A retrospective evaluation of the use of video-capable double-lumen endotracheal tubes in thoracic surgery.

OBJECTIVE: The objective of this study was to evaluate whether the use of a video double-lumen tube reduced the need for fiberoptic bronchoscopy for (1) verification of initial tube placement and for (2) reverification of correct placement after repositioning for thoracotomy. DESIGN: A single-center retrospective study. SETTING: Thoracic surgery in a medical university hospital. PARTICIPANTS & INTERVENTIONS: After institutional review board approval, 29 patients who underwent thoracic surgical procedures using video double-lumen tubes were included in the final retrospective analysis. MEASUREMENTS AND MAIN RESULTS: For 27 (93.2%) patients, the use of fiberoptic bronchoscopy was not needed either for initial placement or for verification of correct video double-lumen tube placement upon final positioning of the patient. However, for two patients, fiberoptic bronchoscopy was needed: for (1) one patient with severe left mainstem bronchus distortion as a result of a large left upper lobe tumor, and (2) a second patient with secretions that were difficult to clear. CONCLUSION: This study demonstrates that the video double-lumen tube requires significantly less (6.8%) fiberoptic use for both initial placement and verification of final position, in stark contrast to standard practice in which bronchoscopy is always used to verify final positioning of the double-lumen tube. As opposed to intermittent bronchoscopy, the continuous visualization offered by an embedded camera may confer an added measure of safety.

Evaluation of digital thermal monitoring as a tool to assess perioperative vascular reactivity.

AIM: The inflammatory response following tissue injury after major surgery is known to affect endothelial function and vascular reactivity. In this study we evaluated the utility of bedside Digital Thermal Monitoring (DTM) as a surrogate for evaluating vascular function in the postoperative period. METHODS: Ischemia-induced reactive hyperemia variables were measured in sixty patients scheduled for major thoracic surgery using DTM (VENDYS 5000BC; Endothelix, Inc., Houston, TX, USA) at baseline and at 24, 48, 72 hours, and day 5 postoperatively. Furthermore, baseline DTM variables (TR, aTR and AUCTR) and postoperative kinetics of these variables were compared among patients with and without preoperative chemo-radiation and cardiovascular risk factors. RESULTS: There were no significant differences in the DTM parameters measured at baseline and on each of the studied postoperative days. Compared to the baseline, the lowest measures of all variables were observed 24 hrs postoperatively and the highest measures of all variables were observed at 72 hrs. Patients with abdominal obesity and smoking had lower DTM values than the rest of the study group. CONCLUSIONS: In our study, DTM as measured by the VENDYS 5000BC DTM system (Endothelix, Inc.) did not reveal significant changes in ischemia-induced reactive hyperemia (vascular reactivity) between the baseline and after surgery in the postoperative period. Patients with certain cardiovascular risk factors (abdominal obesity, smoking) had a significant lower DTM signal. Whether this novel non-invasive technique is able to serve as a perioperative diagnostic tool for patients in a clinical setting warrants further study.

Intravenous anesthesia for thoracic procedures.

PURPOSE OF REVIEW: The article reviews the rationale for using intravenous anesthesia for thoracic operations, the drugs and equipment required, and the methodology involved. RECENT FINDINGS: Recent studies examining whether total intravenous anesthesia offers a physiological advantage over inhalational anesthesia for thoracic surgery remain inconclusive. Nevertheless, total intravenous anesthesia is preferable for certain thoracic procedures incompatible with effective delivery of inhalational anesthetics. Additionally, total intravenous anesthesia offers advantages in procedures conducted in nonideal environments, such as offsite or austere scenarios. SUMMARY: Total intravenous anesthesia is indicated for procedures in which inhalational anesthetics may not be safely or effectively delivered, including endobronchial procedures using flexible or rigid bronchoscopy and proximal airway-disrupting surgeries. Total intravenous anesthesia may be beneficial in lung volume reduction surgery, lung transplantation and thymectomy. Total intravenous anesthesia is safer and more practical for thoracic procedures performed outside of the operating room, such as offsite locations, military field or impoverished areas of the world. Propofol, dexmedetomidine, ketamine and remifentanil may be used in combination with anesthetic depth monitoring to execute an effective total intravenous anesthesia regimen. Target-controlled infusion may improve the delivery of total intravenous anesthesia and is a focus for future research. This article reviews the balanced total intravenous anesthesia technique currently used at the University of Texas M.D. Anderson Cancer Center.