Preoperative thoracic epidural analgesia with and without erector spinae plane block for thoracotomy: A retrospective study

Journal of the Formosan Medical Association, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 1, 2025

Thoracotomy is a highly painful surgical procedure, with thoracic epidural analgesia (TEA) serving as the gold standard for postoperative pain management. However, TEA can induce significant hypotension, especially when combined general anesthesia. The ultrasound-guided erector spinae plane block (ESPB) has emerged complementary technique enhancing while minimizing side effects. This study compares analgesic efficacy and intraoperative hemodynamic outcomes of preoperative without ESPB in patients undergoing thoracotomy. retrospective cohort was conducted at tertiary university hospital, including who underwent thoracotomy tumor resection between March 2017 2023. Patients receiving prior to were compared those alone. Postoperative intensity stability assessed. primary outcome scores, secondary included mean arterial pressure such length hospital stay. A total 64 enrolled study, 43 received alone 21 combination ESPB. After propensity score matching, matched 1:1 each group comparative analysis. addition had significantly lower scores 1 h 24 postoperatively (p < 0.001). Additionally, they demonstrated higher pressures = 0.036) TEA-only group. there no differences outcomes. provides superior early control enhances

Language: Английский

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The Role of Cytokines in Perioperative Neurocognitive Disorders: A Review in the Context of Anesthetic Care

Biomedicines, Journal Year: 2025, Volume and Issue: 13(2), P. 506 - 506

Published: Feb. 18, 2025

Perioperative neurocognitive disorders (PNDs), including postoperative delirium, delayed recovery, and long-term disorders, present significant challenges for older patients undergoing surgery. Inflammation is a protective mechanism triggered in response to external pathogens or cellular damage. Historically, the central nervous system (CNS) was considered immunoprivileged due presence of blood-brain barrier (BBB), which serves as physical preventing systemic inflammatory changes from influencing CNS. However, aseptic surgical trauma now recognized induce localized inflammation at site, further exacerbated by release peripheral pro-inflammatory cytokines, can compromise BBB integrity. This breakdown facilitates activation microglia, initiating cascade neuroinflammatory responses that may contribute onset PNDs. review explores mechanisms underlying neuroinflammation, with particular focus on pivotal role cytokines pathogenesis

Language: Английский

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From Awake to Minimalist Spontaneous Ventilation Thoracoscopic Lung Surgery: An Ongoing Journey

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(7), P. 2475 - 2475

Published: April 4, 2025

Spontaneous ventilation lung surgery (SVLS) without intubation is aimed at avoiding adverse effects of mechanical (MVLS) entailing one-lung through a double-lumen tracheal tube. This innovative strategy has evolved following the publication small randomized study thoracoscopic pulmonary wedge resection carried out under spontaneous in fully awake patients. It now entails target-controlled sedation, use laryngeal mask, and thoracic analgesia by intercostal or paravertebral blocks shown promise both unicenter multicenter studies, resulting optimal feasibility safety highly satisfactory results, particularly patients undergoing cancer metastasectomy, biopsy for undetermined interstitial disease, volume reduction end-stage emphysema, bullectomy primary secondary pneumothorax. However, concerns unresolved issues still exist regarding advantages disadvantages SVLS as well identification indications. perspective providing critical overview current knowledge about with emphasis on recent data comparing results those MVLS published last 10 years.

Language: Английский

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Minimalinvasive Lungenchirurgie unter Spontanatmung (niVATS)

Zentralblatt für Chirurgie - Zeitschrift für Allgemeine Viszeral- Thorax- und Gefäßchirurgie, Journal Year: 2024, Volume and Issue: 149(S 01), P. S73 - S83

Published: Aug. 1, 2024

Non-intubated minimally invasive lung surgery garnered renewed interest during the past decade and many centers across country successfully implemented technique for minor procedures like pleurodesis or wedge resection. Anatomical resection under spontaneous breathing still is considered as challenging, existing data to support it conflicting confusing, approach remains limited few dedicated outfits. We seek present historical perspective, critically report potential advantages limitations of hand out a guideline that might prove be helpful in building up program.

Language: Английский

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