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Background 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. Methods 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 with 6 cmH₂O positive end-expiratory pressure from the incision until the end of CPB, whereas patients in the control group received two-lung ventilation, except during vena cava occlusion. Lung ultrasonography was performed twice in the supine position for each patient: first, 3 min after intubation before surgery (T 1 ), and second, 3 min after lung recruitment maneuvers at the end of surgery (T 2 ). The primary outcome was the incidence of postoperative pulmonary complications within 72 h of surgery and significant atelectasis (defined by a consolidation score of ≥ 2 in any region) at T 2 . Results Overall, 54/96 (56.3%) children developed postoperative pulmonary complications after lateral thoracotomy cardiac surgery with CPB. The incidence of postoperative pulmonary complications was 52.1% (25/48) and 60.4% (29/48) in the OLV and control groups, respectively (odds ratio: 0.712; 95% confidence interval: 0.317–1.600; p  = .411). At the end of surgery, the incidence of significant atelectasis was 37.5% in the OLV group compared to 64.6% in the control group (odds ratio: 0.329; 95% confidence interval: 0.143–0.756; p  = .008). The consolidation score of the left lung (dependent lung) in the OLV group was significantly lower than that in the control group ( p  = .007); there was no significant difference in the right lung's postoperative consolidation score between the two groups ( p  = .051). Conclusions There was no significant difference in the incidence of postoperative pulmonary complications within 72 h of surgery between the two groups. However, children who underwent right lateral thoracotomy cardiac surgery with CPB in the OLV group showed a low incidence of atelectasis at the end of surgery. Trial registration ChiCTR, ChiCTR2100048720. Registered on July 13, 2021, www.chictr.org.cn .

IntroductionLung cancer is a leading cause of cancer deaths worldwide and surgery remains the main treatment for early stage disease. Prior to the introduction of video-assisted thoracoscopic surgery (VATS), lung resection for cancer was undertaken through an open thoracotomy. To date, the evidence base supporting the different surgical approaches is based on non-randomised studies, small randomised trials and is focused mainly on short-term in-hospital outcomes.Methods and analysisThe VIdeo assisted thoracoscopic lobectomy versus conventional Open LobEcTomy for lung cancer study is a UK multicentre parallel group randomised controlled trial (RCT) with blinding of outcome assessors and participants (to hospital discharge) comparing the effectiveness, cost-effectiveness and acceptability of VATS lobectomy versus open lobectomy for treatment of lung cancer. We will test the hypothesis that VATS lobectomy is superior to open lobectomy with respect to self-reported physical function 5 weeks after randomisation (approximately 1 month after surgery). Secondary outcomes include assessment of efficacy (hospital stay, pain, proportion and time to uptake of chemotherapy), measures of safety (adverse health events), oncological outcomes (proportion of patients upstaged to pathologic N2 (pN2) disease and disease-free survival), overall survival and health related quality of life to 1 year. The QuinteT Recruitment Intervention is integrated into the trial to optimise recruitment.Ethics and disseminationThis trial has been approved by the UK (Dulwich) National Research Ethics Service Committee London. Findings will be written-up as methodology papers for conference presentation, and publication in peer-reviewed journals. Many aspects of the feasibility work will inform surgical RCTs in general and these will be reported at methodology meetings. We will also link with lung cancer clinical studies groups. The patient and public involvement group that works with the Respiratory Biomedical Research Unit at the Brompton Hospital will help identify how we can best publicise the findings.Trial registration number ISRCTN13472721

