In the management of patients with severe traumatic hemorrhagic shock, is zone 1 endovascular balloon occlusion of the aorta (REBOA) a safe and effective option compared to resuscitative thoracotomy (RT)? www.annemergmed.comChecking if the site connection is securewww.annemergmed.com needs to review the security of your connection before proceeding.Ray ID: 8087cd5b2c5fdc87Performance & security
Emergency Department Thoracotomy in Children: A PTS, WTA, and EAST Systematic Review and Practice Management Guideline This website uses cookies. By continuing you are agreeing to our privacy statement.CloseSkip to main contentEastern Association for the Surgery of TraumaJobsFellowshipsNews & EventsFind a MemberSearchSearchSIGN INEducation & ResourcesCareer DevelopmentResearchDevelopment FundScholarships & AwardsMembershipAbout EASTEducation & ResourcesAnnual Scientific AssemblyPractice Management GuidelinesTraumacastsEAST Monthly Literature ReviewsEAST MinuteLandmark Papers in Trauma and Acute Care SurgeryInjury Control and Violence PreventionMilitaryEAST StorycastsEAST Master ClassesHome/ Education & Resources/ Practice Management GuidelinesEmergency Department Thoracotomy in Children: A PTS
Preoperative susceptibility to developing secondary hyperalgesia is associated with post-thoracotomy pain at 2 months. Identifying the subset of patients at risk for developing persistent pain after surgery is clinically important as they could benefit from targeted prevention measures. In this prospective study, we investigated if the preoperative assessment of the individual susceptibility to developing experimentally induced secondary hyperalgesia is associated with post-thoracotomy pain at 2 months. Forty-one patients scheduled to undergo a posterolateral thoracotomy were recruited before surgery and followed prospectively for 2 months. The day before surgery, we experimentally induced secondary hyperalgesia at one of the two forearms and measured the change of perception to mechanical
Prehospital Resuscitative Thoracotomy for Traumatic Cardiac Arrest. Traumatic cardiac arrest (TCA) presents a critical challenge in trauma care, often occurring rapidly after injury before effective interventions are available. To evaluate the association of prehospital resuscitative thoracotomy with survival outcomes for TCA. This retrospective cohort study examined all cases of prehospital resuscitative thoracotomy for TCA in London from January 1999 to December 2019. Data were analyzed from July 2022 to July 2023. Prehospital resuscitative thoracotomy for TCA. The primary outcome was survival to hospital discharge. Secondary outcomes included survival to hospital admission and neurological status at discharge. Prehospital resuscitative thoracotomy was undertaken in 601 patients with out
Long-term survival from a randomized controlled trial of lobectomy by video-assisted thoracoscopic surgery versus thoracotomy for early-stage lung cancer. We previously did a randomized clinical trial of lobectomy by VATS or thoracotomy for early-stage lung cancer and found that patients who underwent VATS had less postoperative pain and better quality of life compared with thoracotomy. VATS has ) or anterolateral thoracotomy (n = 103) for proven or suspected early-stage NSCLC. Records from patients with NSCLC on final pathology were identified in the national electronic patient-record system and the Danish Lung Cancer Registry. Overall, disease-free, and cancer-specific survival were estimated using the Kaplan-Meier method and log-rank test was used to compare the two interventions. A total of 196
Effect of one-lung ventilation in children undergoing lateral thoracotomy cardiac surgery with cardiopulmonary bypass on postoperative atelectasis and postoperative pulmonary complications. Right lateral thoracotomy is increasingly used because of its cosmetic benefits, shorter hospital stays, rapid return to full activity, and ease of reoperation in pediatric patients with uncomplicated congenital heart disease. Currently, one-lung ventilation (OLV) is used in these children to facilitate surgical exposure. We aimed to assess the effect of OLV on postoperative outcomes. Children aged 6 months to 6 years undergoing right lateral thoracotomy cardiac surgery with cardiopulmonary bypass (CPB) were randomized into an OLV group or a control group. For the OLV group, the tidal volume was 5 ml/kg
Spinal deformity after thoracotomy in children with pulmonary hydatid disease. Pulmonary hydatid cyst disease is a common zoonotic infection, especially in agricultural and livestock communities. Thoracotomy is an important surgical procedure in the treatment of pulmonary hydatid cysts in children. However, the development of a spinal deformity is one of the long-term musculoskeletal complications of this procedure. The aim of this study was to evaluate the incidence, risk factors and clinical outcomes of spinal deformity in pediatric patients after thoracotomy. Between 2008 and 2022, 116 pediatric patients who underwent thoracotomy for pulmonary hydatid disease and met the study criteria were retrospectively reviewed. Age, sex, side of surgery, pre- and postoperative spinal radiographs
