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Esophageal atresia: Open and thoracoscopic approaches
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Shaun M. Kunisaki, Steven S. Rothenberg
Upon identification of the intercostal muscles, the scapula is elevated and the rib spaces are counted by inspection and palpation. The thorax is best entered through the fourth intercostal space. The external intercostal muscles adjacent to the fifth rib are carefully divided using diathermy (Figure 9.5). The internal intercostal muscles are gently elevated and divided from the underlying parietal pleura. The paravertebral fascia and muscles should not be incised.
Anatomy overview
Published in Stephanie Martin, Working with Voice Disorders, 2020
The rectus abdominis, external and internal oblique and the transversus abdominis are the abdominal muscles responsible for a decrease in the dimensions of the thoracic cavity. Their action increases intra-abdominal pressure, causing the abdominal contents to push upward and inward against the diaphragm, forcing it to return to its relaxed position and helping air to flow out of the lungs. The internal intercostal muscles contract to pull the ribs downwards and stiffen the rib interspaces. The transversus thoracic, the sub-costals, the quadratus lumborum and the serratus posterior inferior are accessory back muscles which exert a downward pull on the ribs.
Blocks of Nerves of the Trunk
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
At the back of the thorax, the intercostal nerves are situated between the posterior intercostal membrane and the pleura until they reach the angle of the ribs. At this level, they pass between the two laminae of the internal intercostal muscles (the internal and innermost intercostal muscles) (Figure 4.2). At the front of the chest, they lie in contact with the pleura, then pass over the sternocostalis muscle, cross the internal mammary artery (upper intercostal nerves only), and, finally, give off their main terminal branches, the anterior cutaneous nerves of the thorax (Figure 4.3).
Expiratory muscle strength training improves swallowing and respiratory outcomes in people with dysphagia: A systematic review
Published in International Journal of Speech-Language Pathology, 2019
Marinda Brooks, Emma McLaughlin, Nora Shields
The expiratory muscles expel air from the lungs and play a vital role in communication and swallowing. Active expiration is coordinated by the internal intercostal muscles, which lower the rib cage and decrease thoracic volume; and the abdominal wall muscles (internal and external obliques, rectus abdominis and transverse abdominis), which press the abdominal organs upwards into the diaphragm, reducing the thoracic cavity (Sapienza & Troche, 2012). Coughing is a coordinated activity involving expiratory muscle contraction to build up high positive intra-pleural and intra-airways pressures and develop peak expiratory flow rates that helps people clear mucous and aspirated material from the lungs. Expiratory muscle contraction also assists communication by moving air through the airways, and the glottis, which vibrates the vocal folds resulting in phonation and in the case of forced exhalation, such as in singing or yelling, by generating abdominal and thoracic pressure to push air out of the lungs (Sapienza & Troche, 2012).
Analgesic efficacy of ultrasound-guided PECS II and transeversus thoracic plane blocks compared to serratus anterior plane block for modified radical mastectomy: A randomized prospective study
Published in Egyptian Journal of Anaesthesia, 2023
Alshaimaa Soliman Alasrag, Amira Mahfouz Elkeblawy, Mohammed Mohye Eldin Abo Elyazid, Hoda Alsaid Ahmed Ezz
Patients were positioned supine. To identify the anterior T4-T5 interspace, a high-frequency linear US probe was positioned, at the midclavicular line lateral to the sternal border in the longitudinal plane till the TTM between the fourth and fifth ribs and the internal intercostal muscle were seen in a parasternal sagittal view above the pleura which was seen as a hypoechoic band. The tip of a 100 mm 22-gauge needle was advanced in caudal to cranial direction in plane with the transducer till it reaches into the TTP, between the TTM and the internal intercostal muscle. After negative aspiration and hydro-dissection with 1–3 mL normal saline to exclude intravascular and intrapleural insertion, 10 ml of 0.25% bupivacaine was injected, Fig1 (1).
The effect of Preoperative threshold inspiratory muscle training in adults undergoing cardiac surgery on postoperative hospital stay: a systematic review
Published in Physiotherapy Theory and Practice, 2023
Adele Cook, Laura Smith, Callum Anderson, Nicole Ewing, Ashley Gammack, Mark Pecover, Nicole Sime, Helen F. Galley
A recent study by D’Arx et al. (2020) reported that one quarter of patients awaiting elective cardiac surgery had inspiratory muscle weakness. Thus, there may be an important role for preoperative interventions which function to increase the function of inspiratory muscles before cardiac surgery. Inspiratory muscle training aims to improve the function of the muscles used in inspiration, primarily the diaphragm, external intercostal muscles and parts of the internal intercostal muscles (McConnell, 2013). Threshold inspiratory muscle training uses pressure-threshold devices which require individuals to generate a sufficiently high inspiratory pressure to overcome a negative pressure load using a one-way spring-loaded valve (McConnell, 2013). As a form of resistance training, threshold training functions to increase respiratory muscle strength by imposing a load on the muscles, increasing tension (McConnell, 2013). A unique feature of threshold devices is the load is independent of the respiratory rate, generating a linear pressure load which can be increased incrementally during training (Menzes et al., 2018; Paiva et al., 2015). Although there is no definitive consensus about which devices are most effective for inspiratory muscle training, this feature may account for its popularity of use in studies. Improvements in respiratory muscle strength using this type of device have been demonstrated across a range of patient populations, including those with chronic kidney disease, chronic obstructive pulmonary disease, heart failure and in patients undergoing bariatric surgery (Beaumont, Forget, Couturaud, and Reychler, 2018; Casali et al., 2011; de Medeiros et al., 2017; Lin et al., 2012).