Analysis of postoperative pulmonary complications after 120 patients lung resection

Airway management of saber-sheath trachea using single use flexible videoscope

Pulmonary and lobar isolation in a patient with aspergilloma within a tuberculous cavity

Additional file 1: of Protective ventilation with high versus low positive end-expiratory pressure during one-lung ventilation for thoracic surgery (PROTHOR): study protocol for a randomized controlled trial

PROTHOR-Patient information. (DOCX 19 kb)

Management of Antiaggregated and Anticoagulated Patients Scheduled for Thoracic Surgery: Recommendations for Venous Thromboprophylaxis

The management of patients under the effect of antiplatelet or anticoagulant agents is a common challenge in thoracic surgery. Their temporary interruption or continuation needs a balanced assessment between the risk of thrombosis (interruption) and bleeding (continuation). Moreover, most patients must receive an anticoagulant for thromboprophylaxis (mainly a low-molecular-weight heparin). So, it is important to have in mind all surgical and anaesthetic implications of these drugs to take the optimal decision in each case.

Review of difficult airway management in thoracic surgery

The management of difficult airway (DA) in thoracic surgery is more difficult due to the need for lung separation or isolation and frequent presence of associated upper and lower airway problems. We performed an article review analysing 818 papers published with clinical evidence indexed in Pubmed that allowed us to develop an algorithm. The best airway management in predicted DA is tracheal intubation and independent bronchial blockers guided by fibroscopy maintaining spontaneous ventilation. For unpredicted DA, the use of videolaryngoscopes is recommended initially, and adequate neuromuscular relaxation (rocuronium/sugammadex), among other maneuvers. In both cases, double lumen tubes shou…

Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial

Background The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. Methods We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a bod…

A noninvasive postoperative clinical score to identify patients at risk for postoperative pulmonary complications: The air-test score

BACKGROUND: Postoperative pulmonary complications (PPCs) negatively affect morbidity, healthcare costs and postsurgical survival. Preoperative and intraoperative peripheral oxyhemoglobin saturation (SpO2) levels are independent risk factors for postoperative pulmonary complications (PPCs). The air-test assesses the value of SpO2 while breathing room-air. We aimed at building a clinical score that includes the air-test for predicting the risk for PPCs. METHODS: This is a development and validation study in patients -randomly divided into two cohorts- from a large randomized clinical trial (iPROVE) that enrolled 964 intermediate-to-high risk patients scheduled for abdominal surgery. Arterial …

The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study

Abstract Background It is uncertain whether the association of the intraoperative driving pressure (ΔP) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our primary objective was to determine and compare the association of time–weighted average ΔP (ΔPTW) with PPCs. We also tested the association of ΔPTW with intraoperative adverse events. Methods Posthoc retrospective propensity score–weighted cohort analysis of patients undergoing open or closed abdominal surgery in the ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery’ (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries.…

The Complex Process of Haemostasis and Interactions due to Hyperosmotic Fluids

The erector spinae plane block: a narrative review

Regional anesthesia and pain management have experienced advances in recent years, especially with the advent of fascial plane blocks. The erector spinae plane block is one of the newest techniques to be described. In the past two years, publications referring to ESP block have increased significantly. The objective of this review is to analyze the articles about ESP block that have been published to date. We performed a search in the main databases and identified 368 articles. After a selection of the relevant articles, 125 studies were found eligible and were included in the review. The ESP block is performed by depositing the local anesthetic in the fascial plane, deeper than the erector…

Comentarios al artículo: «Tratamiento de la rotura traumática del bronquio izquierdo por asta de toro con stent endobronquial. Implicaciones anestésicas»

Abordaje de vía aérea en tráquea en vaina de sable con videoendoscopio flexible desechable

European Association of Cardiothoracic Anesthesiology and Intensive Care Pediatric Cardiac Anesthesia Fellowship Curriculum: First Edition.

International audience; Pediatric cardiac anesthesia is a subspecialty of cardiac and pediatric anesthesiology dedicated to the perioperative care of patients with congenital heart disease. Members of the Congenital and Education Subcommittees of the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) agreed on the necessity to develop an EACTAIC pediatric cardiac anesthesia fellowship curriculum. This manuscript represents a consensus on the composition and the design of the EACTAIC Pediatric Cardiac Anesthesia Fellowship program. This curriculum provides a basis for the training of future pediatric cardiac anesthesiologists by clearly defining the theoretic…

Revisión del manejo de la vía aérea díficil en cirugía torácica

Resumen El manejo de la via aerea dificil (VAD) en cirugia toracica es muy especifico y mas complejo que en otras especialidades debido a la exigencia de separacion o aislamiento pulmonar y a una mayor presencia de anormalidades asociadas a la via aerea superior e inferior. Basandonos en el analisis de las evidencias clinicas de 818 articulos indexados en PubMed, presentamos una revision actualizada y un algoritmo especifico del manejo de la VAD en cirugia toracica. Recomendamos para la VAD prevista la intubacion traqueal con fibroncoscopio en ventilacion espontanea y el uso de bloqueador bronquial. Para la VAD imprevista, el uso inicial de videolaringoscopios y un adecuado nivel de relajac…

Protective ventilation with high versus low positive end-expiratory pressure during one-lung ventilation for thoracic surgery (PROTHOR): study protocol for a randomized controlled trial.

Postoperative pulmonary complications (PPC) may result in longer duration of in-hospital stay and even mortality. Both thoracic surgery and intraoperative mechanical ventilation settings add considerably to the risk of PPC. It is unclear if one-lung ventilation (OLV) for thoracic surgery with a strategy of intraoperative high positive end-expiratory pressure (PEEP) and recruitment maneuvers (RM) reduces PPC, compared to low PEEP without RM.PROTHOR is an international, multicenter, randomized, controlled, assessor-blinded, two-arm trial initiated by investigators of the PROtective VEntilation NETwork. In total, 2378 patients will be randomly assigned to one of two different intraoperative me…