Recent advances in double-lumen tube malposition in thoracic surgery: A bibliometric analysis and narrative literature review.

Thoracic surgery has increased drastically in recent years, especially in light of the severe outbreak of the 2019 novel coronavirus disease (COVID-19). Routine "passive" chest computed tomography (CT) screening of inpatients detects some pulmonary diseases requiring thoracic surgeries timely. As an essential device for thoracic anesthesia, the double-lumen tube (DLT) is particularly important for anesthesia and surgery. With the continuous upgrading of the DLTs and the widespread use of fiberoptic bronchoscopy (FOB), the position of DLT in thoracic surgery is gradually becoming more stable and easier to observe or adjust. However, DLT malposition still occurs during transferring patients from a supine to the lateral position in thoracic surgery, which leads to lung isolation failure and hypoxemia during one-lung ventilation (OLV). Recently, some innovative DLTs or improved intervention methods have shown good results in reducing the incidence of DLT malposition. This review aims to summarize the recent studies of the incidence of left-sided DLT malposition, the reasons and effects of malposition, and summarize current methods for reducing DLT malposition and prospects for possible approaches. Meanwhile, we use bibliometric analysis to summarize the research trends and hot spots of the DLT research.

Anaesthetic Management of Pulmonary Metastasectomy in a Patient Infected with Novel Corona Virus SARS-CoV-2.

Prioritisation of individual patients for thoracic surgeries gained importance during the current COVID-19 pandemic to ensure optimal utilisation of resources. We report a 76-year-old-male patient who presented to a tertiary care hospital in Muscat, Oman, 2020, with bilateral pulmonary metastasis. The patient underwent an urgent pulmonary metastasectomy with successful anaesthesia management in an elderly patient despite him testing positive for COVID-19 twice via real-time reverse transcription-polymerase chain reaction. At the 3-month follow-up some pulmonary abnormalities persisted but the patient was recovering well. This report discusses the rationale to perform surgery in this case and highlights the precautions taken for reducing aerosol generation during the various stages of anaesthesia.

[Application and Research Progress of Video Double-lumen Tube in Thoracic Surgery].

The rapid development and promotion of minimally invasive thoracic surgery represented by video-assisted thoracoscopy surgery has gradually replaced traditional thoracic surgery technique as the primary choice for the treatment of pulmonary nodules, including early lung cancer. With the clinical application of double-lumen bronchial catheters, the realization of one-lung ventilation technology not only provides a solid anesthesia foundation for the popularization of minimally invasive thoracic surgery, but also provides a guarantee for the rapid and smooth implementation of the operation. However, compared with single-lumen bronchial catheters, the diameter of the double-lumen bronchial catheter is thicker, and the tube body is hard and difficult to shape, which brings inconvenience to anesthesia intubation. The bronchial structure is different, and the incidence of dislocation during anesthesia intubation is also high. With the gradual clinical use of video double-lumen tube (VDLT), it has become a hot spot in thoracic surgery in recent years. This article reviews the application and research progress of VDLT in thoracic surgery.
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ENDOBRONCHIAL VALVES POSSIBILITIES FOR PNEUMOTHORAX IN COVID-19

AIM: Spontaneous pneumothorax and PAL are complications of SARS-CoV-2 infection. Endobronchial valves could be an effective and less invasive treatment option and may facilitate the weaning from the MV in patients with SARS-CoV-2 pneumonia. Despite the using of conservative options some patients may require thoracic surgery which must be balanced against their comorbidities and ability to tolerate the intervention. METHODS: A 32-year-old woman at 35 weeks of gestation was admitted to the hospital with a positive nasopharyngeal swab of SARS-CoV-2. On day 4, due to the progression of respiratory failure caused by bilateral pneumonia, she underwent a cesarean section. Then high-flow oxygen was delivered with a following decrease to 12 L/min. On day 10 patient felt sharp chest pain and her chest CT revealed bilateral consolidation with a right-sided pneumothorax. A chest tube was placed to the right pleural space. Due to the onset of life threating hypoxia, on day 20, the patient was put on ventilator and VVECMO was initiated immediately. MV via tracheotomy was continued. Despite the adequate suction drainage, the patient kept having recalcitrant pneumothorax with PAL. Given high risks of single lung ventilation, a decision to use the EBV with endoscopic insertion was made. Flexible bronchoscopy was performed under general anesthesia, a solution of hydrogen peroxide and sterile dye was injected into the pleural cavity via chest tube with their further detection in the lower right lobe. A size 11 Medlung endobronchial valve was installed into the intermediate bronchus, which led to the immediate cessation of air leakage. RESULTS: Chest X-ray after the intervention showed complete inflating of the lungs and the resolution of the pneumothorax. CONCLUSIONS: EBV may play a potential role in the treatment of PAL and contribute to weaning patients with COVID-19 from ventilation without the need for invasive intervention.

Application of Continuous Positive Airway Pressure During Video-Assisted Thoracoscopic Surgery.

PURPOSE OF REVIEW: Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are used for anatomic resection of early stage cancer. These surgical techniques require the use of one-lung ventilation (OLV). During OLV, an obligatory intrapulmonary shunt may produce hypoxemia. One method to correct hypoxemia is with the use of continuous positive airway pressure (CPAP). This review focuses on 1) the lung physiology of OLV; 2) application of CPAP in VATS or RATS during supine and lateral position; and 3) the application of CPAP in COVID-19 patients during OLV. RECENT FINDINGS: Studies have shown the beneficial effects of CPAP to improve oxygenation during OLV while the patient is in the lateral decubitus position. In contrast, studies have shown no benefit on improving oxygenation with CPAP in patients undergoing OLV in supine position. SUMMARY: The application of CPAP to the non-dependent lung is one of the options to treat hypoxemia during VATS or RATS.

Anesthetic Management for Thoracic Surgery During the COVID-19 Pandemic.

PURPOSE OF REVIEW: This review explores recent international guidance on the anesthetic management of patients undergoing thoracic surgery during the COVID-19 pandemic: those with suspected or confirmed COVID-19 requiring urgent thoracic surgery and those presenting for elective procedures. RECENT FINDINGS: A significant mortality risk is associated with patients with COVID-19 undergoing thoracic surgery; therefore, where possible, it should be avoided. Thoracic surgery also carries a significant risk of viral transmission to healthcare workers due to the necessarily high frequency of intraoperative aerosol-generating procedures involved, such as lung isolation, one-lung ventilation, and flexible bronchoscopy. SUMMARY: Guidelines recommend appropriate personal protective equipment and numerous procedural modifications to prevent viral transmission to staff and other patients. With appropriate disease mitigation strategies in place, elective thoracic surgery, in particular for lung cancer, has been able to continue safely in many centres.

The Year in Thoracic Anesthesia: Selected Highlights From 2020.

Selected highlights in thoracic anesthesia in 2020 include updates in the preoperative assessment and prehabilitation of patients undergoing thoracic surgery; updates in one-lung ventilation (OLV) pertaining to the devices used for OLV; the use of dexmedetomidine for lung protection during OLV and protective ventilation, recommendations for the care of thoracic surgical patients with coronavirus disease 2019; a review of recent meta-analyses comparing truncal blocks with paravertebral and thoracic epidural blocks; and a review of outcomes after initiating the enhanced recovery after surgery guidelines for lung and esophageal surgery.