Comparison of Intercostal Block and Epidural Analgesia for Post-thoracotomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials Thoracotomy is associated with severe postoperative pain. Effective management of acute pain after thoracotomy may reduce complications and chronic pain. Epidural analgesia (EPI) is considered the gold standard for postthoracotomy analgesia; however , it is associated with complications and limitations. Emerging evidence suggests that an intercostal nerve block (ICB) has a low risk of severe complications. Anesthetists will benefit from a review that assesses the advantages and disadvantages associated with ICB and EPI in thoracotomy. This meta-analysis aimed to evaluate the analgesic efficacy and adverse effects of ICB and EPI for pain treatment after
Developing a clamshell thoracotomy training model to support hybrid teaching in simulation-based education. Thoracotomy is an acute, time-sensitive procedure. Simulation-based education provides a safe-learning platform to learn these techniques under close supervision. We used the spiral model and concepts of functional fidelity to guide the evolutionary design and fabrication of a hybrid thoracotomy simulator. This model simulates a clamshell thoracotomy that physically integrates with bespoke manikins and adds a high-fidelity technical skills element to immersive team-based simulation training. We describe the creation of a thoracotomy simulation model that allows trainees to practice these techniques in a safe-learning environment.
Erector spinae plane block as an anesthesia technique for an emergent thoracotomy; a case report. The erector spinae plane block (ESPB) is a novel regional block technique for pain management following thoracic surgeries. However, there are minimal cases in which the technique was used as the main anesthesia technique during surgery. Here, we report the successful use of ESBP for applying anesthesia in a case during an emergent thoracotomy for performing pericardiotomy and loculated tamponade evacuation. Using ESPB with a higher concentration of local anesthetics, in this case, prepared appropriate anesthesia for performing an emergent thoracotomy while avoiding multiple needle insertions and the risk of further hemodynamic instability.
Comparison of Dexmedetomidine and Ketamine in Serratus Anterior Plane Block for Postoperative Pain Control in Thoracotomy Patients: A Randomized Clinical Trial. Postoperative pain control after thoracotomy is very important, and if not controlled, it can cause severe complications. This study aimed to compare dexmedetomidine and ketamine in serratus anterior plane block (SAPB) in pain control after thoracotomy. This randomized clinical trial was conducted on 74 patients aged 18 to 60 years old with American Society of Anesthesiologists (ASA) class I or II who were referred to Imam Khomeini hospital in Ahvaz, Iran, for thoracotomy and randomly divided into two groups. After surgery, the SAPB with ultrasound-guided was performed. In the ropivacaine-ketamine (RK) group, ketamine 0.5 mg/kg
Comparison of Postoperative Opioid Consumption of Paravertebral Block and Erector Spinae Plane Block After Thoracotomy: A Randomized Controlled Trial. Background Thoracotomy is associated with severe postoperative pain. Pain developing after thoracotomy causes lung infections, inability to expel secretions, and atelectasis as a result of deep breathing. Effective management of acute pain after thoracotomy may prevent these complications. A multimodal approach to analgesia is widely employed by thoracic anesthetists using a combination of regional anesthetic blockade and systemic analgesia, with both non-opioid and opioid medications and local anesthesia blockade. Nowadays, regional anesthesia techniques such as thoracic epidural paravertebral block (PVB), erector spinae plane block (ESPB
Laparoscopic or open abdominal surgery with thoracotomy for patients with oesophageal cancer: ROMIO randomized clinical trial. This study investigated if hybrid oesophagectomy with minimally invasive gastric mobilization and thoracotomy enabled faster recovery than open surgery. In eight UK centres, this pragmatic RCT recruited patients for oesophagectomy to treat localized cancer. Participants
Pain management after thoracotomy with dexamethasone and bupivacaine through a peripleural cather: a randomized controlled trial. Thoracotomy procedures can result in significant pain and cause nausea/vomiting. Glucocorticoids have anti-emetic and analgesic effects due to their anti-inflammatory and nerve-blocking properties. This study investigates the additive effect of local dexamethasone with bupivacaine as sole analgesic medication through a peripleural catheter after thoracotomy. The study was conducted as a randomized control trial on 82 patients. Participants were allocated to receive either 2.5 mg/kg of bupivacaine plus 0.2 mg/kg of dexamethasone or 2.5 mg/kg of bupivacaine plus the same amount of normal saline as placebo through a 6 French peripleural catheter implemented above
