ABSTRACT
Despite the ongoing further development of high definition imaging techniques (CT, MRI), mediastinoscopy and thoracoscopy remain essential instruments e.g. for extracting mediastinal lymph nodes allowing further histological diagnostics, or increasingly complex thoracoscopic procedures. Furthermore, in the course of the development of endoscopic thoracic and percutaneous interventions, the therapy of thoracic aortic aneurysms is increasingly the domain of endovascular procedures. In the second part of this review the anaesthesiological procedure and specialties concerning endoscopic thoracic interventions and percutaneous aortic aneurysm repair (EVAR) will be described.
Subject(s)
Anesthetics, General/administration & dosage , Aortic Aneurysm, Thoracic/therapy , Endoscopy/methods , Thoracic Surgical Procedures/methods , Vascular Surgical Procedures/methods , HumansABSTRACT
Further development of surgical techniques and instruments provide complex endoscopic or transcatheter guided interventions in thoracic organs. However, minimalinvasive surgery does not mean minimalinvasive anaesthesia. Particularly concerning cardiothoracic surgery, complex endoscopic procedures represent a challenge to the anaesthesiological management. These interventions require a close interdisciplinary cooperation. Considering the surgical procedures, this review describes the anaesthesiological management for transcatheter aortic valve implantation (TAVI) and percutaneous mitral valve repair. Furthermore it focuses on the anaesthesiological management of pitfalls and complications related to the surgical procedure.
Subject(s)
Anesthesia/methods , Endoscopy/methods , Heart Valve Prosthesis Implantation/methods , Minimally Invasive Surgical Procedures/methods , Aortic Valve/surgery , Endoscopy/adverse effects , Endoscopy/instrumentation , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/instrumentation , Humans , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/instrumentation , Mitral Valve/surgery , Perioperative Care , RiskABSTRACT
INTRODUCTION: The triggering receptor expressed on myeloid cells-1 (TREM-1) is known to be expressed during bacterial infections. We investigated whether TREM-1 is also expressed in non-infectious inflammation following traumatic lung contusion. METHODS: In a study population of 45 adult patients with multiple trauma and lung contusion, we obtained bronchoalveolar lavage (BAL) (blind suctioning of 20 ml NaCl (0.9%) via jet catheter) and collected blood samples at two time points (16 hours and 40 hours) after trauma. Post hoc patients were assigned to one of four groups radiologically classified according to the severity of lung contusion based on the initial chest tomography. Concentration of soluble TREM-1 (sTREM-1) and bacterial growth were determined in the BAL. sTREM-1, IL-6, IL-10, lipopolysaccharide binding protein, procalcitonin, C-reactive protein and leukocyte count were assessed in blood samples. Pulmonary function was evaluated by the paO2/FiO2 ratio. RESULTS: Three patients were excluded due to positive bacterial growth in the initial BAL. In 42 patients the severity of lung contusion correlated with the levels of sTREM-1 16 hours and 40 hours after trauma. sTREM-1 levels were significantly (P < 0.01) elevated in patients with severe contusion (2,184 pg/ml (620 to 4,000 pg/ml)) in comparison with patients with mild (339 pg/ml (135 to 731 pg/ml)) or no (217 pg/ml (97 to 701 pg/ml)) contusion 40 hours following trauma. At both time points the paO2/FiO2 ratio correlated negatively with sTREM-1 levels (Spearman correlation coefficient = -0.446, P < 0.01). CONCLUSIONS: sTREM-1 levels are elevated in the BAL of patients following pulmonary contusion. Furthermore, the levels of sTREM-1 in the BAL correlate well with both the severity of radiological pulmonary tissue damage and functional impairment of gas exchange (paO2/FiO2 ratio).
