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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.

In: European Journal of Cardio-Thoracic Surgery, 2008, vol. 33, no. 2, p. 272-275

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    Titre
    • Reduction of airspace after lung resection through controlled paralysis of the diaphragm
    Auteur
    • Carboni, Giovanni L.. Division of General Thoracic Surgery, University Hospital Bern, Switzerland
    • Vogt, Andreas. Department of Anesthesiology, University Hospital Bern, Switzerland
    • Küster, Jan R.. Division of General Thoracic Surgery, University Hospital Bern, Switzerland
    • Berg, Peter. Division of Pulmonology, University Hospital Bern, Switzerland
    • Wagnetz, Dirk. Division of General Thoracic Surgery, University Hospital Bern, Switzerland
    • Schmid, Ralph A.. Division of General Thoracic Surgery, University Hospital Bern, Switzerland
    • Dutly, André E.. Division of General Thoracic Surgery, University Hospital Bern, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Journal of Cardio-Thoracic Surgery, 2008, vol. 33, no. 2, p. 272-275. Elsevier Science B.V.
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:290151
    Summary
    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 1300ml, 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 3ml/h (30mg/h). Postoperative ICU surveillance for 24h and daily measurement of vital signs, drainage output, and bedside spirometry were performed. Within 48h 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