Chest Trauma: Current Recommendations for Rib Fractures, Pneumothorax, and Other Injuries

This article provides an overview of the common and important chest injuries that the anesthesiologist may encounter in patients following trauma including blunt injury, pneumothorax, hemothorax, blunt aortic injury, and blunt cardiac injury.Recent FindingsRib fractures are frequently associated with chest injury and are associated with significant pain and other complications. Regional anesthesia techniques combined with a multimodal analgesic strategy can improve patient outcomes and reduce complications. There is increasing evidence for paravertebral blocks for this indication, and the myofascial plane blocks are a popular emerging technique. Recent changes to recommended management of tension pneumothorax are also described.SummaryChest trauma is commonly encountered, and anesthesiologists have the potential to significantly improve morbidity and mortality in this group of patients.
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research

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This study assessed the analgesic efficacy of different techniques for the management of postoperative pain following video-assisted thoracic surgery for pneumothorax.BMC Anesthesiology
Source: Medscape Pathology Headlines - Category: Pathology Tags: Anesthesiology Journal Article Source Type: news
There is no defined gold standard for pain management after video-assisted thoracic surgery (VATS) for pneumothorax. In addition to systemic analgesia, various loco-regional analgesic techniques have been prop...
Source: BMC Anesthesiology - Category: Anesthesiology Authors: Tags: Research article Source Type: research
U. Kartoun raises a point related to the improvement of future spontaneous pneumothorax guidelines based on his personal experience as a patient who underwent video-assisted thoracoscopic surgery. He suggests that inserting a peripheral venous line and a chest tube on opposite sides of the body may limit mobility and increase pain. Although it may be adventurous to judge this particular case without further data, the underlying question is what clinical guidelines say about the ideal side for peripheral venous cannulation in patients subjected to thoracoscopy [1–3]. The information on this is deceptively scarce, prob...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Original Articles: Correspondence Source Type: research
We read with interest the recent paper discussing an ultrasound guided oblique intercostal approach for paravertebral catheters placement in 2 neonates scheduled for tracheoesophageal fistula repair [1]. While we applaud the author's choice of using for paravertebral catheters (PVBCs) in such small neonates, we question the technique used; an ultrasound image was not presented, and the figure and block details do not seem to be in concordance with the approach used. The depth of paravertebral space with intercostal approach is only few millimiters, making this approach extremely challenging, with a high risk of pneumothora...
Source: Journal of Clinical Anesthesia - Category: Anesthesiology Authors: Tags: Correspondence Source Type: research
FDA has approved a new device intended to treat breathing difficulty associated with severe emphysema. The approval comes just two weeks after an FDA advisory panel shot down a competing technology targeting the same patient population. The agency approved Pulmonx Inc.'s Zephyr endobronchial valve through the breakthrough device designation, a pathway reserved for devices that provide for more effective treatment or diagnosis of a life-threatening or irreversibly debilitating disease or condition. Devices also must meet one of the following criteria: the device must represent a breakthrough technology; there must be no app...
Source: MDDI - Category: Medical Devices Authors: Tags: Regulatory and Compliance Source Type: news
The FDA today granted pre-market approval under its breakthrough devices designation to the Zephyr endobronchial valve made by Pulmonx for treating severe emphysema. Emphysema, a chronic obstructive pulmonary disease, causes irreversible damage to the lung’s alveoli, trapping air during exhalation that in turn can cause the diseased tissue to grow larger and pressure healthy lung tissue. The Zephyr device is designed to decrease the volume of the chest to improve function in the heart, respiratory muscles and healthy lung tissue. Inserted via bronchoscopy, the pencil-eraser-sized valves prevent air from ent...
Source: Mass Device - Category: Medical Devices Authors: Tags: Endoscopic / Arthroscopic Food & Drug Administration (FDA) Regulatory/Compliance Respiratory Pulmonx Source Type: news
CONCLUSIONS: This is the first known case in the literature of direct viewing of LA diffusion in a paravertebral space other than the one in which the block is administered and may open important scenarios for the improvement of anesthesia technique. PMID: 29714650 [PubMed - as supplied by publisher]
Source: Tumori - Category: Cancer & Oncology Tags: Tumori Source Type: research
The erector spinae plane (ESP) block is a pain management strategy for both pediatric and adult patients undergoing abdominal and thoracic surgeries [1 –3]. In the ESP block, local anesthetic is injected into the interfascial plane block between the erector spinae and the underlying transverse process. With respect to a paravertebral nerve block and epidural anesthesia, the ESP block may be a safer option because of sense injection site. However, complications such as pneumothorax and artery puncture are theoretically possible.
Source: Journal of Clinical Anesthesia - Category: Anesthesiology Authors: Tags: Correspondence Source Type: research
Conclusions: SGB are relatively safe and effective management in patients with neuropathic conditions already on pharmacotherapy. Serial blocks attained an average reduction in pain by >3 NPRS points from the baseline for both spontaneous and provoked pain with a decrease in mean DASH score and improvement in ROM.
Source: Journal of Anaesthesiology Clinical Pharmacology - Category: Anesthesiology Authors: Source Type: research
Conclusion: To our knowledge, this is the first case series of pneumomediastinum in patients with pulmonary fibrosis following EBUS-TBNA. We believe the radial traction placed on the airways (splinting) by the fibrotic lung disease and the increased airway pressure may have allowed air in to the mediastinum through the needle puncture sites. Both physicians and patients should be aware of this complication and we suggest a smaller 22 G EBUS-TBNA needle be used in patients with pulmonary fibrosis.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Interventional Pulmonology Source Type: research
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