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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The hemodynamic modifications during anesthesia induction with etomidat or thiopentalum, with and without pretreatment with fentanyl, were studied in 60 ASA I-II patients. The patients were randomly divided into six subgroups, as a function of the induction agent (etomidat, 0.15 mg/kg, or thiopentalum, 3 mg/kg) and of the pretreatment used (fentanyl, 5 micrograms/kg, or 0.9% 1 ml/kg saline solution). Systolic, diastolic ATs and pulse were followed and measured during induction and after tracheal intubation. During induction the presence or absence of the thoracic rigidity, after fentanyl administration, and also the appearance of myoclonias and of local pain after etomidat injection were noted. Measurement of hemodynamic constants showed, in the control subgroups unprotected by fentanyl, that AT and pulse frequency increase following laryngoscopy and intubation irrespective of the induction agent used. Association of thiopentalum with fentanyl influenced partially tachycardia and postintubation hypertension. Administration of 5 micrograms/kg fentanyl prevented the SAT and pulse modifications but not the DAT variation. Association of 10 micrograms/kg fentanyl ensured a complete protective effect versus the tracheal intubation but, it led, first, to a SAT decrease by intensification of the myocardial depressing effect of the barbiturate. On the other hand, use of fentanyl as induction adjuvant with etomidat ensured the blockage of the pressure response to intubation, with hemodynamic stability during anesthesia induction, irrespective of the dose of fentanyl injected. Thoracic rigidity and the side effects generated by etomidate were absent.
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PMID:[The effect of fentanyl as an adjuvant to etomidate and thiopental on the hemodynamic response to the induction of anesthesia and endotracheal intubation]. 253 39

After standard preparation, the catheter is preferably inserted in a sitting position. A test dose of 4 ml etidocaine 1% is injected, initially followed by 1 ml per segment of the total calculated analgesic dose. Analgesic spread, blood pressure, and pulse are checked every 2 min. If a sufficient effect is not reached within 20 min, a further 2 ml per segment is injected. The patient is sedated in the operating room with diazepam, droperidol, or chlorpromazine and receives 6-8 l O2 during spontaneous respiration via a Hudson mask. The epidural catheter is left in place for postoperative analgesia. Intubation is used only as required. Of a total of 52 patients, 31 (60%) did not require intubation, 24 (46%) were age 70 or older, and 31 (60%) were classified as ASA risk group III-IV. Thirty-three of all the procedures (63%) involved upper abdominal surgery (liver, gallbladder) and the majority of these received thoracic (Th 9-10) punctures, with the catheter inserted 5 cm in the epidural space; 88% were punctured medially and 12% laterally. The most frequent complications were bradycardia and hypotension. Respiratory arrest and aspiration were not seen. Thoracic epidural catheter anesthesia can be carried out with or without intubation and with a minimum of complications in selected procedures. Postoperative analgesia is an important advantage.
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PMID:[Endotracheal intubation in thoracic catheter peridural anesthesia]. 277 75

A combination of aspirin and prednisolone was used in an attempt to modify the pulmonary disease produced by thiacetarsamide treatment of heartworm-infected dogs. Results of 6 heartworm-infected dogs treated with prednisolone (1 mg/kg, daily for 4 weeks) and aspirin (10 mg/kg, daily for 4 weeks) after thiacetarsamide treatment were compared with previously published results of 3 groups of dogs (6 dogs/group). One of these 3 groups was a nontreated control group, another was treated with prednisolone, and the 3rd was treated with aspirin. All dogs, each with 9 adult heartworms transplanted, were treated with a 2-day, twice-a-day treatment of thiacetarsamide (1 mg/kg) 4 weeks after the transplant. Thoracic radiographs were taken before and at 1, 2, and 3 weeks after thiacetarsamide treatment to evaluate lung disease. Pulmonary arteriography was performed before and 3.5 weeks after thiacetarsamide treatment to evaluate pulmonary blood flow. After treatment, radiographs of the aspirin-prednisolone group were similar to radiographs of the prednisolone group, both with a marked attenuation of the parenchymal disease, as compared with the non-treated group. Addition of aspirin to prednisolone prevented the blood flow obstruction and intraluminal filling defects that were present in the groups not receiving aspirin. Sixteen of 54 transplanted heartworms survived thiacetarsamide treatment in both prednisolone-treated groups, in contrast to complete elimination of heartworms in the nontreated group. Aspirin may be considered for treatment of any heartworm-infected dog that does not have hemotypsis, but postthiacetarsamide use of prednisolone should be restricted to the dog that develops severe lung disease after the heartworms have been killed.
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PMID:An aspirin-prednisolone combination to modify postadulticide lung disease in heartworm-infected dogs. 652 31

