Surgical cases
Surgical cases
Maria I. Dalamagka
Chapter 1
J Pain Relief 2017, 6:5(Suppl), DOI: 10.4172/2167-0846-C1-015
5th International Conference and Exhibition on
Pain Research And Management, October 05-06, 2017, London, UK
A 31-year-old woman with reflex sympathetic dystrophy syndrome (CRPS): Case report
Maria Dalamagka
A case of a 31-year-old woman with complex regional pain syndrome type I (reflex sympathetic dystrophy syndrome) (CRPS) of the left arm is described. Brachial plexus block (BPB) has been cited as a treatment modality for CRPS. This report is based on the retrospective observations of the outcome and effects of axillary branchial plexus block (BPB) in a patient with CRPS. 31 -year-old woman suffered from CRPS of the left upper limb after trauma for 5 months. Symptoms over the left upper limb were not alleviated under conventional pharmacological treatment and rehabilitation and severe painful swelling of the left wrist persisted. Axillary BPB with 30 ml Naropeine 0.2% was performed and 12 hours later resulted in significant reduction of pain and improvement of function of the left wrist. Complex regional pain syndrome type I (CRPS I); formerly reflex sympathetic dystrophy) is a syndrome that develops after a trauma affecting the limbs, without obvious peripheral nerve lesion. Its features include pain and related sensory abnormalities, edema, autonomic dysfunction, movement disorder, and trophic changes. Typically, spontaneous pain or allodynia is not limited to the territory of a single peripheral nerve and is disproportionate to the inciting event. Numerous pathophysiologic components of the disease have been identified, including neurogenic inflammation, peripheral and central sensitization, and impaired sympathetic function. We present this case of 31 -year-old woman with CRPS of the upper extremity, who was treated with brachial plexus block. The woman was presented to the orthopaedic clinic, declaring that she could not use her left hand and resisted even the touch of anyone who attempted to examine it for the last five months. An orthopaedic consultation was assessed soon after her trauma, and no fracture nor soft tissue damage of the musculoskeletal system could be detected. She had severe pain, edema and limitation of passive flexion of the fingers. The diagnosis of CRPS was confirmed and anti-inflammatory medication started. The patient started a rehabilitation program of passive range of motion exercises, followed by occupational therapy to the left hand. The therapy was not able to diminish significantly her pain and function of the left hand within five months. Axillary BPB with 30 ml Naropaine 0.2% was performed and after 12 hours resulted in significant reduction of pain with gradual improvement of function of left hand. The edema also diminished and a week later the left hand had a perfect recovery. Based on the case reported brachial plexus block seems to have a significant effect. Despite the popularity of brachial plexus block, only few patients and poorly defined outcomes are reported in the literature, substantiating the need of well-designed studies on the effectiveness of the procedure.
Acupuncture and Related Therapies 2 (2014) 57. http://dx.doi.org/10.1016/j.arthe.2014.08.001-
Corpus ID: 73376443
-------Maria Dalamagka
https://www.researchgate.net/publication/382428764_ebookpdf.
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Chapter 2
https://academicstrive.com/IJARO/IJARO180005.pdf
Enliven Archive, 2018, 5(1), 1. ISSN: 2374-4448. Enliven: Journal of Anesthesiology and Critical Care Medicine. https://www.researchgate.net/publication/382428764_ebookpdf
Citation: Dalamagka M, et al. Surgery on obese patient under infusion with Dexdor. Int J Adv Res Ortho 2018, 1(1): 180005.
Surgery on obese patient under infusion with Dexdor
Numerous studies have demonstrated that the drugs currently used for sedation are associated with adverse events, particularly when combined with opiates.Regardless of the agent or agents used, it is important tomonitor the depth of sedation, allowing a rational “targeted sedation practice. Titration and interruption of sedative in fusions may be an important tool to maintain patients within a predefined target sedation range.Dexmedetomidine, when compared to conventional sedatives and opiates, has been demonstrated to be associated with both sedative and analgesic sparing effects, reduced delirium and agitation, minimal respiratory depression and predictable and desirable cardiovascular effects [1-10].
