One lung ventilation management in a patient with Reinke's edema.

Introduction: Reinke's edema (RE) is a benign laryngeal disease. We describe the case of a patient with history of bilateral RE requiring surgical treatment, that came to our attention for a lung lobectomy due to adenocarcinoma. In consideration of the possible complications at the time of extubation and of the probable difficult control of the airways, the patient underwent intervention of microflap surgery for the RE at the same time of lobectomy.

Erector spine plane block as postoperative rescue analgesia in thoracic surgery.

Objective: Erector spine plane block (ESPB) is a newly defined regional anesthesia technique performed by injection of local anesthetic beneath the erector spine muscle. We tested ESPB as a regional rescue analgesia bedside technique to be performed in the thoracic surgical ward, reporting a 7-patient case series.

Methods: We report our experience in rescue analgesia after thoracic surgery.

Management of chest impalement injury.

Presentation Of Case: We will describe the case of a man who impaled himself on a greenhouse pole by falling off a ladder.

Discussion: The belated radiological exclusion of any spine and neck lesions forced the surgeons to operate with the patient supine and on a spine board, which prevented them from performing the classic thoracotomy and reaching the entry hole in the right scapula area.

Conclusion: A double thoracotomy and the expedient of a haemostatic plug, positioned simultaneously with the extraction of the pole, allowed to control bleeding with absolute safety margins.

Bronchial blocker positioning: learning curve and confidence in its use.

Background: Despite being simple and safe to use and cheap, EZ blocker (EZB) remains underused probably because it requires particular skills in recognizing airway and in using fiber-bronchoscopy to check the exact position of their cuffs. Thus, we planned an education training program on the use of EZB for novices in anesthesia and evaluated the number of procedures required for the acquisition of the skills of this technique.

Methods: The educational training program included three different phases as follows.

Preoperative optimization with levosimendan in heart failure patient undergoing thoracic surgery.

Introduction: We present the case of a patient with dilatative cardiomyopathy waiting for heart transplantation with pleural effusion to be subjected to pleural biopsy, treated with preoperative infusion of levosimendan to improve heart performances.

Presentation Of Case: A 56-year-old man (BMI 22,49) with dilatative cardiomyopathy (EF 18%) presented right pleural effusion. The levosimendan treatment protocol consisted of 24h continuous infusion (0,1ug/kg/min), without bolus.

Major thoracic surgery in Jehovah's witness: A multidisciplinary approach case report.

Introduction: A bloodless surgery can be desirable also for non Jehovah's witnesses patients, but requires a team approach from the very first assessment to ensure adequate planning.

Presentation Of The Case: Our patient, a Jehovah's witnesses, was scheduled for right lower lobectomy due to pulmonary adenocarcinoma. Her firm denies to receive any kind of transfusions, forced clinicians to a bloodless management of the case.

Intraoperative Extracorporeal Carbon Dioxide Removal During Apneic Oxygenation with an EZ-Blocker in Tracheal Surgery.

Tracheal surgery requires continued innovation to manage the anesthetic during an open airway phase. A common approach is apneic oxygenation with continuous oxygen flow, but the lack of effective ventilation causes hypercapnia, with respiratory acidosis. We used extracorporeal carbon dioxide removal for intraoperative decapneization during apneic oxygenation in a 64-year-old woman who was scheduled for tracheal surgery because of tracheal stenosis caused by long-term intubation.

Long-term cardiovascular effects of levothyroxine therapy in young adults with congenital hypothyroidism.

Context: Congenital hypothyroidism (CH) is the most prevalent endocrine disorder in the newborn and is routinely treated with life-long levothyroxine replacement therapy. Although several studies have demonstrated that such therapy may impact on the cardiovascular system, little is known with regard to the effects of long-term levothyroxine administration in patients with CH.

Objective: The aim of the current study was to evaluate whether long-term levothyroxine replacement therapy in young adults with CH is associated with cardiovascular abnormalities.