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Eden's test. Eden's test for the costoclavicular syndrome form of thoracic outlet syndrome. The patient is asked to push the chest out and pull the shoulders back as if standing at military attention, while the therapist palpates the strength of the radial pulse. Pushing the chest out brings the first rib forward, while pulling the shoulder girdles back brings the clavicle back, thereby decreasing the space between them. A positive finding is a weakening of the strength of the radial pulse, indicating compression of the subclavian artery in the costoclavicular space. It can be assumed that if the subclavian artery is being compressed, the brachial plexus is also being compressed.
Source publication
Introduction:
During prone esophagectomy, placement of a port in the third intercostal space for upper mediastinal dissection requires adequate axillary expansion. To facilitate this, the right arm is elevated cranially and simultaneously turned outward. Brachial plexus paralysis associated with esophagectomy in the prone position has not been doc...
Context in source publication
Context 1
... to the strangled segment, the resultant paralytic signs are called scalenus syndrome, costoclavicular syndrome, or pectoralis minor syndrome. These three syndromes are collectively called thoracic outlet syndrome. In the present case, MRI revealed nerve injury at the costoclavicular space. Eden's test is used to detect costoclavicular syndrome (Fig. 4). Costoclavicular syndrome is a neurovascular entrapment syndrome caused by a decrease in the costoclavicular space between the first rib and clavicle. Eden's test intentionally decreases this space by bringing the clavicle and first rib closer together. The brachial plexus and subclavian vessels run through this space; therefore, ...
Citations
... In the case of RAMIE, difficult airway access must also be taken into account (21). Finally, the possibility for nerve plexus injury needs to be careful evaluated during the positioning of the patients (22). ...
Objective: This review summarizes the peri-operative anesthesiological approaches to esophagectomy
considering the best up-to-date, evidence-based medicine, discussed from the anesthesiologist’s standpoint.
Background: Esophagectomy is the only curative therapy for esophageal cancer. Despite the many
advancements made in the surgical treatment of this tumour, esophagectomy still carries a morbidity rate
reaching 60%. Patients undergoing esophagectomy should be referred to high volume centres where they
can receive a multidisciplinary approach to treatment, associated with better outcomes. The anesthesiologist
is the key figure who should guide the peri-operative phase, from diagnosis through to post-surgery
rehabilitation. We performed an updated narrative review devoted to the study of anesthesia management for
esophagectomy in cancer patients.
Methods: We searched MEDLINE, Scopus and Google Scholar databases from inception to May
2021. We used the following terms: “esophagectomy”, “esophagectomy AND pre-operative evaluation”,
“esophagectomy AND protective lung ventilation”, “esophagectomy AND hemodynamic monitoring” and
“esophagectomy AND analgesia”. We considered only articles with abstract written in English and available
to the reader. We excluded single case-reports.
Conclusions: Pre-operative anesthesiological evaluation is mandatory in order to stratify and optimize
any medical condition. During surgery, protective ventilation and judicious fluid management are the
cornerstones of intraoperative “protective anesthesia”. Post-operative care should be provided by an intensive
care unit or high-dependency unit depending on the patient’s condition, the type of surgery endured and the
availability of local resources. The provision of adequate post-operative analgesia favours early mobilization
and rapid recovery. Anesthesiologist has an important role during the peri-operative care for esophagectomy.
However, there are still some topics that need to be further studied to improve the outcome of these patients.
... Pesquisas sugerem medidas, como o uso de coxins, para reduzir a pressão sobre os músculos peitorais e impedir que sejam empurrados para a fossa axilar, pressionando o plexo, bem como palpação do tendão do músculo peitoral maior para monitorar sua tensão (34)(35) . ...
Objective:
to describe scientific evidence regarding the use of prone positioning in the care provided to patients with acute respiratory failure caused by COVID-19.
Method:
this is a scoping review. PRISMA Extension for Scoping Reviews was used to support the writing of this study. The search was conducted in seven databases and resulted in 2,441 studies, 12 of which compose the sample. Descriptive statistics, such as relative and absolute frequencies, was used to analyze data.
Results:
prone positioning was mainly adopted in Intensive Care Units, lasted from a minimum of 12 up to 16 hours, and its prescription was based on specific criteria, such as PaO2/FiO2 ratio, oxygen saturation, and respiratory rate. The most prevalent complications were: accidental extubation, pressure ulcer, and facial edema. Decreased hypoxemia and mortality rates were the main outcomes reported.
Conclusion:
positive outcomes outweighed complications. Various cycles of prone positioning are needed, which may cause potential work overload for the health staff. Therefore, an appropriate number of trained workers is necessary, in addition to specific institutional protocols to ensure patient safety in this context.