52 years old patient, ASA |||, weight 160Kg, Mallampati |||, with chronic obstructive pulmonary disease and sleep apnea syndrome, adhered to left brachy therapy fracture surgery. Prematured with 10 mg of ketamine, 10 μg of Fentanyl and Apotel 1g i.v. was given. An axillary block was made under ultrasound guidance with 0.5% Naropaine 30 ml, Lidocaine 10 ml 2%. A Dexdor infusion at a dose of 1.2μg / Kg / h with a calculated ideal weight of 85Kg (continuous infusion of 2μg / ml at a rate of 40 ml / h) was initiated 20 minutes before the start of the surgery. The dose was then changed to 1 μg / kg for 10 minutes and continued to 0.8 μg / kg. Local anesthesia was also performed with 20 ml Lidocaine 2%. Additionally, i.v. dose of 0.05mg Fentanyl was given.The patient had hemodynamic stability with blood pressure 110/70 mmHg, heart rate 80 and SpO2 93%. The surgery was lasting 2 hours, and the patient was totally satisfied as the surgery was completed with complete success.Due to the patient's particular problems, we did not choose general anesthesia as we would be facing a difficult airway and a need of ICU cover. In addition, although the axillary block at first appeared to be successful, the patient was disturbed by the control, so we chose Dexdor in order to avoid undesirable complications from respiratory depression
References
1. Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D,et al (1998) The use of continuous IV sedation is associated with prolongation of mechanical ventilation. Chest 114(2):541-548.
2. Peck TE, Hill SA, Williams M (2003) Pharmacology for Anaesthesia and Intensive Care. (2nd edn), Greenwich Medical Media London, UK, pp. 376.
3. Wolf A, Weir P, Segar P, Stone J, Shield J (2001) Impaired fatty acid oxidation in propofol infusion syndrome. Lancet 357(9256):606-607.
4. Corbett SM, Montoya ID, Moore FA (2008) Propofol related infusion syndrome in intensive care patients. Pharmacotherapy 28(2):250-258.
5. Shafer A (1998) Complication of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens. Crit Care Med 26(5): 947-956.
6. Riker RR, Fraser GL (2005) Adverse events associated with sedative, analgesic, and other medications to provide patient comfort in the ICU. Pharmacotherapy 25(5 pt 2):8s-18s.
7. Pisani MA, Murphy TE, Araujo KL, Slattum P, Van Ness PH, et al. (2009) Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population. Crit Care Med 37(1):177-183.
8. Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y (2007) Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 33(1):66-73.
9. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, et al. (2002) The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166(10):1338-1344.
10. Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342(20):1471-1477.
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Chapter 3
Maria Dalamagka
Aristotle University Electroacupuncture book Greek edition
https://www.researchgate.net/publication/382428532_Aristotle_University_Electroacupuncture_book_Greek_edition
Postoperative analgesia after low-frequency electroacupuncture as adjunctive treatment in inguinal hernia surgery with abdominal wall mesh reconstruction. Dalamagka M, Mavrommatis C, Grosomanidis V, Karakoulas K, Vasilakos D. Acupunct Med. 2015 Oct;33(5):360-7. doi: 10.1136/acupmed-2014-010689. Epub 2015 Jun 3. PubMed PMID: 26040491
https://www.researchgate.net/publication/382428282_Postoperative_analgesia_after_low-frequency_electroacupuncture_as_adjunctive_treatment_in_inguinal_hernia_surgery_with_abdominal_wall_mesh_reconstruction_Maria_Dalamagka_Christos_Mavrommatis_Vassilios#fullTextFileContent
International Conference on Pain Research & Management, October 03-04, 2016 Vancouver, Canada. J Pain Relief 2016, 5:5(Suppl) http://dx.doi.org/10.4172/2167-0846.C1.012
Abstract Citation: Dalamagka M, Mavrommatus C, Grosomanidis V, Karakoulas K, Vasilakos D. C Postoperative analgesia after electroacupuncture
PHYSIOTHERAPY 2020, Bangkok, Thailand, August 10-11, 2020, pp: 0-1.
