Double lumen endobronchial tube intubation: lessons learned from anatomy.

Background: Double lumen endobronchial tubes (DLTs) are frequently used to employ single lung ventilation strategies during thoracic surgical procedures. Placement of these tubes can be challenging even for experienced clinicians. We hypothesized that airway anatomy, particularly of the glottis and proximal trachea, significantly impacts the ease or difficulty in placement of these tubes.

A novel negative pressure isolation device reduces aerosol exposure: A randomized controlled trial.

Background And Aim: The COVID-19 pandemic has led to a proliferation of intubation barriers designed to protect healthcare workers from infection. We developed the Suction-Assisted Local Aerosol Containment Chamber (SLACC) and tested it in the operating room. The primary objectives were to determine the ease and safety of airway management with SLACC, and to measure its efficacy of aerosol containment to determine if it significantly reduces exposure to health care workers.

Research and development of the sOLVe Tube™ dual lumen endobronchial tube: from concept to construct.

Introduction: Dual lumen endobronchial tubes (DLTs) are frequently used for lung isolation and one lung ventilation in thoracic surgery and other specialized clinical scenarios. Modern DLTs are large and rigid, and account for half of all tracheobronchial injuries. Their 70 year old design has numerous flaws which limit their safety and clinical utility.

Proof-of-concept study of compartmentalized lung ventilation using system for asymmetric flow regulation (SAFR).

Asymmetrical distribution of acute lung injury in mechanically ventilated patients can result in a heterogeneity of gas distribution between different regions, potentially worsening ventilation-perfusion matching. Furthermore, overdistension of healthier, more compliant lung regions can lead to barotrauma and limit the effect of increased PEEP on lung recruitment. We propose a System for Asymmetric Flow Regulation (SAFR) which, combined with a novel double lumen endobronchial tube (DLT) may offer individualized lung ventilation to the left and right lungs, better matching each lung's mechanics and pathophysiology.

Minimally Invasive Bilateral Stellate Ganglionectomy for Refractory Ventricular Tachycardia.

Cardiac sympathetic denervation (CSD) for refractory ventricular tachycardia (VT) has been shown to decrease VT recurrence and defibrillator shocks in patients with ischemic and nonischemic cardiomyopathy. Here and in the accompanying Video, we demonstrate the technique for minimally invasive CSD, highlight important technical points, and report surgical outcomes. CSD is accomplished through bilateral resection of the inferior one-third to one-half of the stellate ganglion en bloc with T2-T4 sympathectomy.

Minimally Invasive Bilateral Stellate Ganglionectomy for Refractory Ventricular Tachycardia.

Cardiac sympathetic denervation (CSD) for refractory ventricular tachycardia (VT) has been shown to decrease VT recurrence and defibrillator shocks in patients with ischemic and nonischemic cardiomyopathy. Here and in the accompanying Video, we demonstrate the technique for minimally invasive CSD, highlight important technical points, and report surgical outcomes. CSD is accomplished through bilateral resection of the inferior one-third to one-half of the stellate ganglion en bloc with T2-T4 sympathectomy.

Recurrent ventricular tachycardia after cardiac sympathetic denervation: Prolonged cycle length with improved hemodynamic tolerance and ablation outcomes.

Introduction: Cardiac sympathetic denervation (CSD) is utilized for the management of ventricular tachycardia (VT) in structural heart disease when refractory to radiofrequency ablation (RFA) or when patient/VT characteristics are not conducive to RFA.

Methods: We studied consecutive patients who underwent CSD at our institution from 2009 to 2018 with VT requiring repeat RFA post-CSD. Patient demographics, VT/procedural characteristics, and outcomes were assessed.

A Novel Negative Pressure Isolation Device for Aerosol Transmissible COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic creates a need to protect health care workers (HCWs) from patients undergoing aerosol-generating procedures which may transmit the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Existing personal containment devices (PCDs) may protect HCWs from respiratory droplets but not from potentially dangerous respiratory-generated aerosols. We describe a new PCD and its aerosol containment capabilities.

Autonomic nervous system involvement in pulmonary arterial hypertension.

