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Biomedical subjects

P E Krucylak

Publications and source records attributed to P E Krucylak.

9 recordsLinked to original sources
PubMed1999

Current status of thoracoscopic lung volume reduction.

Surgical therapy has recently been reintroduced for the treatment of emphysema, and a number of investigators have used video-assisted thoracic surgical (VATS) techniques to accomplish lung volume reduction. The published reports differ with regard to patient selection, preoperative preparation, operative approach, and surgical technique. The results of these reports are reviewed and compared. Thoracoscopic lung volume reduction appears to be a useful part of the surgeon's armamentarium in managing patients with severe pulmonary emphysema.

Humans↗
PubMed1999

Intraoperative considerations during minimal-access cardiac surgery.

The range of minimal-access cardiac surgery approaches has many implications in intraoperative management. A modified anesthetic regimen is required to deal with the type of surgical exposure, hemodynamic instability, whether cardiopulmonary bypass is used, and early extubation. Intraoperative considerations include hemodynamic monitoring, one-lung ventilation, pharmacological stabilization of the myocardium, pacing, hypothermia, bleeding, and rapid emergence with a minimum of postoperative mechanical ventilation. As a result, anesthetic methods and intraoperative management were modified to meet these specific needs of minimally invasive cardiac procedures.

Anesthesia, General↗
PubMed1999

Preoperative preparation and anesthetic management of patients with myasthenia gravis.

Patients with myasthenia gravis have specific clinical problems that must be addressed by the anesthesiologist when surgery is contemplated. Optimal perioperative management of myasthenia gravis patients undergoing thymectomy requires careful preoperative assessment and preparation. This assessment and preparation includes evaluation for concomitant autoimmune, respiratory, and cardiac disorders as well as optimization of medical management for myasthenia. There are important intraoperative concerns to be addressed including appropriate monitoring, premedication, and other agents used during surgery including muscle relaxants and anesthetic agents. Postoperatively, attention must be directed specifically to pain relief, ventilatory management, and the appropriate titration of reversal agents and anticholinesterase inhibitors. Optimal management of all these factors maximizes the chance for successful and uncomplicated hospitalization.

Anesthesia, General↗
PubMed1997

Hemodynamics and gas exchange after single lung transplantation and unilateral thoracoscopic lung reduction.

BACKGROUND: Single lung transplantation and recently thoracoscopic lung reduction (TLR) have become surgical alternatives to manage emphysema. We report here early outcomes of 10 single lung transplant (SLT) recipients with severe emphysema compared with 10 patients treated with unilateral TLR. METHODS: Ten consecutive recipients of (SLT) and 10 patients undergoing unilateral TLR were studied. Both groups had measurements of preoperative pulmonary function and arterial blood gases. Hemodynamic measurements were made by use of a right ventricular ejection fraction/volumetric pulmonary artery catheter during and immediately after surgery in both groups to compare hemodynamic and gas exchange response in each procedure. Pulmonary function tests were repeated 3 months and 1 year after surgery. Complications and functional outcome are reported. RESULTS: Both groups had the same severity of obstructive disease (mean forced expiratory volume in 1 second = 20% +/- 5% for the SLT group and 23% +/- 9% for the TLR group) and similar patterns of right ventricular dysfunction. During operation, SLT recipients showed worse hypercapnia and pulmonary hypertension than TLR subjects when ventilation and perfusion to the operative lung were interrupted. Patients undergoing TLR only had interrupted ventilation, which was transiently reversed when severe hypoventilation or hypoxemia occurred. All patients undergoing TLR were extubated immediately after surgery. SLT recipients were extubated an average of 42 hours later. Pulmonary function testing performed 3 months after surgery showed improvement in both groups. SLT recipients showed larger improvements in airflow but comparable improvements in forced vital capacity. Both groups achieved similar improvements in gas exchange. This trend continued a year after surgery. Patients undergoing TLR were not subjected to complications of immunosuppressive therapy or exposed to opportunistic infections. CONCLUSIONS: Early results show TLR as an acceptable alternative to SLT in carefully selected patients with the same severity of obstructive lung disease. Long-term follow-up studies are needed to establish long-term differences in functional outcome and development of complications. TLR may be an option for patients with severe dyspnea related to emphysema who do not meet criteria for transplantation.