Objective Protein-rich nutrition is necessary for wound healing after surgery. In this study, the benefit of preoperative nutritional support was investigated for non-small cell lung cancer patients who underwent anatomic resection. Methods A prospective study was planned with the approval of our institutional review board. Fifty-eight patients who underwent anatomic resection in our department between January 2014 and December 2014 were randomized. Thirty-one patients were applied a preoperative nutrition program with immune modulating formulae (enriched with arginine, omega-3 fatty acids and nucleotides) for ten days. There were 27 patients in the control group who were fed with only normal diet. Patients who were malnourished, diabetic or who had undergone bronchoplastic procedures or neoadjuvant therapy were excluded from the study. Patients’ baseline serum albumin levels, defined as the serum albumin level before any nutrition program, and the serum albumin levels on the postoperative third day were calculated and recorded with the other data. Results Anatomic resection was performed by thoracotomy in 20 patients, and 11 patients were operated by videothoracoscopy in the nutrition program group. On the other hand 16 patients were operated by thoracotomy and 11 patients were operated by videothoracoscopy in the control group. In the control group, the patients’ albumin levels decreased to 25.71 % of the baseline on the postoperative third day, but this reduction was only 14.69 % for nutrition program group patients and the difference was statistically significant ( p  < 0.001). Complications developed in 12 patients (44.4 %) in the control group compared to 6 patients in the nutrition group ( p  = 0.049). The mean chest tube drainage time was 6 (1–42) days in the control group against 4 (2–15) days for the nutrition program group ( p  = 0.019). Conclusions Our study showed that preoperative nutrition is beneficial in decreasing the complications and chest tube removal time in non-small cell lung cancer patients that were applied anatomic resection with a reduction of 25 % in the postoperative albumin levels of non-malnourished patients who underwent resection.

Background 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. Methods 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% ropivacaine solution) (group R) and ropivacaine plus dexmedetomidine (0.5 μg/kg) (group RD). Pain (with verbal rating scale, VNRS), blood pressure (systolic, diastolic, and mean arterial pressure (MAP)), heart rate (HR), and blood oxygen saturation (O2 sat) were measured and recorded before the intervention, and 1, 6, 12, 24, and 48 h after the intervention. Results Finally, 74 patients were included in this study. Both groups exhibited significant pain reduction at one hour, with sustained pain relief observed in the RD group at 6, 12, and 24 h ( P  < 0.001). The RD group also showed having lower values HR and MAP at 6 and 12 h ( P  < 0.001). Patients in the RD group received painkillers faster ( P  = 0.005) and required lower total narcotic usage ( P  < 0.0001). Two RD group patients experienced transient bradycardia, which resolved without treatment. Conclusion The findings of this study show that SAP block with dexmedetomidine is an effective and safe drug along with ropivacaine as a nerve-blocking agent in thoracotomy candidates.

Lung adenocarcinoma (NSCLC) is a common subtype of lung cancer, and its prevalence has gradually increased in recent years. There are various treatment methods for NSCLC, and surgical resection, as one of the important treatments, is crucial to improving the survival rate and quality of life of patients. To explore the effect and complications of video-assisted thoracic surgery (VATS) and radical thoracotomy for lung cancer (RTLC) in the treatment of stages IIB-IIIA non-small cell lung cancer (NSCLC). A total of 80 patients with NSCLC admitted to the hospital were enrolled between June 2019 and January 2021. According to the random number table method, they were divided into the VATS group (40 cases, VATS) and RTLC group (40 cases, RTLC). The operation time, intraoperative blood loss, postoperative drainage time, number of lymph node dissections, score of visual analogue scale (VAS) at 24 h after surgery, and hospitalization time were compared between the two groups. We chose specific inclusion criteria, including patients diagnosed with non-small cell lung cancer (NSCLC) who did not receive radiation therapy or chemotherapy before surgery, to ensure consistency and comparability across studies. We focused on indicators related to lung function and immune system, such as CD3+, CD4+ and CD8+ levels, as well as FEV1, FVC and MVV, to evaluate the impact of surgery on lung function and immune status. The levels of CD3+, CD4+, and CD8+ in both groups were detected by flow cytometry at 1 d before surgery and 3 d after surgery. The forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and maximal voluntary ventilation (MVV) in both groups were detected by spirometry before and at 1 month after surgery. The occurrence of postoperative complications in both groups was recorded. After 12 months of follow-up, survival rates in both groups were statistically analyzed. The progression-free survival (PFS) and 12-month overall survival (OS) in both groups were analyzed by the Kaplan-Meier method. The incision length, operation time, intraoperative blood loss, postoperative drainage time, VAS score at 24 h after surgery, and hospitalization time in VATS group were significantly lower than those in RTLC group (P < .05). The two groups had no significant difference in the number of lymph node dissections (P > .05). At 3 d after surgery, levels of CD3+, CD4+ and CD8+ in VATS group were significantly higher than those in RTLC group (P < .05). At 1 month after surgery, FEV1, FVC, and MVV in VATS group operation were significantly higher than those in RTLC group (P < .05). The incidence of postoperative complications in VATS group was lower than that in RTLC group (5.00% vs. 20.00%) (P < .05). Kaplan-Meier survival analysis showed that there was no significant difference in 12-month OS or PFS between the two groups (P > .05). The long-term curative effect of VATS and RTLC is comparable on patients with stages IIB-IIIA NSCLC. The former has advantages such as less surgical injury, faster postoperative recovery, and higher safety, which can reduce the incidence of postoperative complications. This study provides clinicians with important information about the treatment of stage IIb ~ IIIa NSCLC and helps them choose surgical methods more wisely. These results also alert physicians to focus on operative time, blood loss, and complication risk to maximize patient outcomes.

