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Cardiothoracic
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
This is a chest drain set (Figure 5.1). It has a selection of syringes and needles, a scalpel, a blade, sutures, a guidewire, a dilator, a chest tube and a closed drainage system. The chest drain is available in different sizes typically ranging from 8 Ch to 36 Ch. It can be inserted by thoracotomy or using the Seldinger technique with a guidewire. Although the British Thoracic Society (BTS) guidelines strongly recommend that this procedure should be done under ultrasound guidance, clear understanding of the anatomical landmarks is important. The preferred site of chest drain insertion is the safety triangle. This is defined as the space bordered superiorly by the base of the axilla, anteriorly by the lateral edge of the pectoralis major, inferiorly by the 5th intercostal space and laterally by the lateral edge of the latissimus dorsi muscle. The needle should be inserted just above a rib to avoid damage to the neurovascular bundle though the lower the rib is, the less likely it is that the rib flange will cover the bundle and as such, a more anterior site may avoid damage (Carney and Ravin, 1979; Havelock et al., 2010). The chest tube is secured at the skin using the sutures provided. The chest drain should be connected to a closed drainage system to prevent entrapping air or fluid into the pleural cavity. A wide range of systems can be used including the underwater seal, flutter valve or a multifunction chest drainage system.
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
An end-to-end esophageal anastomosis is performed using interrupted full thickness sutures of absorbable 4/0 or 5/0 suture with intracorporeal knots. Sutures are initially placed in the posterior wall. The anesthesiologist then passes a transanastomotic tube and the anterior part of the anastomosis is completed using the same suture material (Figure 9.20). By leaving the end of the suture a little longer, traction can be applied so that the next suture can be placed more easily. As with the open repair, a chest drainage tube is left in place if there is concern for a postoperative tension pneumothorax that may be caused by inadvertent lung injury or if the anastomosis is tenuous. As with the open repair, we no longer routinely leave a transanastomotic tube.
Military Environments
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Radiological features can range from a typical ‘butterfly pattern’ bihilar shadowing on the chest x-ray to a ‘white-out’. Management is principally supportive. Mechanical ventilation and effective chest drainage form the mainstay of treatment. High-peak inspiratory pressures should be avoided to decrease the chance of iatrogenic pulmonary barotraumas.
Key factors for successful cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy to treat diffuse malignant peritoneal mesothelioma: results from specialized peritoneal cancer center in China
Published in International Journal of Hyperthermia, 2022
Yan-Dong Su, Zhi-Ran Yang, Xin-Bao Li, Yang Yu, Xue-Mei Du, Yan Li
According to the PSOGI textbook on CRS + HIPEC for PM [10], SAEs are classified into nine organ systems. In our study, the most common postoperative SAEs was in the respiratory system, with pleural effusion (PE) accounting for 95.5%. Singh et al. [31] found that 73% of patients with mesothelioma required diaphragmatic interventions, increasing the incidence of postoperative PE. Campos et al. [32] also indicated that almost all patients required diaphragmatic peritonectomy as a part of their CRS. A total of 72/73 patients who underwent diaphragmatic peritonectomy developed PE, but only six patients required pleural drainage. Therefore, it was suggested that the routine use of pleural tubes was not advocated. However, in another study [33], Carboni et al. analyzed the feasibility of diaphragmatic interventions in CRS + HIPEC for PM. All patients who underwent diaphragmatic surgery were routinely placed on chest drains. The routine placement of chest drains may reduce the incidence of adverse respiratory events. Of all our patients, 22 (20.0%) developed grade III–IV PE after CRS + HIPEC. These findings suggest that preventive chest drainage in patients undergoing diaphragmatic interventions may be beneficial.
Effect of Preoperative Nutritional Risk Screening and Enteral Nutrition Support in Accelerated Recovery after Resection for Esophageal Cancer
Published in Nutrition and Cancer, 2021
Yi Shen, Yunfeng Zhou, Tao He, Xiang Zhuang
Both groups underwent standard radical esophagectomy(thoracoscopic and laparoscopic esophageal cancer resection + expanded two wild lymph node dissection), and a gastric tube was replaced during the operation. A chest drainage tube and a mediastinal drainage tube were placed at the end of the operation. Electrolyte solution was administered through the feeding tube on postoperative day 1, and EN support was started on day 2. The chest drainage tube was removed once chest X-rays showed no apparent effusion and gas accumulation and the chest drainage volume was <200 mL/day. Upper gastrointestinal imaging was performed during postoperative day 5–7; if imaging showed good thoracic gastric emptying with no anastomosis abnormalities, then the patient was permitted to start a fluid diet, and then, the feeding tube and the mediastinal drainage tube could be removed. Patients were discharged if they could tolerate a semi-fluid diet and were in good condition.
Application of Narrow-Band Imaging thoracoscopy in diagnosis of pleural diseases
Published in Postgraduate Medicine, 2020
Xinglu Zhang, Feng Wang, Zhaohui Tong
Each thoracoscopic procedure was completed by two pulmonologists in order to reduce the visual bias. The patients were positioned on the non-target side, and the surrounding skin was sterilized. With the targeted location by pleural ultrasound as the puncture point, the patient were given 5–10 ml 2% lidocaine to get local anesthesia. An entrance trocar was inserted into the thoracic cavity for inspection. After evacuating pleural effusions, the pleural cavity was first thoroughly inspected by conventional thoracoscopy (white light thoracoscopy, WLT) followed by NBI. Pictures of endoscopic real-time lesions were recorded, at least five pieces of tissue in either mode were taken, respectively. Then, we put the biopsy specimens from WLT into bottle A and biopsy specimens from NBI into bottle B, which were both filled with formalin, then they were processed for pathologic analysis. When active bleeding occurred, we stopped the bleeding by local compression with gauze strips stained with 0.1% ice norepinephrine saline or solution. A chest drainage tube was inserted after the evacuation of fluid. The tube was not removed until daily drainage was less than 50 ml and an optimal expansion of lung was shown from the chest radiography.