Journal of Osteoporosis and Physical Activity ISSN: 2329-9509
8th International Conference on Physiotherapy & Physical Rehabilitation, Bangkok, Thailand, August 10-11, 2020
https://www.longdom.org/open-access-pdfs/postoperative-analgesia-after-electroacupuncture.pdf
Abstract: Post-operative pain after inguinal hernia surgery is attributed to surgical manipulation or placement of the preperitoneal mesh. Perioperative use of acupuncture can probably be a useful adjunct for postoperative analgesia. AIM: The aim of this study was to evaluate the effect of EA in mesh inguinal hernia open repair, using pain scales, anxiety questionnaire, the evaluation of pain with an algometer and measurements of stress hormones. Methods, Participants: 54 male patients were included in the study (23 inguinal left and 31 with inguinal right, classification in ASA I-II) submitted in programmed mesh inguinal hernia open repair with the technique Lichtenstein. Investigation parameters included: 1) Pain scales (VAS, PPI, VRS, SS, FS) and the anxiety questionnaire at 30′, 90′, 10 hours and 24 hours postoperatively. 2) Pain threshold and tolerance were evaluated preoperatively, before and after electroacupuncture, and postoperatively at 30′, 90′, 10 hours and 24 hours after surgery. 3) Blood levels of stress hormones cortisol, corticotropin and prolactin were measured at the same time points (excluding 24 hours). The frequency of complications of opiates was recorded. Patients were randomly allocated in 3 treatment groups of 18 patients. The three groups were: Group 1: placebo EA, Group 2: preoperative (40′) and postoperative (60′) EA, Group 3: preoperative, intraoperative and postoperative EA. The trial used low frequency EA of 2 Hz and frequency scanning mode. Needles were placed bilaterally at points of great analgesic effect. Electroacupuncture was applied to the points in pairs SP6–ST36; LI4–PC6; Shen-Men 55-Thalamus 26a. If the pain VAS score was greater than or equal to 3 cm within 90 minutes after surgery, an intravenous bolus dose of 5 mg pethidine was given and continuous intravenous infusion pump of pethidine at a rate of 10 mg/h was administered for 12 hours.
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Chapter 4
Dalamagka Maria, & Zervas Konstantinos. (2018). Seven main trends in Aesthetic Medicine in 2018. Clinical Pediatric Dermatology, 04. https://doi.org/10.21767/2472-0143-c2-006
Clinical Pediatric Dermatology 2021, vol.7
Wound Congress & Clinical Dermatology Congress 2018: Inhalation burn, crush-syndrome and rhabdomyolysis syndrom - Dalamagka Maria - UK University Medical Centre Schleswig-Holstein
5th International Conference on Advances in Skin, Wound Care and Tissue Science, 14th International Conference on Clinical Dermatology, October 15-16, 2018 Rome, Italy
International Journal of Clinical & Medical Informatics, 2018, 1(2), 82-84. ISSN: 2582-2268. https://www.researchgate.net/publication/382428764_ebookpdf
Corpus ID: 81582526
https://doi.org/10.4172/2167-0846.1000332
M. Dalamagka and K. Zervas
Inhalation burn is responsible for 50% of the mortality associated with thermal burn. Inhalation burns are usually observed in exposure to smoke, heat, toxic gases, and combustion components. Inhalation burn causes damage to airway epithelium, mucosal edema, and reduces surface activity. These conditions are clinically manifested by airway obstruction, bronchospasm and atelectasis. The area above the tongue is particularly vulnerable to thermal damage. Often the burn develops swelling and obstruction of the upper airways, which may not be immediately apparent. The larynx can be affected not only by thermal burn but also by the direct toxic action of irritant gases, showing early tibial swelling and laryngospasm.
Unlike the upper airway lesions, lesions of the tracheobronchial tree are almost never caused by heat. Heat burn of the lower airways is only observed in exceptional cases of fire in a saturated water vapor environment. The lesions are usually of a chemical nature of irritating gases and soot. The diagnosis is usually based on clinical behaviors such as: facial burns, soot deposition in the rat, pharynx, epiglottis and tongue, voice gurgle, laryngospasm image and bronchospasm. Smoke exfoliation is also a positive diagnostic point.