Introduction 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. Method 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 the parietal pleura and beneath the musculoskeletal structure of the chest wall. The primary outcome was the severity of pain 24 h after the operation in the visual analogue scale (VAS) score. Secondary outcomes were the incidence of nausea/vomiting, opioid consumption for pain control, and incidence of any adverse effects. Results : A total of 50 participants were randomized to each group, and the baseline characteristics were similar between the groups. Median of VAS score (6 (3-8) vs. 8 (6-9), p  < 0.001), postoperative opioid consumption (9 (36%) vs. 17 (68%) patients, p =0.024), and median length of hospital stay (4 (3-8) vs. 6 (3-12) days, p  < 0.001) were significantly lower in the dexamethasone group. However, postoperative nausea/vomiting ( p =0.26 for nausea and p =0.71 for vomiting) and surgical site infection ( p = 0.55) were similar between the two groups. Conclusion In thoracotomy patients, administering local dexamethasone + bupivacaine through a peripleural catheter can reduce postoperative pain, analgesic consumption, and length of hospital stay. Trial Registration Iranian Registry of Clinical Trials (IRCT20220309054226N1, registration date: 3/21/2022.

Background The clamshell incision (CI) offers a better exposure than the left anterolateral thoracotomy (LAT) as a resuscitative thoracotomy. Most surgeons will have to manage a heart wound only once or twice in their career. The patient’s survival depends on how fast the surgeon can control the heart wound; however, it is unclear which of the two incisions allows for faster control in the hands of inexperienced surgeons. The aim of this study was to compare the time needed to access and control a standardized stab wound to the right ventricle, by inexperienced surgical trainees, by LAT or CI; we hypothesized that the CI does not take longer than the LAT. Methods Sixteen residents were shown a video on how to perform both procedures. They were randomly assigned to control a standardized stab wound of the right ventricle on perfused human cadavers by LAT ( n  = 8) or CI ( n  = 8). Access time (skin to maximal exposure), control time (maximal exposure until control of the heart wound) and total time (the sum of access and control times) were recorded. Results Total time was 6.62 min [3.20–8.14] (median [interquartile range]) for LAT and 4.63 min [3.17–6.73] for CI ( p  = 0.46). Access time was 2.39 min [1.21–2.76] for LAT and 2.33 min [1.58–4.86] for CI ( p  = 0.34). Control time was 4.16 min [2.32–5.49] for LAT and 1.85 min [1.38–2.23] for CI ( p  = 0.018). Conclusions The time needed from skin incision until cardiac wound control via CI was not longer than via LAT and the easier control of the cardiac wound when using CI was confirmed.