Fractures and other chest wall abnormalities after thoracotomy for esophageal cancer: A retrospective cohort study. Chest pain following a thoracotomy for esophageal cancer is frequently reported but poorly understood. This study aimed to (1) determine the prevalence of thoracotomy-related thoracic fractures on postoperative imaging and (2) compare complications, long-term pain, and quality of life in patients with versus without these fractures. This retrospective cohort study enrolled patients with esophageal cancer who underwent a thoracotomy between 2010 and 2020 with pre- and postoperative CTs (<1 and/or >6 months). Disease-free patients were invited for questionnaires on pain and quality of life. Of a total of 366 patients, thoracotomy-related rib fractures were seen in 144 (39
Criteria for continuous neuraxial analgesia associated with reduced mortality in patients undergoing thoracotomy. Both thoracic epidural analgesia and thoracic paravertebral analgesia are effective techniques to control pain and minimize the stress response following thoracic surgery. We hypothesized that continuous neuraxial techniques may be associated with a decrease in the incidence of postoperative mortality after thoracotomy. Additionally, we aimed to identify subgroup populations that may benefit more from neuraxial anesthesia. 1620 patients who underwent open thoracotomy were included in this retrospective study from the German Thoracic Registry database at four university hospitals. All-cause inpatient mortality was determined for patients who had and did not have neuraxial anesthesia
Impact of cryoablation on operative outcomes in thoracotomy patients. Cryoablation is increasingly being utilized as an alternative to epidurals for patients undergoing thoracotomies. Current evidence suggests cryoablation may decrease postoperative analgesia utilization, but could increase operative times. We hypothesized that the adoption of intraoperative cryoablation to manage post -thoracotomy pain would result in reduced length of stay and reduced perioperative analgesia compared to routine epidural use. A retrospective analysis was performed from a single, quaternary referral centre, prospective database on patients receiving thoracotomies between January 2020 and March 2022. Patients undergoing transthoracic hiatal hernia repair, lung resection or double-lung transplant were
Predictors of pulmonary metastases on chest computed tomography in children and adolescents with osteosarcoma-tips for qualifying patients for thoracotomy. Osteosarcoma is the most common primary malignant bone tumour in children and adolescents. Lungs are the most frequent and often the only site of metastatic disease. The presence of pulmonary metastases is a significant unfavourable prognostic factor. Thoracotomy is strongly recommended in these patients, while computed tomography (CT) remains the gold imaging standard. The purpose of our study was to create tools for the CT-based qualification for thoracotomy in osteosarcoma patients in order to reduce the rate of useless thoracotomies. Sixty-four osteosarcoma paediatric patients suspected of lung metastases on CT and their first
Muscle-sparing Vertical Thoracotomy in Children and Adolescents. Traditional posterolateral thoracotomy (PLT) is a painful and potentially morbid operation associated with an extensive recovery and a long, unsightly scar. In contrast, vertical thoracotomy (VT) is designed to spare muscles, avoid skin flaps, and minimize incision length, thereby limiting postoperative pain, hastening recovery 3.5 ± 1.8mgOME/kg, p = 0.035) compared to those who underwent PLT. Additionally, no patients in the VT group required division of the serratus or latissimus, compared to 8 (8%) in the PLT group (p = 0.004). Muscle-sparing vertical thoracotomy provides excellent exposure for most intrathoracic pediatric operations, results in a cosmetically acceptable scar that is easily hidden by the upper arm, may
Ropivacaine versus ropivacaine plus dexmedetomidine in serratus anterior plane block patients undergoing post-thoracotomy surgery: a randomized, double-blinded clinical trial. This study was designed and implemented to investigate the addition of dexmedetomidine to Serratus Anterior Plane Block (SAP) with ropivacaine in reducing pain in patients undergoing post-thoracotomy surgery. This study included patients classified as American Society of Anesthesiology (ASA) Physical Status II, with a body mass index (BMI) under 40, who were undergoing thoracotomy at Imam Khomeini Hospital in Ahvaz. The subjects were randomly divided into two groups using a randomized controlled trial design. After surgery, in the recovery room, SAP was performed for patients with ropivacaine (0.4 ml/kg of 0.2