Heart Transplantation in the Rat
Waldemar L. Olszewski in CRC Handbook of Microsurgery, 2019
The donor is anesthetized with ether. The thorax is shaved and the animal is taped on its back onto a cork board. About 500 U of heparin dissolved in 1 mℓ of saline is injected into the tail vein to prevent clotting in the donor heart. The anterior thoracic wall is cut free from the diaphragm and further opened via the two mid-axillary lines. The pericardium is incised and the heart is retracted distally. To obtain access to the ascending aorta and the pulmonary artery, these vessels are freed from one another by careful dissection. The ascending aorta is cut with iridectomy scissors close to the origin of the first branch and the pulmonary artery at its bifurcation. The heart is lifted up and one ligature (linen 100) is placed around the vena cavae and pulmonary veins. After cutting these veins distal to the ligature, the heart is removed. A fine polyethylene catheter connected with a 2-mℓ syringe containing Hanks’ balanced salt solution (HBSS) at 4°C is introduced into the ascending aorta. Under low pressure, the coronary system is gently perfused until the effluent escaping from the pulmonary artery is clear. The heart is stored in HBSS at 4°C.
Ribs
Amaka C Offiah, Christine M Hall in Radiological Atlas of Child Abuse, 2018
Rib fractures may be identified anywhere along the length of the ribs. They most commonly result from squeezing, compressive forces applied to the chest. This is the typical mechanism when groups or runs of fractures are seen one above the other. The fractures result from significant bending of the ribs during the course of squeezing and occur at the site of maximum distortion of the rib cage. This means that they tend to occur at right angles to the major direction of the squeezing force. In other words a front-to-back compression will result in fractures at the sides of the chest in the mid-axillary lines toward the anterior ends of the ribs.
Chylothorax
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
A 5 mm incision is made in the sixth intercostal space midway between the nipple and scapula tip along the mid-axillary line. The pleural space is entered with a Veress needle or artery forceps. A 5 mm port is placed, and the hemithorax is insufflated with carbon dioxide to 4 mmHg. The posterior mediastinum is visualized using a 5 mm 30-degree thoracoscope. Two additional ports are placed in a triangular configuration along the mid-axillary and posterior axillary lines (Figure 18.3). This orientation of the ports allows for optimal visualization of the posterior mediastinum at the level of the diaphragm.
The improvement in respiratory function by inspiratory muscle training is due to structural muscle changes in patients with stroke: a randomized controlled pilot trial
Published in Topics in Stroke Rehabilitation, 2018
Ji-Eun Cho, Hwang-Jae Lee, Min-Kyu Kim, Wan-Hee Lee
A real-time B-mode ultrasound imaging system (MYSONO U5, Samsung Medicine, Seoul, Korea) with a 5.0–14.0 MHz linear transducer was used for examination of the muscle architecture (DT) at rest and during maximum voluntary contraction. For measurement of DT, the mid-axillary lines between ribs 8 and 9 on both sides, for all participants, were checked in a standing posture, and then the chest wall was perpendicularly illuminated, using a linear transducer, in a supine position, to observe the region between rib 8 and rib 9 and to obtain 2-dimensional images. The DT was measured as the distance between the two parallel lines that appeared bright in the middle of the pleura and in the middle peritoneum (Figure 1). The distance was measured 3 times at rest and 3 times during contraction, and the average distance value and DT ratio were calculated. The formula that was used to obtain standardized DT ratios is shown below.20
Impact of early versus late tracheotomy on diaphragmatic function assessed by ultrasonography in mechanically ventilated stroke patients
Published in Egyptian Journal of Anaesthesia, 2022
Amr Abdalla Elsayed, Mohammed Refaat Mousa, Bassem Nashaat Beshey
In the subcostal area, between the mid-clavicular and anterior axillary lines, using liver or spleen as acoustic windows, diaphragm was identified as a hyperechoic line (produced by the pleura tightly adherent to the muscle) that approaches the probe during inspiration (Figure 1c). The inspiratory excursion (DE) was measured in M-mode (Figure 1d). In healthy subjects during quiet spontaneous breathing, diaphragm inspiratory excursion was found to be 13.4 ± 0.18 mm [8,18]. Both DE and DTF were measured and calculated once daily till performing early or late tracheotomy in both groups I & II consecutively and continued until weaning off mechanical ventilation. DD was diagnosed by DE less than 15 mm and DTF less than 20% [12].
Comparison of analgesic efficacy of ultrasound-guided erector spinae block with port site infiltration following laparoscopic cholecystectomy
Published in Egyptian Journal of Anaesthesia, 2023
Magdy Mohammed Mahdy, Essam Ezzat Abdelhakeem, Ayman Mohamed Fawzy, Mostafa Samy Abbas
For the local infiltration approach, the same surgeon conducted pre-incisional port-site infiltration using a 20 ml mixture of 10 ml bupivacaine 0.5%, 5 ml lidocaine 2%, and 5 ml saline after inducing anesthesia. The volume was equally divided between port sites. A total of four ports were created: one each in the supraumbilical, subxiphoid, and right subcostal regions at the mid-clavicular and anterior axillary lines. At the end of surgery, train of four (TOF) was used to guide reversal of neuromuscular blockade by neostigmine and atropine. After extubation, patients were moved to the post-anesthesia care unit (PACU).
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