Pulmonary arterial hypertension (PAH) is a chronic pulmonary vascular disease characterized by increased pulmonary vascular resistance (PVR) leading to right ventricular (RV) failure. Autonomic nervous system involvement in the pathogenesis of PAH has been demonstrated several years ago, however the extent of this involvement is not fully understood. PAH is associated with increased sympathetic nervous system (SNS) activation, decreased heart rate variability, and presence of cardiac arrhythmias.

Utilizing Forced Vital Capacity to Predict Low Lung Compliance and Select Intraoperative Tidal Volume During Thoracic Surgery.

Background: Tidal volume selection during mechanical ventilation utilizes dogmatic formulas that only consider a patient's predicted body weight (PBW). In this study, we investigate whether forced vital capacity (FVC) (1) correlates better to total lung capacity (TLC) than PBW, (2) predicts low pulmonary compliance, and (3) provides an alternative method for tidal volume selection.

Methods: One hundred thirty thoracic surgery patients had their preoperative TLC calculated via 2 methods: (1) pulmonary function test (PFT; TLCPFT) and (2) computed tomography 3D reconstruction (TLCCT).

A Comparison of the Haider Tube-Guard® Endotracheal Tube Holder Versus Adhesive Tape to Determine if This Novel Device Can Reduce Endotracheal Tube Movement and Prevent Unplanned Extubation.

Background: Endotracheal tube security is a critical safety issue. We compared the mobility of an in situ endotracheal tube secured with adhesive tape to the one secured with a new commercially available purpose-designed endotracheal tube-holder device (Haider Tube-Guard). We also observed for the incidence of oropharyngeal or facial trauma associated with the 2 tube fixation methods.

Acute vocal fold dystonic reaction to propofol: a case report.

A 67-year old male underwent uneventful robotic-assisted thoracoscopic resection of a solitary pulmonary fibrous tumor. Immediately following extubation at the completion of the surgical procedure, the patient developed respiratory distress that did not resolve with treatment. Benadryl provided only temporary relief.

Revised Cardiac Risk Index (RCRI) is a useful tool for evaluation of perioperative cardiac morbidity in kidney transplant recipients.

Background: We evaluated a published Revised Cardiac Risk Index (RCRI) to determine if this preoperative cardiovascular risk stratification tool would be useful in the kidney transplant recipient population.

Methods: We identified all kidney transplants from 2005 to 2009 (n=1652) at our institution. We performed a detailed retrospective chart review of (a) all recipients who underwent preoperative coronary angiography (n=169) and (b) an age-matched and transplantation year-matched group who did not undergo coronary angiography (n=156).

Positive end expiratory pressure during one-lung ventilation: selecting ideal patients and ventilator settings with the aim of improving arterial oxygenation.

The efficacy of positive end-expiratory pressure (PEEP) in treating intraoperative hypoxemia during one-lung ventilation (OLV) remains in question given conflicting results of prior studies. This study aims to (1) evaluate the efficacy of PEEP during OLV, (2) assess the utility of preoperative predictors of response to PEEP, and (3) explore optimal intraoperative settings that would maximize the effects of PEEP on oxygenation. Forty-one thoracic surgery patients from a single tertiary care university center were prospectively enrolled in this observational study.

Unintentional subdural injection: a complication of neuraxial anesthesia/analgesia.

Unintentional subdural injection during neuraxial anesthesia/analgesia continues to be a challenge for anesthesiologists. This unusual complication is often poorly recognized, with the diagnosis made in retrospect, or not at all. The clinical presentation of these regional blocks can be heterogeneous, ranging from restricted, patchy, or unilateral sensory blockade all the way to extensive and even life-threatening motor and autonomic nervous system depression.

Two cases of Horner syndrome after administration of an epidural test dose that did not recur with subsequent epidural activation.

Objective: We describe 2 cases of Horner syndrome after epidural test dose injections in thoracic surgery patients. The Horner syndrome was transient and did not recur with full epidural activation and infusion.

Case Report: Two patients undergoing thoracic surgery procedures received preoperative midthoracic epidural catheters for postoperative analgesia.

Diagnosis of unintentional subdural anesthesia/analgesia: analyzing radiographically proven cases to define the clinical entity and to develop a diagnostic algorithm.

Background And Objectives: : Subdural injection is a well-known but often poorly recognized complication of neuraxial anesthesia/analgesia. This report aims to further describe the clinical presentation of subdural injection by analyzing radiographically proven cases. A new diagnostic algorithm is then proposed.