How to Set up a Minimally Invasive Program
Theo Kofidis in 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.
Surgery for the Enlarged Thyroid
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
The patient is positioned 30 ° semi-supine with the right side slightly elevated. A double lumen tube allows for lung isolation. The possible approaches include a lateral camera position with medial utility ports allowing for retraction and dissection, or a subxiphoid camera position which can allow for visualization of both hemithoracic cavities. This approach provides good visualization from below and of the phrenic nerves, internal mammary vessels and great vessels. The mass is removed through the cervical incision. The subxiphoid approach limits visualization of the posterior mediastinum as the pericardium lies in the way.
Thoracic surgery
Brian J Pollard, Gareth Kitchen in Handbook of Clinical Anaesthesia, 2017
An alternative to a double lumen tube is a bronchus blocker with an ordinary endotracheal tube or a combined tube and blocker (the Combivent). There are several disposable types of blocker. The blocker is passed through the endotracheal tube and placed in the main bronchus of the upper lung using bronchoscopy. When lung isolation is required, the blocker is inflated. Deflation of the lung occurs through the lumen of the blocker but this is often considerably slower than by using a double lumen tube. Positional stability is not as good as with a double lumen tube.
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.
Efficacy of adding dexmedetomidine as adjuvant with bupivacaine in ultrasound-guided erector spinae plane block for post thoracotomy pain: Randomized controlled study
Published in Egyptian Journal of Anaesthesia, 2021
Mamdouh Mahmoud Elshal, Reham Mohamed Gamal, Aya Mohamed Ahmed, Nevine Mahmoud Gouda, Mohamed Mohammed Abdelhaq
GA was induced for both groups using IV fentanyl 2 μg/kg and propofol 2 mg/kg. Tracheal intubation was facilitated by rocuronium 0.5 mg/kg and done by a left-sided double-lumen endobronchial tube (Mallinckrodt’s 37 or 39 Fr) and a fiberoptic bronchoscope was used to ensure the correct position of the tube. Tidal volume was adjusted to be 6–8 ml/kg, and the respiratory rate was adjusted to keep the end-tidal CO2 between 30 and 40 mmHg.
Related Knowledge Centers
- Breathing
- Respiratory Tract
- Trachea
- Tracheal Tube
- Tracheotomy
- Larynx
- Catheter
- Intubation
- Mechanical Ventilation
- Cricothyrotomy