Twenty-one ASA I or II patients undergoing upper abdominal surgery were studied for 24 hours after operation. They were entered into a prospective, randomised study of patient-controlled intravenous morphine compared with continuous thoracic epidural fentanyl combined with 0.2% bupivacaine. Pain relief was superior in the bupivacaine series (P < 0.05) throughout the 24 hour study period and this was associated with significantly greater pulmonary ventilation compared with the PCA series. Forced expiratory parameters were reduced in both series after the operation but significantly less so in the epidural group. There was a reduced incidence of emetic symptoms in the epidural group (P < 0.05) but the incidence of other minor side effects did not differ significantly. Thoracic epidural fentanyl/bupivacaine results in significantly better analgesia than patient-controlled intravenous morphine.
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PMID:Thoracic epidural analgesia compared with patient controlled intravenous morphine after upper abdominal surgery. 788 2

We have determined if thoracic extradural block before surgical incision for thoracotomy produces pre-emptive analgesia. Using a double-blind, placebo-controlled, crossover design, 45 patients (ASA II-III) undergoing posterolateral thoracotomy for lung resection were randomized to one of three groups: group 1 received 0.5% bupivacaine and adrenaline 1/200,000 (B+E) 8 ml through a thoracic extradural catheter (tip T3-T5) 30 min before skin incision and saline 8 ml 15 min after skin incision; group 2 received saline 8 ml extradurally before incision and B+E 8 ml after incision; group 3 received saline 8 ml extradurally before and after incision. General anaesthesia was induced and maintained with propofol, alfentanil and atracurium. The alfentanil infusion was stopped before chest closure and fentanyl 50 micrograms in saline 10 ml was given extradurally. Patient-controlled extradural analgesia (PCEA) was commenced with 0.125% bupivacaine, adrenaline 1/400,000 and fentanyl 6 micrograms ml-1 (continuous rate of 2 ml h-1 and supplementary doses of 0.5 ml per 6 min). Visual analogue scale (VAS) scores (recorded at rest, on mobilization and after cough), verbal rating scale (VRS) (recorded at rest), number of successful PCEA demands and complications were measured during the first 48 h after operation. There was no significant difference between groups, either in PCEA requirements (P > 0.21) or in VAS scores (either at rest, during mobilization of the ipsilateral arm of surgery or after cough). No significant differences between groups were found in the VRS. Thoracic extradural block with bupivacaine did not produce an early preemptive effect after thoracotomy.
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PMID:Absence of an early pre-emptive effect after thoracic extradural bupivacaine in thoracic surgery. 867 84

Many anaesthesia practitioners caring for patients with a cardiac implantable electronic device (CIED) lack the knowledge, experience, and requisite programming devices to independently manage these patients perioperatively. A recently updated ASA task force Practice Advisory presents expert opinion regarding the perioperative management of patients with CIEDs, and the Heart Rhythm Society (HRS) recently published a consensus statement on this subject in collaboration with the ASA, American Heart Association (AHA), and Society of Thoracic Surgeons (STS). The main intent of these documents is to provide recommendations that promote safe management of patients with CIEDs throughout the perioperative period and reduce the likelihood of adverse outcomes. Reviews of this topic focusing on the actions of the anaesthesiologist have been published, but a multidisciplinary approach to the perioperative management is now advocated. In emergent situations, however, or when there is no time for the requisite consultations, and in practice settings where the suggested multidisciplinary approach is simply not feasible, the anaesthesia team must still provide effective, safe perioperative management. Thus, all anaesthesiologists should become familiar with the basics of the current CIED technology and the essential tenets of perioperative CIED management. This review discusses relevant advances in CIED technology and practical perioperative management as outlined in the 2011 ASA Practice Advisory and HRS consensus statement.
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PMID:Perioperative management of patients with cardiac implantable electronic devices. 2249 54