The burning of natural material (wood, wool, silk) and certain synthetic substances such as nylon and polyurethane causes the release of cyanide with the most important hydrogen cyanide. Their poisonous action is due to the binding of cytochrome oxidase and inhibition of oxygen uptake at the cellular level. Cyanide poisoning should be suspected of any victim of fire in an enclosed space where unexplained metabolic (lactic) acidosis occurs. Concentration of lactate> 10 mmol / L indicates a high probability of cyanide poisoning. Blood cyanide concentration greater than 40 mmol / L is considered to be toxic, with a concentration of 100 mmol / L being fatal. The clinical picture includes tachypnea, tachycardia, confusion, convulsions, metabolic acidosis, and at higher concentrations of respiratory depression and circulatory insufficiency.
The specific treatment of cyanide intoxication involves the administration of 25% sodium thiosulphate at a dose of 50 ml at an infusion rate of 2.5 ml / min, which converts cyanide into thiocyanates that are less toxic and are eliminated by the kidneys. Also reported is the administration of hydroxybutylamine (Vit B12) which binds cyanide to the formation of hydroxycyanocobalamin. The dose used is 5 g at slow intravenous infusion. Burn injury is characterized by the development of burnout. Burning shock is due to a combination of hypovolemia and local and systemic secretion of a large
number of mediators of inflammation. The most popular equation for calculating liquids is the Parkland equation: R / L 4ml × body weight (kg) ×% EU; 50% of the volume of fluid is given in the first 8 hours, the rest - 16 hours; If the EU assessment is not feasible, it is recommended to administer 20 ml / kg of body weight; crystalline solutions during the first hour of injury the first 24 term is recommended to use only crystallized solutions. Factors which increase the needs of the liquids delivered: Inhalation burns; Delay in fluid delivery; Electric burn; Extensive extent of burn surface; Concurrent injuries; In recent years, the so-called "fluid creep" phenomenon has been described Crush-syndrome and rhabdomyolysis syndrome: It was first described after a London bombing during the Second World War.
The syndrome occurs during natural disasters, wars, explosions, industrial accidents. Compression of muscle mass leads to tissue ischemia, an increase in tissue pressure, which exceeds the capillary filtration pressure. After lifting the external pressure, the muscle tissue is reperfused. The mechanism of ischemia-reperfusion injury is the major patho physiologylogical mechanism of this syndrome. Often, pressure damage is associated with vascular damage, traumatic vascular rupture, thrombosis and stroke. Occlusion syndrome is clinically manifested by hypoemia sequelae due to high accumulation of fluids in damaged tissues and by seo resulting from the release of large amounts of toxic substances from the injured tissues. The first manifestation of the syndrome is usually hypoaemic shock, which is the most common cause of death during the first 4 days after the injury. Hyperkalemia with its effect on heart function is the second cause of premature death. Myoglobin is a protein that accounts for 1-3% of the dry weight of the muscle tissue. Normally, myoglobin binds to actoglobinand α-2 globin and is eliminated through the duodenal endothelial system.
The saturation of aptoglobin (when a large amount is produced of myoglobin) leads to an increase in free myoglobin in plasma that is excreted by the kidneys. In the renal tubules, myoglobin forms casts, especially in acidic environment. Urine alkalinisation reduces the generation of these complexes. Myoglobin causes immediate action in the renal tubules, helping to increase free radicals of oxygen and promoting fat peroxidation. This action of myoglobin is also limited to alkaline environment. Patients usually experience: extensive soft tissue injury with ischemia-reperfusion effect, edematous edges, compartment syndrome, dark-colored urine, positive test for hemoglobin, absence of red blood cells in the urine, elevation of CPK levels in the blood.