Aged↗
PubMed1996

Unilateral video-assisted thoracic surgical lung reduction.

BACKGROUND: Lung reduction has been demonstrated to be a promising treatment for end-stage emphysema when performed on both lungs via sternotomy. The role for a thoracoscopic approach has not yet been determined. METHODS: Unilateral video-assisted thoracic surgical lung reduction was performed on 50 patients for the treatment of end-stage emphysema. There were 34 men and 16 women with a mean age of 61.5 years (range, 31 to 78 years). Emphysema was secondary to smoking in 45 patients (90%), and alpha 1-antitrypsin deficiency in 5 patients (10%), 4 of whom had smoked in the past. Lung reduction was performed unilaterally using a thoracoscope and a stapled resection without the routine use of bovine pericardium. The side to be operated on and site of resection were determined preoperatively by examination of the perfusion and computed tomographic scans of the lungs. The average amount of lung removed was 59 +/- 15 g (range, 29 to 111 g). RESULTS: Morbidity included prolonged air leak in 15 patients (30%), bleeding in 3 (6%), pneumonia requiring reintubation in 3 (6%), myocardial infarction in 1 (2%), and perforated ulcer in 1 (2%). Seven patients (14%) required a second thoracic procedure for management of these complications. Two patients died, for an operative mortality of 4%. Follow-up obtained between 1 and 3 months in 25 patients revealed significant improvement in forced expiratory volume in 1 second (0.71 to 0.95 L; p < 0.001), forced vital capacity (2.24 to 2.58 L; p < 0.01), and oxygen tension (59 to 67 mm Hg; p < 0.01). The improvement in functional capacity as measured by 6-minute walk approached statistical significance (771 to 923 ft; p = 0.06). CONCLUSIONS: Significant subjective improvement in dyspnea has been noted in 41 of 48 hospital survivors (85%). For patients with end-stage emphysema, unilateral video-assisted thoracic surgical lung reduction appears to be a preferable alternative to standard medical management.

Adult↗
PubMed1996

Anesthetic management of patients undergoing unilateral video-assisted lung reduction for treatment of end-stage emphysema.

OBJECTIVES: Nonanatomic resection of peripheral areas of lung is being performed via sternotomy for the treatment of end-stage emphysema. Recent technologic advances have allowed the resection of lung tissue using video-assisted thoracic surgery (VATS) techniques. The study was performed to document the physiologic changes that occur during unilateral VATS lung reduction in hopes of determining appropriate monitoring and intraoperative management strategies. DESIGN: Prospective trial of unilateral VATS lung reduction. SETTING: Tertiary care university hospital. PARTICIPANTS: Twenty patients with end-stage emphysema. INTERVENTIONS: Participants underwent unilateral VATS lung reduction. MEASUREMENTS AND MAIN RESULTS: Invasive hemodynamic monitoring was performed using radial and pulmonary artery catheters. Hemodynamic and respiratory gas exchange data were collected at four intraoperative points: (1) supine, two-lung ventilation; (2) lateral decubitus, two-lung ventilation; (3) lateral decubitus, one-lung ventilation, and (4) end of surgery, supine, two-lung ventilation. Data were compared with that collected at the first point. Patients tolerated lengthy surgical procedures and remained hemodynamically stable with no episodes of hypoxemia requiring treatment. Extubation was tolerated by 19 of 20 patients at the conclusion of surgery without further requirement of mechanical ventilation. CONCLUSIONS: VATS lung reduction under general anesthesia with one-lung ventilation is well tolerated. Permissive hypercapnia was well tolerated by all patients. Early extubation can be routinely accomplished in these patients.

Adult↗