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How to Set up a Minimally Invasive Program
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Human nature is, at its core, the desire to preserve, protect and delineate one’s territory, a strategy that is detrimental to innovation and progress. The other negative force that stands in your way of becoming an excellent MICS surgeon is habit. Entropy can be a massive disruption in your progress. Why trouble yourself to spend 45 extra minutes to set up properly for an MICS mitral valve procedure? Why bother your anesthetist to insert a double lumen tube? Why stress your nurses and perfusionists to learn something totally new? Why force the surgeon following you in the same theater to risk postponing their case? These are important logistic considerations that you will face in the beginning. Therefore, as long as you live and work within a group of people, you must win their buy-in and their enthusiasm. How? Be inclusive. Even with those who are not born to be pioneers and will watch you fall and stand up again, strike through the bush and get bruised, produce a few complications and struggle through the consequences, until your program “stands” and they can harvest the benefits.
Thorax
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The right and left main bronchi originate at the carina. The right main bronchus is shorter (2.5 cm vs 5 cm), wider and more vertical to the midline (25° vs 45°). This structure has a couple of clinical implications in anaesthesia (Figure 2.4). Endobronchial intubations are, more often than not, on the right side.Foreign bodies traversing the trachea are more likely to enter the right side.During use of a right-sided double lumen tube, careful positioning and confirmation with a fibreoptic scope is necessary to prevent occlusion of the right upper lobe bronchus arising at 2.5 cm.
The Chest
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Massive air leaks and a substantial airway bleeding should initially be treated by intubation with a normal endotracheal tube; preferably below the injury in the trachea, or in the healthy lung. A double lumen tube should only be used as a primary device if the anaesthesiologist is very experienced with this. Bronchus blocker might be considered at later stage.
Dynamic analysis of human small intestinal microbiota after an ingestion of fermented milk by small-intestinal fluid perfusion using an endoscopic retrograde bowel insertion technique
Published in Gut Microbes, 2020
Toshihiko Takada, Daisuke Chinda, Tatsuya Mikami, Kensuke Shimizu, Kosuke Oana, Shiro Hayamizu, Kuniaki Miyazawa, Tetsu Arai, Miyuki Katto, Yusuke Nagara, Hiroshi Makino, Akira Kushiro, Kenji Oishi, Shinsaku Fukuda
Small-intestinal fluid perfusion using an endoscopic retrograde bowel insertion (ERBI) technique is a powerful tool which allows to collect ileal perfusion fluid periodically.23 A double-lumen tube, featuring an occluding balloon, is inserted retrograde through the colon and placed at the terminal ileum. This makes it possible to collect the ileal fluids over time under physiological conditions without affecting secretion of gastric juice and bile. This ERBI technique has been used for analyses of the dynamics and metabolism of indigestible polysaccharides such as resistant starch24 and raffinose,25 and of dietary fibers such as pectin26 and cellulose.27
Fluorodeoxyglucose positron emission tomography for detection of tumor recurrence following radiofrequency ablation in retrospective cohort of stage I lung cancer
Published in International Journal of Hyperthermia, 2018
Yingbing Wang, Michael Lanuti, Adam Bernheim, Jo-Anne O. Shepard, Amita Sharma
RFA was performed whenever possible using conscious sedation. Intravenous administration of Fentanyl, Demerol and Midazolam was titrated to the patient's needs, with the aim of maintaining steady, low level respirations throughout the procedure. Requirements for general anesthesia were determined by the patient’s cardiorespiratory status and associated comorbidities. General anesthesia was also used in larger peripheral lesions where ablation was likely to be more painful. Low-level ventilation and a double lumen tube were used in 3 patients to reduce movement in the lung to be ablated.
Lung ultrasound compared to fiber-optic bronchoscopy in detecting proper endotracheal tube position in intubated patients in the intensive care unit
Published in Egyptian Journal of Anaesthesia, 2023
Omar Sayed Osman Abdeen, Raouf Ramzy Gad Allah, Tarek Samir Shabana, Thabet Aziz Nasr, Waleed Abdalla Ibrahem
A study by Sustic et al. showed that adding ultrasound to clinical assessment improved the accuracy of the double-lumen tube positioning compared to clinical assessment alone. Wei-Cai Hu, Swapnil parab, and Alvarez Diaz found comparable results when comparing ultrasound to auscultation in positioning double-lumen tubes in elective thoracic surgeries requiring single lung ventilation [12–15].