5 results
Chest tube drainage placement may not be a necessity in paediatric thoracoscopic surgery: a retrospective study
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- Gang Zhang, Dandan Liu, Ruiming Kuang, Chun Cai, Xiao Li, Gang Yu, Xiujing Fan
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- Journal:
- Cardiology in the Young / Volume 32 / Issue 2 / February 2022
- Published online by Cambridge University Press:
- 14 May 2021, pp. 198-202
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Objective:
Chest tube drainage placement, a standard procedure in video-assisted thoracoscopic surgery, was reported to cause perioperative complications like pain and increased risk of infection. The present study was designed to evaluate the necessity of chest tube drainage inpaediatric thoracoscopic surgery.
Methods:Thirty children admitted to our hospital from April 2018 to April 2020 were included in the current study and were grouped as the tube group (children receiving video-assisted thoracoscopic surgery with chest tube drainage) and the non-tube group (children receiving video-assisted thoracoscopic surgery without chest tube drainage). Laboratory hemogram index, length of hospitalisation, post-operative performance of involved children, and psychological acceptance of indicated therapy by guardians of the involved children were investigated.
Results:Laboratory examination revealed that the mean corpuscular haemoglobin concentration in the non-tube group was significantly higher than that in the tube group on post-operative day 1 (p < 0.05). Children in the non-tube group had a shorter length of hospitalisation (7–9 days) than that of patients from the tube group. Additionally, the frequency of crying of children was decreased and psychological acceptance by patients’ guardians was improved in the non-tube group when compared with the tube group.
Conclusion:This study showed that chest tube drainage placement may not be necessary in several cases of paediatric video-assisted thoracoscopic surgery. Rapid recovery with decreased perioperative complications in children operated by video-assisted thoracoscopic surgery without tube placement could also reduce the burden of the family and society both economically and psychologically.
Comparison of outcomes following thoracoscopic versus thoracotomy closure for persistent patent ductus arteriosus
- Chen Wei, Steven Staffa, David Zurakowski, Susan Saleeb, Francis Fynn-Thompson, Sitaram M. Emani
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- Journal:
- Cardiology in the Young / Volume 30 / Issue 10 / October 2020
- Published online by Cambridge University Press:
- 05 August 2020, pp. 1433-1438
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Background:
Patent ductus arteriosus closure is traditionally performed by thoracotomy approach. Video-assisted thoracoscopic surgery is a less frequently utilised alternative. We sought to compare elective surgical outcomes between the two methods via a single-centre retrospective cohort analysis.
Methods:All patients >3.2 kg undergoing surgical patent ductus arteriosus ligation at a single institution from 2000 to 2018 were retrospectively reviewed. Propensity matching for age, weight, diuretic usage, and preterm status was conducted to adjust for differences in baseline patient characteristics. Outcome measures included operative time, hospitalisation duration, post-operative complications, and re-operation.
Results:A total of 173 patients were included, 127 thoracoscopy and 46 thoracotomy. In the unmatched cohorts, no significant difference in closure success was found (94% thoracoscopy versus 100% thoracotomy, p = 0.192). Although median operative time was longer for thoracoscopy (87 versus 56 minutes, p < 0.001), hospitalisation duration was shorter (1.05 versus 2.41 days, p < 0.001), as was ICU stay (0.00 versus 0.75 days, p < 0.001). There were no significant differences in re-operation or complication rates, except chest tube placement (11% thoracoscopy versus 50% thoracotomy, p < 0.001). After matching (69 thoracoscopy versus 20 thoracotomy), these differences persisted, including median operative time (81 versus 56 minutes, p = 0.007; thoracoscopy versus thoracotomy), hospitalisation duration (1.25 versus 2.27 days, p < 0.001), and chest tube placement (17% versus 60%, p < 0.001). There remained no significant difference in complications or re-operations.
Conclusions:Thoracoscopic ligation was associated with shorter ICU and hospital stays and less frequent chest tube placement, but longer operative times. Other risks, including bleeding, chylothorax, and recurrent laryngeal nerve injury, were similar.
Chapter 23 - Thoracic Surgery in Children
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- By Kasia Rubin
- Edited by Adam C. Adler, Arvind Chandrakantan, Ronald S. Litman
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- Book:
- Case Studies in Pediatric Anesthesia
- Published online:
- 30 November 2019
- Print publication:
- 05 December 2019, pp 104-107
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Summary
This chapter, reviews thoracic surgery for a host of pathologies in children.The author discusses commonly encountered pediatric congenital lung tumors (i.e.. Congenital lobar emphysema and Congenital Cystic Adenomatous Malformations). Anesthetic implications for VATS vs open thoracotomy as well as approaches for one lung ventilation is considered. Treatment of intraoperative pulmonary issues as well as strategies for post-operative analgesia are presented.