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Chapter 5
Dalamagka Maria. (2020). Obesity - COVID-19 and mechanical ventilation of intubated patient. Journal of Clinical Images and Medical Case Reports, 1. https://doi.org/10.52768/2766-7820/1002
M Dalamagka (2020)
https://www.heraldopenaccess.us/article_pdf/1/obesity-covid-19-and-mechanical-ventilation-of-intubated-patient.pdf
https://jcimcr.org/articles/JCIMCR-v1-1002.html
Obesity - COVID-19 and Mechanical Ventilation of Intubated Patient. J Anesth Clin Care 7: 060. DOI: 10.24966/ACC-8879/100060
Journal of Addiction Research. ISSN: 2573 – 9514, volume 4/ issue 2/ 72 , Journal DOI: doi.org/10.33140/JAR.
J Clin Images Med Case Rep. 2020; 1(1), 1-2: 1002. Journal of Clinical Images and Medical Case Reports. www.jcimcr.org
Int J Fam Med Prim Care. 2021; 2(1), 1-2: 1030. International Journal of Family Medicine and Primary Care. Remedy Publications
Obesity as a disease causes a restrictive lung disease and is a sufficient predisposing factor for difficult ventilation of the patient in the ventilator. In addition to covid-19, the phenomenon of “hard lung” is observed as the ventilation of intubated patients is very arduous and recruitment requires a lot of effort. The combination is quite difficult as these patients oppose the ventilator. This paper aims to explore the link between obesity and mechanical ventilation in COVID-19 patients. The prevalence of adult obesity and severe obesity in 2017 to 2018 has increased since 2009 to 2010 and is now 42% and 9%, respectively [1]. Obesity is a global disease with at least 2.8 million people dying each year as a result of being overweight or obese according to the world health organization figures. Obesity is affecting most of the physiological processes and modifying the functions of the system including the immune system [2]. It is crucial to understand the effect of obesity on the course of infection to prevent or mitigate the morbidities and mortality[3,4]. In the current COVID-19 era, bariatric teams are aware of the potential risks and thus stressing the extra caution and appropriate management of these patients [5]. Knowing the scale of the obesity problem in the world, we anticipate difficult times for this group of patients in Europe, America, Middle East and rest of the world with a high rate of obesity [6]. In 2009, a significant percentage of admissions to the hospitals and mortality because of H1N1 Influenza a virus infection was due to obesity, an estimated 151,700–575,400 total deaths was reported U [7,8].
A 55 -year-old man, with a body weight of 130 kg and active covid-19 was intubated and put into mechanical ventilation with model ACV, FiO2 70% which gradually dropped to 50%, PEEP 18 which gradually dropped to 14, Tidal Volume 500 ml which gradually dropped to 480 ml and respiratory rate 30/min which gradually dropped to 25/min, and I: E ½ to 1/3 and finally to 1/4. Suppression of the patient was achieved by drip co-administration of Ultiva, Diprivan, Esmeron, Dormicum, and Levophed in titrated doses for the best possible ventilation of the patient. Obesity in combination with covid-19 leads to increased peak up to 60 and high airway resistance. Satisfactory dosing of Esmeron 60 mg / h and placement of low tidal volumes <500 ml, as well as respiratory rate < 30/min, PEEP < 16, appears to improve ventilator ventilation when co-administered: Ultiva, Diprivan, Dormicum at satisfactory levels in combination with Levophed to maintain hemodynamic stability.
Thus it appeared that low respiratory rate < 30/min and low tidal volume < 500 ml with a desired PEEP less than or equal to 14, has a beneficial effect on obese patients.
References
1. Hales K, Carroll MD, Fryar CD, Ogden CL (2020) Prevalence of obesity and severe obesity among adults: United States, 2017-2018. NCHS Data Brief, no. 360: 1-8.
2. Fischer-Posovszky P, Moller P (2020) The immune system of adipose tissue: obesity-associated inflammation. Pathologe 41: 224-229.
3. Houdek MT, Griffin AM, Ferguson PC, Wunder JS (2019) Morbid obesity increases the risk of postoperative wound complications, infection, and repeat surgical procedures following upper extremity limb salvage surgery for Soft tissue sarcoma. Hand (N Y) 14: 114-120.
4. Zhou X, Ye Y, Tang G, Zhou X (2018) Obesity and infection, accompanying phenomenon or causal association? Clin Microbiol Infect 24: 668.
5. Dietz W, Santos-Burgoa C (2020) Obesity and its implications for COVID-19 mortality. Obesity (Silver Spring) 28: 1005.
