ABSTRACT
BACKGROUND: Postoperative pulmonary and renal complications are frequent in patients undergoing lung surgery. Hyper- and hypovolaemia may contribute to these complications. We hypothesized that goal-directed haemodynamic management based on oesophageal Doppler monitoring would reduce postoperative pulmonary complications in a randomized clinical parallel-arm trial. METHODS: One hundred patients scheduled for thoracic surgery were randomly assigned to either standard haemodynamic management (control group) or goal-directed therapy (GDT group) guided by an oesophageal Doppler monitoring-based algorithm. The primary endpoint was postoperative pulmonary complications, including spirometry. Secondary endpoints included haemodynamic variables, renal, cardiac, and neurological complications, and length of hospital stay. The investigator assessing outcomes was blinded to group assignment. RESULTS: Forty-eight subjects of each group were analysed. Compared to the control group, fewer subjects in the GDT group developed postoperative pulmonary complications (6 vs. 15 patients; P = 0.047), while spirometry did not differ between groups. Compared to the control group, patients of the GDT group showed higher cardiac index (2.9 vs. 2.1 [l min - 1 m - 2 ]; P < 0.001) and stroke volume index (43 vs. 34 [ml m 2 ]; P < 0.001) during surgery. Renal, cardiac and neurological complications did not differ between groups. Length of hospital stay was shorter in the GDT compared to the control group (9 vs. 11 days; P = 0.005). CONCLUSIONS: Compared to standard haemodynamic management, oesophageal Doppler monitor-guided GDT was associated with fewer postoperative pulmonary complications and a shorter hospital stay. CLINICAL TRIAL REGISTRATION.: The study was registered in the German Clinical Trials Register (DRKS 00006961). https://drks-neu.uniklinik-freiburg.de/drks_web/.
Subject(s)
Esophagus/diagnostic imaging , Thoracic Surgical Procedures/methods , Aged , Cardiac Output , Female , Goals , Hemodynamic Monitoring/methods , Humans , Length of Stay , Lung Diseases/epidemiology , Lung Diseases/prevention & control , Male , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , Stroke Volume , Ultrasonography, DopplerABSTRACT
Mastocytosis is a rare disorder caused by the proliferation and accumulation of mast cells in various organs. It has a broad variety of clinical manifestations, including cardiovascular collapse. Diverse stimuli trigger the release of vasoactive substances and parturients with systemic mastocytosis are at high risk for precipitating mast cell degranulation. As a result, women with systemic mastocytosis should have an anaesthetic plan for labour and delivery. Anxiety, stress, sleep deprivation, pain and numerous pharmacological agents are all triggers for mast cell degranulation. For pain relief in labour, epidural analgesia is recommended. Pharmacological agents with a high potential for triggering mast cell degranulation should be avoided. This is particularly important in the case of an emergency caesarean section. Resuscitation equipment must be available should life-threatening haemodynamic instability occur during surgery. We report the case of a pregnant woman with systemic mastocytosis who required emergency caesarean section.
Subject(s)
Anesthesia, Obstetrical/methods , Cesarean Section , Emergency Medical Services/methods , Mastocytosis, Systemic/complications , Abdominal Pain/etiology , Adult , Anesthesia, General , Anesthetics, Intravenous , Female , Heart Rate, Fetal , Humans , Infant, Newborn , Patient Care Planning , Pregnancy , Propofol , StillbirthABSTRACT
A case of sufficient high-frequency jet ventilation with a tip-cut nasogastric tube in a patient requiring endobronchial 192iridium irradiation is described. In order to allow the endotracheal introduction of a bronchoscope together with an 192iridium applicator during anesthesia with mechanical ventilation, the nasogastric tube was used instead of an endotracheal tube for jet ventilation. Using a frequency of 60/min and a fresh-gas flow of 15 l/min, FIO2 = 1.0, normocapnic, normoxemic ventilation could be achieved during the whole procedure. It is concluded that the method can be considered as an alternative in patients with narrow airways, provided that airway-pressure monitoring and bronchoscopy to confirm the position of the tube are employed.