Background Aortic coarctectomy (AC) is associated with marked intraoperative hemodynamic alterations and significant post-thoracotomy pain. In this study, the analgesic effects of erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) were compared. Methods 28 pediatric patients were randomized into the ESPB group (received unilateral ESPB using a volume of 0.4 ml/kg of bupivacaine 0.25% and lidocaine 1% on the same side of the planned thoracotomy) and the SAPB group (received unilateral block by injecting the same local anesthetic volume and mixture at the level of the 5th rib). Both blocks were given after anesthetic induction. The primary endpoint was total intraoperative fentanyl dose, while postoperative pain scores and the first 24 h morphine dose were secondary endpoints. Results Intraoperative fentanyl consumption (mcg/kg) didn’t show a significant difference between the ESPB group (1.21 ± 0.43) and the SAPB group (1.36 ± 0.5), mean difference = 0.14, 95% CI (-0.21 to 0.50), p value = 0.421. Pain scores and first 24 h. morphine dose after surgery were comparable between both groups, p  > 0.05. Conclusion Both SAPB and ESPB provided comparable perioperative analgesia in pediatric AC, which was reflected by comparable intraoperative fentanyl dose, postoperative pain scores, and postoperative morphine dosage. Trial registration NCT06567275, trial registration date: (22-08-2024)

Background Thoracoscopic surgery has greatly alleviated the postoperative pain of patients, but postsurgical acute and chronic pain still exists and needs to be addressed. Indwelling drainage tubes are one of the leading causes of postoperative pain after thoracic surgery. Therefore, the aim of this study was to explore the effects of alternative drainage on acute and chronic pain after video-assisted thoracoscopic surgery (VATS). Methods Ninety-two patients undergoing lung wedge resection were selected and randomly assigned to the conventional chest tube (CT) group and the 7-Fr central venous catheter (VC) group. Next, the numeric rating scale (NRS) and pain DETECT questionnaire were applied to evaluate the level and characteristics of postoperative pain. Results NRS scores of the VC group during hospitalization were significantly lower than those of the CT group 6 h after surgery, at postoperative day 1, at postoperative day 2, and at the moment of drainage tube removal. Moreover, the number of postoperative salvage analgesics (such as nonsteroidal anti-inflammatory drugs [(NSAIDs]) and postoperative hospitalization days were notably reduced in the VC group compared with the CT group. However, no significant difference was observed in terms of NRS pain scores between the two groups of patients during the follow-up for chronic pain at 3 months and 6 months. Conclusion In conclusion, a drainage strategy using a 7-Fr central VC can effectively relieve perioperative pain in selected patients undergoing VATS wedge resection, and this may promote the rapid recovery of such patients after surgery. Trial registration ClinicalTrials.gov, NCT03230019. Registered July 23, 2017.

Background. Shedding of the endothelial glycocalyx layer (EGL) is known to occur during major surgery, but its degradation associated with minimally invasive video-assisted thoracoscopy (VATS) remains unclear. We investigated if serum biomarkers of EGL disruption were elevated during VATS lobectomy, and whether the urinary trypsin inhibitor (UTI) ulinastatin exerted a protective effect during this procedure. Materials and Methods. Sixty ASA II-III lung cancer patients undergoing elective VATS lobectomy were divided equally into UTI and control groups. UTI group patients received intravenous UTI during surgery. Serum levels of syndecan-1 and heparan sulfate were examined before (T0) and at the end of surgery (T1). Serum albumin and hemoglobin were measured before surgery (BOD) and on the first postoperative day (POD1). Results. In control group, syndecan-1 levels were significantly elevated at T1 compared with T0 (3.77±3.15 versus 4.28±3.30, P=0.022⁎) and increased even more significantly in patients whose surgery lasted >3 h (3.28±2.84 versus 4.31±3.39, P=0.003⁎⁎). Serum albumin levels on POD1 were significantly lower in control group compared with UTI group (32.63±4.57 versus 35.76±2.99, P=0.031⁎). Conclusion. EGL degradation occurs following VATS lobectomy. UTI can alleviate this shedding, thus helping preserve normal vascular permeability. Trail Registration. This trial is registered with ChiCTR-IOC-17010416 (January 13, 2017).