6. Bluher M (2019) Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol 15: 288-298.
7.Louie JK, Acosta M, Samuel MC (2011) A novel risk factor for a novel virus: obesity and 2009 pandemic influenza A (H1N1). Clin Infect Dis 52: 301-312.
8. Dawood FS, Iuliano AD, Reed C (2012) Estimated global mortality associated with the first 12 months of 2009 pandemic influenza A H1N1 virus
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Chapter 6
https://www.walshmedicalmedia.com/open-access/report-of-open-cholecystectomy-in-two-obese-patients-with-severe-lung-disease-under-awake-thoracic-epidural-anaesthesia-jpmme-1000104.pdf
M Dalamagka, CH Kontovitsis
(2015) Report of Open Cholecystectomy in Two Obese Patients with Severe Lung Disease under Awake Thoracic Epidural Anaesthesia. Pain Manage Med 1(1), 1-2: 104.
Abstract
Thoracic epidural anaesthesia is commonly used for everyday procedures. After major abdominal surgery, thoracic epidural anaesthesia results in pain free ventilation and increases the abdominal ventilation, resulting in a lower incidence of postoperative complications. There is a lack of data in the literature regarding open cholecystectomy being performed under epidural anaesthesia alone, especially in patients who are deemed at high risk for general anesthesia. In this case report, we describe two cases of awake open cholecystectomy in two high-risk surgical patients performed under thoracic epidural anaesthesia. We report 2 cases of cholecystitis and cholelithiasis in patients with obesity, chronic obstructive pulmonary disease, American Society of Anaesthesiologists classification IV, that they were treated with open cholecystectomy. In both cases, successful open cholecystectomy was performed, under thoracic epidural anaesthesia, and the patients recovered uneventfully.
Introduction
The steep head-down position in an anesthetized patient results in atelectasis and sometimes hypoxemia due to decreased functional residual capacity. With induction of anesthesia, the increased central blood volume, cephalad displacement of the diaphragm, and the weight of the abdominal contents impending diaphragmatic excursion reduces pulmonary vital capacity. As a result of these changes, impedance of the chest wall and lung increases, an effect which is more pronounced in elderly and obese patients [1-3]. Respiratory failure in morbidly obese patients is associated with greater in-hospital mortality after bariatric surgery [4]. Patients under regional anesthesia usually develop fewer pulmonary complications than those under general anesthesia [5]. Regional block such as low thoracic epidural, spinal, and combined spinal-epidural blocks have been used in patients with relevant medical problems [6-14].
Case Report
The patients were 78 -years-old and 80 years-old, American Society of Anaesthesiologists classification IV, both male, weighed 105 and 120 Kg respectively. They were admitted to the emergency room with intermittent sharp and dull pain to their right lower quadrant. Their medical history included obesity, decrease cardiac output, chronic obstructive pulmonary disease, dyspneic on minimal exertion, hypertensive and a room oxygen saturation of 87-90 % which improved with supplemental oxygen. Axial CT image showed in both cases multiple low-attenuation areas of emphysema. The percentage of predicted FEV1 was 45.6% and 40.8% respectively. The patients were premedicated with 1 mg of midazolam intravenously before the procedure. Continuous pulse oximetry, blood pressure cuff and electrocardiographic monitoring were performed. The patients were placed in seated position. A nasogastric tube was inserted. For epidural anaesthesia, a midline approach was used under complete aseptic preparation. Local anaesthesia ( lidocaine 2%, 2 ml was injected into the skin. An 18-gauge Tuohy needle was introduced at Th11-Th12 intervertebral space. The epidural space was identified using the loss of resistance technique and an epidural catheter was passed through the needle. The Aspiration test for subarachnoid and intravascular placement was negative. A test dose of 2% lidocaine 2 ml was administrated through the epidural catheter with no change on sensorimotor examination. Epidural anaesthesia was established with 12 ml bupivacaine 0.5% and 0.05 mg Fentanyl. The patients remained hemodynamically stable during the surgery. The surgery was completed in approximately 2 hours. Half an hour before the end of surgery was given 2 mg epidural morphine for postoperative coverage requirements. Postoperative analgesia was satisfactory and the patients remained calm in the postoperative period.