Preoperative antiplatelet drug use is common in patients undergoing coronary artery bypass grafting (CABG). The impact of these drugs on bleeding and blood transfusion varies. We hypothesize that review of available evidence regarding drug-related bleeding risk, underlying mechanisms of platelet dysfunction, and variations in patient response to antiplatelet drugs will aid surgeons as they assess preoperative risk and attempt to limit perioperative bleeding. The purpose of this review is to (1) examine the role that antiplatelet drugs play in excessive postoperative blood transfusion, (2) identify possible mechanisms to explain patient response to antiplatelet drugs, and (3) formulate a strategy to limit excessive blood product usage in these patients. We reviewed available published evidence regarding bleeding risk in patients taking preoperative antiplatelet drugs. In addition, we summarized our previous research into mechanisms of antiplatelet drug-related platelet dysfunction. Aspirin users have a slight but significant increase in blood product usage after CABG (0.5 U of nonautologous blood per treated patient). Platelet adenosine diphosphate (ADP) receptor inhibitors are more potent antiplatelet drugs than aspirin but have a half-life similar to aspirin, around 5 to 10 days. The American Heart Association/American College of Cardiology and the Society of Thoracic Surgeons guidelines recommend discontinuation, if possible, of ADP inhibitors 5 to 7 days before operation because of excessive bleeding risk, whereas aspirin should be continued during the entire perioperative period in most patients. Individual variability in response to aspirin and other antiplatelet drugs is common with both hyper- and hyporesponsiveness seen in 5 to 25% of patients. Use of preoperative antiplatelet drugs is a risk factor for increased perioperative bleeding and blood transfusion. Point-of-care tests can identify patients at high risk for perioperative bleeding and blood transfusion, although these tests have limitations. Available evidence suggests that multiple blood conservation techniques benefit high-risk patients taking antiplatelet drugs before operation. Guidelines for patients who take aspirin and/or thienopyridines before cardiac procedures include some or all of the following: (1) preoperative identification of high-risk patients using point-of-care testing; (2) withdrawal of aspirin or other antiplatelet drugs for a few days and delay of operation in patients at high risk for bleeding if clinical circumstances permit; (3) selective perioperative use of evidence-based blood conservation interventions (e.g., short-course erythropoietin, off-pump procedures, and use of intraoperative blood conservation techniques), especially in high-risk patients; and (4) platelet transfusions if clinical bleeding occurs.
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PMID:Antiplatelet drugs: mechanisms and risks of bleeding following cardiac operations. 2253 65

The American Thoracic Society (ATS), the preeminent professional organization in the field of respiratory, critical care, and sleep medicine, is now 107 years old. For the most part, the Society's administrative and medical-scientific interests evolved in an orderly fashion, but two "revolutions" took place that should be remembered. What ultimately metamorphosed into the ATS in 1960 began in 1905 as the 34-member American Sanatorium Association, which in 1915 became the medical section of the National Association for the Study and Prevention of Tuberculosis (NASPT). In 1918, the NASPT became the National Tuberculosis Association and in 1939, the ASA became the American Trudeau Society, cosmetic revisions having no effect on either the medical section-parent relationship or the one-disease orientation of both organizations. After World War II, the narrow focus of the ATS on tuberculosis was progressively enlarged through coalescence of several factors that transformed the practice of pulmonary medicine: the growth of intensive care units and pulmonary function laboratories and the advent of fiberoptic bronchoscopy; the rise of asthma, chronic obstructive pulmonary disease, and lung cancer coincident with the withering of tuberculosis; and the arrival of pulmonary physician-scientists who sought enrichment through a professional society. The newcomers found a home in the ATS, but it was slow to fulfill their needs for scientific communication and administrative responsibility. The first revolution, the formation of Scientific Assemblies, got the job done quickly and well, as described in Part 1 of this perspective. The second revolution, separation from the American Lung Association, is described in Part 2.
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PMID:Evolution and revolution: the formation of today's American Thoracic Society, part 1. 2282 21

Thoracic endometriosis syndrome is a relatively uncommon disorder characterized by recurrent pneumothoraces, hemothorax, chest pain, dyspnea, and hemoptysis within 48 to 72 hours of menstruation. A 34 year old, ASA physical status 2 woman with recurrent catamenial pneumothoraces due to thoracic endometriosis syndrome is presented. After treatment with video-assisted thoracoscopic surgery, she underwent successful elective diagnostic abdominal laparoscopy without incident. The presence of parenchymal injury and damage predisposes these patients to ventilator-induced lung injury. Postponement of surgery until the intermenstrual period, with lung protective ventilation, allows patients with this disease to successfully undergo general anesthesia and surgery.
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PMID:Anesthetic evaluation and management of a patient with thoracic endometriosis syndrome presenting for elective surgery. 2368 59

Two guidelines from the American College of Cardiology (ACC), the American Heart Association (AHA), and collaborating societies address the risk of aortic dissection in patients with bicuspid aortic valves and severe aortic enlargement: the "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease" (Circulation. 2010;121:e266-e369) and the "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease" (Circulation. 2014;129:e521-e643). However, the 2 guidelines differ with regard to the recommended threshold of aortic root or ascending aortic dilatation that would justify surgical intervention in patients with bicuspid aortic valves. The ACC and AHA therefore convened a subcommittee representing members of the 2 guideline writing committees to review the evidence, reach consensus, and draft a statement of clarification for both guidelines. This statement of clarification uses the ACC/AHA revised structure for delineating the Class of Recommendation and Level of Evidence to provide recommendations that replace those contained in Section 9.2.2.1 of the thoracic aortic disease guideline and Section 5.1.3 of the valvular heart disease guideline.
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PMID:Surgery for Aortic Dilatation in Patients With Bicuspid Aortic Valves: A Statement of Clarification From the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 2663 30


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