Catheterization in an ultrasound-guided thoracic paravertebral block using thoracoscopy.

Thoracic paravertebral block (TPVB) is an efficient alternative to epidural anesthesia. The location of a catheter within the thoracic paravertebral space (TPVS) has been examined in the human cadaver studies, but it is unclear how it goes into the TPVS during catheterization. In this report, thoracoscopy was used to observe the thoracic cavity in real-time during a parasagittal in-plane approach of ultrasound-guided TPVB. During thoracoscopy, we observed whether a paravertebral catheter could be advanced caudally beyond the ribs into the neighboring TPVS. Our result demonstrated that the catheter was difficult to be advanced beyond the ribs and confined within the same level of TPVS as where it was inserted. In the previous thoracoscopic observation of the paravertebral spread, we assumed that the local anesthetic acts most strongly at the intercostal level of the injection. Therefore, we recommend to insert the catheter for TPVB at the level corresponding to the incision site of thoracotomy.

Monitoring hepatic venous hemoglobin oxygen saturation in patients undergoing liver surgery.

Hepatic venous oxygen saturation (ShvO2) was continuously monitored in 33 consecutive patients undergoing hepatic lobectomy. Fiberoptic pulmonary artery catheters were inserted into the hepatic vein (HV) and in the pulmonary artery through the right internal jugular vein before anesthetic induction. The success rate and mean time for HV catheterization were 100% and 14 min, respectively. The only complication of the procedure was nonsustained atrial or ventricular arrhythmias. Eighteen patients showed decreases in ShvO2 to less than 30% at skin incision, at temporary cessation of hepatic inflow, and/or at surgical manipulation of the liver. Clinical HV catheterization was easy to accomplish and may be a valuable technique in studying the extent and significance of hepatic ischemia during liver surgery.