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Objective To discuss the clinical effect of artificial pneumothorax combined with intercostal nerve block in alleviating chest pain occurring during and after percutaneous microwave ablation (MWA) for subpleural lung malignancy.Methods A total of 30 patients with subpleural lung malignancy were randomly and equally divided into group A (n=10),group B (n=10) and group C (n=10).The patients in group A received both artificial pneumothorax and intercostal nerve block before MWA.The patients in group B only received artificial pneumothorax before MWA,and the patients in group C only received intercostal nerve block before MWA.The degree of pain was evaluated by visual analogue scale (VAS) score during MWA,immediately after MWA and at 6 h,12 h and 24 h after WMA.The side effects after MWA were recorded.Results During MWA,no statistically significant differences in VAS scores existed between each other among the three groups (P=0.885).The VAS scores determined at 6 h,12 h and 24 h after MWA in group C were significantly increased (P=0.014,P=0.006 and P=0.006 respectively).No patient in group A and group B developed symptoms of chest tightness after artificial pneumothorax was performed.After treatment,a small amount of asymptomatic residual pneumothorax was still observed in 6 patients of group A and group B,which disappeared spontaneously in about one week.Another patient still showed massive pneumothorax even after thoracic gas suction,and the patient recovered after thoracic closed drainage for three days.No other serious complications related to artificial pneumothorax occurred.Conclusion Artificial pneumothorax combined with intercostal nerve block can effectively relieve the chest pain occurring during and after MWA in patients with subpleural lung malignancy,and clinically this technique is quite safe.(J Intervent Radiol,2017,26:269-273)
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Objective To evaluate the application value of the VATS combined with artificial pneumothorax in extended thymectomy. Methods From March 2013 to November 2014, we completed 45 cases of expanded thymectomy in patients with myasthenia gravis .According to the choice of patients , the surgeries were divided into two groups .The artificial pneumothorax group (24 cases) was given thoracoscopic expanded resection under artificial pneumothorax , while the conventional surgery group (21 cases) was given conventional thoracoscopic surgery .The operation time , intraoperative bleeding , operative field show ( to expose the offside mediastinal fat and cardiophrenic angle fat fully ) and symptom relief were compared between the two groups . Results The operations were successful in all the 45 cases.As compared with the conventional surgery group , the artificial pneumothorax group had shorter operation time [(93.8 ±16.8) min vs.(119.5 ±23.3) min, t=-4.293, P=0.000], less intraoperative hemorrhage [(54.2 ±43.7) ml vs.(92.9 ±41.0) ml, t=-3.048, P=0.004] and better operation exposure [91.7% (22/24) vs.57.1%(12/21),χ2 =7.228, P=0.007].However, there was no significant difference in symptom remission rate between the two groups . Conclusion VATS under artificial pneumothorax for thymus expanded resection can fully expose the operation field , with shorter operation time and less blood loss .
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BACKGROUND: When microwave ablation (MWA) is used for subpleural lesions, severe pain was the common side effect under the local anesthesia conditions during the procedure and postprocedure. To study the pain relief effect of artificial pneumothorax in the treatment of subpleural lung tumors with MWA. MATERIALS AND METHODS: From February 2012 to October 2014, 37 patients with 40 subpleural lung tumors underwent MWA, including 17 patients of 19 sessions given artificial pneumothorax prior to MWA (group‑I), and 20 patients of 21 sessions without artificial pneumothorax (group‑II). Patient’s pain assessment scores (10‑point visual analog scale [VAS]) at during‑procedure, 6, 12, 24, and 48 h after the MWA procedure and mean 24 h morphine dose were compared between the two groups. Complications of the artificial pneumothorax were also summarized. RESULTS: Pain VAS were 0.53, 0.65, 1.00, 0.24, and 0.18 at during‑procedure, 6, 12, 24, and 48 h for group‑I and 5.53, 2.32, 2.82, 1.21, and 0.21 for group‑II, respectively. Pain VAS in group I was significantly decreased at during‑procedure, 6, 12, and 24 h after the MWA (P < 0.001). No statistical pain VAS difference was observed at 48 h after the MWA between the two groups (P > 0.05). The mean 24 h morphine dose was 5.00 mg in group‑I and 12.63 mg in group‑II (P = 0.000). “Artificial pneumothorax” related complications occurred in two patients from group‑I, including one pleural effusion and one minor hemoptysis. No patient in group‑I and group‑II died during the procedure or in 30 days after MWA. CONCLUSION: Artificial pneumothorax is a safe and effective method for pain relief during MWA of subpleural lung tumors.
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Um dos possíveis traumas que pode acometer o paciente durante a anestesia geral é o chamado barotrauma, cuja origem for a partir de um pneumotórax hipertensivo. Esse tipo de trauma pode trazer graves riscos ao paciente, se não for rapidamente identificado e tratado. Dessa forma, o objetivo desse artigo é o de apresentar um relato de caso, apresentando as condutas de diagnóstico e terapêuticas que foram adotadas bem como fazer uma revisão da literatura sobre o tema.
One of the possible injuries that may affect the patient during general anesthesia is known as barotrauma, which originates from a hypertension pneumothorax. This type of trauma may represent a serious risk to the patient if it is not promptly identified and treated. In view of this, the aim of this article is to report a case of hypertension pneumothorax, its diagnosis and treatment, as well to review the literature on this subject.