Discussion
There are several advantages to using regional anesthesia for bariatric surgery in both cases. First, preoperative pulmonary function parameters may be maintained throughout the surgery. In contrast, pulmonary function parameters may not return to preoperative levels until the seventh postoperative day in patients receiving general anesthesia.
Conclusion
Thoracic epidural anaesthesia and analgesia can decrease the incidence of postoperative morbidity and mortality. Thoracic epidural anaesthesia improves postoperative analgesia, resulting in increased patient satisfaction. However, awake thoracic epidural anaesthesia as the sole anaesthetic technique was successfully employed for risk surgical patients with chronic obstructive pulmonary disease undergoing abdominal surgery, regarding postoperative pulmonary infections, better pain relief and faster return of bowel activity.
References
1. Kopacz DJ, Pollack JE (1998) Thoracic epidural anesthesia for chest and upper abdominal surgery. J Crit Care 17: 38-48
2. Waurick R, Van Aken H (2005) Update in thoracic epidural anaesthesia. Best Pract Res Clin Anaesthesiol 19: 201-213.
3. Kalmar AF, Foubert L, Hendrickx JF, Mottrie A, Absalom A, et al. (2010) Influence of steep Trendelenburg position and CO(2) pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy. Br J Anaesth 104: 433-439.
4. Masoomi H, Reavis KM, Smith BR, Kim H, Stamos MJ, et al. (2013) Risk factors for acute respiratory failure in bariatric surgery: data from the Nationwide Inpatient Sample, 2006-2008. Surg Obes Relat Dis 9: 277-281.
5. Pedersen T, Viby-Mogensen J, Ringsted C (1992) Anaesthetic practice and postoperative pulmonary complications. Acta Anaesthesiol Scand 36: 812-818.
6. Gramatica L Jr, Brasesco OE, Mercado Luna A, Martinessi V, Panebianco G, et al. (2002) Laparoscopic cholecystectomy performed under regional anesthesia in patients with chronic obstructive pulmonary disease. Surg Endosc 16: 472-475.
7. Hamad MA, El-Khattary OA (2003) Laparoscopic cholecystectomy under spinal anesthesia with nitrous oxide pneumoperitoneum: a feasibility study. Surg Endosc 17: 1426-1428.
8. van Zundert AA, Stultiens G, Jakimowicz J J, van den Borne BE, van der Ham WG, et al. (2006) Segmental spinal anaesthesia for cholecystectomy in a patient with severe lung disease. Br J Anaesth 96: 464-466.
9. Kim YI, Lee JS, Jin HC, Chae WS, Kim SH (2007) Thoracic epidural anesthesia for laparoscopic cholecystectomy in an elderly patient with severely impaired pulmonary function tests. Acta Anaesthesiol Scand 51: 1394-1396.
10. van Zundert AA, Stultiens G, Jakimowicz JJ, van den Borne BE, van der Ham WG, et al. (2006) Segmental spinal anaesthesia for cholecystectomy in a patient with severe lung disease. Br J Anaesth 96: 464-466.
11. Pursnani KG, Bazza Y, Calleja M, Mughal MM (1998) Laparoscopic cholecystectomy under epidural anesthesia in patients with chronic respiratory disease. Surg Endosc 12: 1082-1084.
12. Nguyen NT, Anderson JT, Budd M, Fleming NW, Ho HS, et al. (2004) Effects of pneumoperitoneum on intraoperative pulmonary mechanics and gas exchange during laparoscopic gastric bypass. Surg Endosc 18: 64-71.
13. Hurley RW, Wu C (2009) Acute Postoperative Pain. In Miller’s Anesthesia, (7Thedn) Churchill Livingstone, Philadelphia.
14. van Lier F, van der Geest PJ, Hoeks SE, van Gestel YR, Hol JW, et al. (2011) Epidural analgesia is associated with improved health outcomes of surgical patients with chronic obstructive pulmonary disease. Anesthesiology 115: 315-321.
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