Reduction of airspace after lung resection through controlled paralysis of the diaphragm

Carboni, Giovanni L; Vogt, Andreas; Küster, Jan R; Berg, Peter; Wagnetz, Dirk; Schmid, Ralph A; Dutly, André E (2008). Reduction of airspace after lung resection through controlled paralysis of the diaphragm. European journal of cardio-thoracic surgery, 33(2), pp. 272-5. Oxford: Elsevier Science B.V. 10.1016/j.ejcts.2007.10.023

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OBJECTIVES: Residual airspace following thoracic resections is a common clinical problem. Persistent air leak, prolonged drainage time, and reduced hemostasis extend hospital stay and morbidity. We report a trial of pharmacologic-induced diaphragmatic paralysis through continuous paraphrenic injection of lidocaine to reduced residual airspace. The objectives were confirmation of diaphragmatic paralysis and possible procedure related complications. METHODS: Six eligible patients undergoing resectional surgery (lobectomy or bilobectomy) were included. Inclusion criteria consisted of: postoperative predicted FEV1 greater than 1300 ml, right-sided resection, absence of parenchymal lung disease, no class III antiarrhythmic therapy, absence of hypersensitivity reactions to lidocaine, no signs of infection, and informed consent. Upon completion of resection an epidural catheter was attached in the periphrenic tissue on the proximal pericardial surface, externalized through a separate parasternal incision, and connected to a perfusing system injecting lidocaine 1% at a rate of 3 ml/h (30 mg/h). Postoperative ICU surveillance for 24h and daily measurement of vital signs, drainage output, and bedside spirometry were performed. Within 48 h fluoroscopic confirmation of diaphragmatic paralysis was obtained. The catheter removal coincided with the chest tube removal when no procedural related complications occurred. RESULTS: None of the patients reported respiratory impairment. Diaphragmatic paralysis was documented in all patients. Upon removal of catheter or discontinuation of lidocaine prompt return of diaphragmatic motility was noticed. Two patients showed postoperative hemodynamic irrelevant atrial fibrillation. CONCLUSION: Postoperative paraphrenic catheter administration of lidocaine to ensure reversible diaphragmatic paralysis is safe and reproducible. Further studies have to assess a benefit in terms of reduction in morbidity, drainage time, and hospital stay, and determine the patients who will profit.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Thoracic Surgery
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Carboni, Giovanni Luca; Vogt, Andreas; Schmid, Ralph and Dutly, André Emanuel

ISSN:

1010-7940

ISBN:

18061470

Publisher:

Elsevier Science B.V.

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

04 Oct 2013 14:57

Last Modified:

27 Apr 2018 09:52

Publisher DOI:

10.1016/j.ejcts.2007.10.023

PubMed ID:

18061470

Web of Science ID:

000253752500034

BORIS DOI:

10.7892/boris.24569

URI:

https://boris.unibe.ch/id/eprint/24569 (FactScience: 51574)

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