracostomy group. In the aspiration group, there were more recurrences during the 3-month follow-up period (15 versus 8%), though the difference was not significant. Recurrence rates at 1 and 2 yrs were 16 (22%) and 20 (31%) for patients who had undergone simple aspiration, respectively, and 17 (24%) and 18 (25%) for patients who had undergone tube thoracostomies, respectively. Complications occurred in 5 (7%) patients who had undergone a tube thoracostomy and 1 (2%) patient who had undergone simple aspiration. Analgesia was required in 22 (34%) patients of the simple aspiration group versus 40 (56%) patients of the tube thoracostomy group. These findings suggest that simple aspiration could be an acceptable alternative to tube thoracostomy in the treatment of primary spontaneous pneumothorax.
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PMID:Aspiration versus tube drainage in primary spontaneous pneumothorax: a randomised study. 1650 46

We report a case of anesthesia in an adolescent with recurrent left pneumothorax, Kartagener's syndrome, and severe learning disability with behavioral difficulties. After induction of anesthesia, he rapidly developed severe desaturation as measured on pulse oximetry. Placement of an intercostal chest drain did not remedy the situation and he was found to have blocked the left main bronchus with viscous secretions. Subsequent suctioning relieved the obstruction. Despite successful postoperative thoracic epidural analgesia and minitracheostomy for bronchial toilet, he developed bronchopneumonia that resolved with antibiotics. We discuss anesthesia for patients with Kartagener's syndrome and for patients with pneumothorax.
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PMID:Sudden hypoxia during anesthesia in a patient with Kartagener's syndrome. 1691 62

This paper describes a new method of brachial plexus block via subclavian access. The method minimizes the risk of pneumothorax, impairments of nerves and vessels and does not require the use of an electrical stimulator. In addition, it prevents catheter migration during continuous analgesia.
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PMID:[A new mode of brachial plexus block]. 1706 75

Thoracic epidural analgesia has been widely used to reduce both postoperative and posttraumatic pain. We describe a case of inadvertent right-sided interpleural catheter placement and pneumothorax during attempted epidural catheter placement for left-sided rib fractures that went unrecognized because of bilateral blockade and adequate analgesia.
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PMID:Unrecognized contralateral intrapleural catheter: bilateral blockade may obscure detection of failed epidural catheterization. 1731 36


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