Fig 1 - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Findings of short-tau inversion recovery sequences in MRI. Short-tau inversion recovery sequences in MRI showed (A) clear high signal intensity and edematous swelling of the right posterior cord of the brachial plexus (arrowhead) at the costoclavicular space and (B) slightly high signal intensity (arrowheads) on the distal side of the cord. These signals indicated the most severely damaged part.
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
... we could not reasonably assume that a procedural injury due to intraoperative error had occurred. MRI short-tau inversion recovery sequences showed clear high signal intensity and edematous swelling of the right posterior cord of the brachial plexus at the costoclavicular space and slightly high signal intensity on the distal side of the cord (Fig. 1). Therefore, we diagnosed the patient with right brachial plexus injury caused by the intraoperative patient position. The plexus injury was presumed to have occurred by exaggerated lateral rotation and abduction of the right arm associated with the prone position. The postoperative course was uneventful other than the brachial plexus ...
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.