Chapter 20 - Significance of age in practice of thoracic anesthesia
- from Section 2 - Anesthesia for operative procedures
- Edited by Cait P. Searl, Sameena T. Ahmed
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- Book:
- Core Topics in Thoracic Anesthesia
- Published online:
- 10 December 2009
- Print publication:
- 02 April 2009, pp 137-144
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Summary
Video-assisted thoracoscopic surgery (VATS) has become a vital part of the armamentarium of the surgeon. VATS is associated with shorter length of hospital stay and less use of pain medication than thoracotomy in the treatment of pneumothorax and minor resections. General anesthesia is usually induced with an intravenous agent such as propofol or thiopentone and maintained with an inhalational agent such as isoflurane in an air/oxygen mixture. The isolation and division of the bronchi and pulmonary blood vessels require more accurate and extensive dissection with VATS than conventional surgery. Thoracoscopic lobectomy can be oncologically equal to conventional open procedures with an experienced surgeon and have similar survival for early stage non-small cell lung cancer. Conversion to a thoracotomy is sometimes required if there is an unexpected change in the patient's condition such as chest wall invasion or the need for a sleeve resection.
Evolution of strategies for management of the patent arterial duct
- Jorge M. Giroud, Jeffrey P. Jacobs
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- Journal:
- Cardiology in the Young / Volume 17 / Issue S4 / September 2007
- Published online by Cambridge University Press:
- 26 November 2007, pp. 68-74
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Persistent patency of the arterial duct represents one of the most common lesions in the field of congenital cardiac disease. The strategies for management continue to evolve. In this review, we focus on management beyond the neonatal period. We review the temporal evolution of strategies for management, illustrate the currently available the techniques for permanent closure of the patent arterial duct, review the expected outcomes after closure, discuss the current controversy over the appropriate treatment of the so-called “silent” duct, and provide recommendations for the current state of management of patients with persistent patency of the arterial duct outside of the neonatal period.
At the Congenital Heart Institute of Florida, we now recommend closure of all patent arterial ducts, regardless of their size. Before selecting and performing the type of procedure, we explain the natural history of the persistently patent arterial duct to the parents or legal guardian of the child. Particular emphasis is placed on the risks of endocarditis, including the recognition that many cases of endocarditis may not be preventable.
The devastating effects of endocarditis, coupled with the perception of more anecdotal reports of endocarditis with the silent duct, as well as the low risk of interventions, has led us to recommend closure of the patent arterial duct in these situations. We now recommend intervention, after informed consent, for all patients with a patent arterial duct regardless of size, including those in which the patent duct is “silent”. We recognize, however, that this remains a controversial topic, especially given the new recommendations for endocarditis prophylaxis from American Heart Association.
Since 2003, our strategy for closure of the patent arterial duct has changed subsequent to the availability of the Amplatzer occluder. This new device has allowed significantly larger patent arterial ducts to be closed with interventional catheterization procedures that in the past would have been closed at surgery. During the interval between 2002 and 2006 inclusive, the overall surgical volume at our Institute has been stable. Over this period, the number of patients undergoing surgical ligation of the patent arterial duct has decreased, with this decline in volume most notable for the subgroup of patients weighing more than five kilograms. This decrease has been especially notable in thoracoscopic procedures and is attributable to the increased ability to close larger ducts using the Amplatzer occluder.
For infants with symptomatic pulmonary overcirculation weighing less than 5 kilograms, our preference is for the surgical approach. For patients who have ductal calcification, significant pleural scarring, or “window-like” arterial ducts, video-assisted ligation is not an option and open surgical techniques are used. When video-assisted ligation is possible, the approach is based on family and surgeon preference. When open thoracotomy is selected, we usually use a muscle-sparing left posterolateral thoracotomy.
For patients weighing more than 5 kilograms, we currently recommend percutaneous closure for all patent arterial ducts as the first intervention, reserving surgical treatment for those cases that are not amenable to the percutaneous approach. For symptomatic infants weighing greater than 5 kilogram with large ducts, we prefer to use the Amplatzer occluder. In rare instances, the size of the required ductal occluder is so large that either encroachment into the aorta or pulmonary arteries is noted, and the device is removed. The child is then referred for surgical closure. We can now often predict via echocardiography that a duct is too large for transcatheter closure, even with the Amplatzer occluder, and refer these patients directly to surgery.
For patients with an asymptomatic patent arterial duct, we prefer to wait until the weight is from 10 to 12 kilograms, or they are closer to 2 years of age. If the patent arterial duct is greater than 2.0 to 2.5 millimetres in diameter, our preference is to use the Amplatzer occluder. For smaller ducts, we typically use stainless steel coils. Using this strategy, we close all patent arterial ducts, regardless of their size.