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Diaphragm-sparing brachial plexus blocks: a focused review of current evidence and their role during the COVID-19 pandemic / Laura Girón Arango  

Público ISBD Título : Diaphragm-sparing brachial plexus blocks: a focused review of current evidence and their role during the COVID-19 pandemic Tipo de documento : documento electrónico Autores : Laura Girón Arango, Fecha de publicación : 2020 Títulos uniformes : Current Opinion in Anaesthesiology Idioma : Inglés (eng) Palabras clave : brachial plexus  COVID-19  diaphragm-sparing  nerve block  phrenic nerve  regional anesthesia Resumen : Purpose of review: Given that COVID-19 can severely impair lung function, regional anesthesia techniques avoiding phrenic nerve paralysis are relevant in the anesthetic management of suspected/confirmed COVID-19 patients requiring shoulder and clavicle surgical procedures. The objective of this review is to provide an overview of recently published studies examining ultrasound-guided diaphragm-sparing regional anesthesia techniques for the brachial plexus (BP) to favor their preferent use in patients at risk of respiratory function compromise. Recent findings: In the last 18 months, study findings on various diaphragm-sparing regional anesthesia techniques have demonstrated comparable block analgesic effectivity with a variable extent of phrenic nerve paralysis. The impact of hemi-diaphragmatic function impairment on clinical outcomes is yet to be established. Summary: Existing diaphragm-sparing brachial plexus regional anesthesia techniques used for shoulder and clavicle surgery may help minimize pulmonary complications by preserving lung function, especially in patients prone to respiratory compromise. Used as an anesthetic technique, they can reduce the risk of exposure of healthcare teams to aerosol-generating medical procedures (AGMPs), albeit posing an increased risk for hemi-diaphragmatic paralysis. Reducing the incidence of phrenic nerve involvement and obtaining opioid-sparing analgesia without jeopardizing efficacy should be prioritized goals of regional anesthesia practice during the COVID-19 pandemic. Mención de responsabilidad : Cubillos, Javier; Girón-Arango, Laura; Muñoz-Leyva, Felipe Referencia : Curr Opin Anaesthesiol. 2020 Oct;33(5):685-691. DOI (Digital Object Identifier) : 10.1097/ACO.0000000000000911 PMID : 32826625 En línea : https://journals.lww.com/co-anesthesiology/Abstract/2020/10000/Diaphragm_sparing [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5129 Diaphragm-sparing brachial plexus blocks: a focused review of current evidence and their role during the COVID-19 pandemic [documento electrónico] / Laura Girón Arango,  . - 2020. Obra : Current Opinion in Anaesthesiology Idioma : Inglés (eng) Palabras clave : brachial plexus  COVID-19  diaphragm-sparing  nerve block  phrenic nerve  regional anesthesia Resumen : Purpose of review: Given that COVID-19 can severely impair lung function, regional anesthesia techniques avoiding phrenic nerve paralysis are relevant in the anesthetic management of suspected/confirmed COVID-19 patients requiring shoulder and clavicle surgical procedures. The objective of this review is to provide an overview of recently published studies examining ultrasound-guided diaphragm-sparing regional anesthesia techniques for the brachial plexus (BP) to favor their preferent use in patients at risk of respiratory function compromise. Recent findings: In the last 18 months, study findings on various diaphragm-sparing regional anesthesia techniques have demonstrated comparable block analgesic effectivity with a variable extent of phrenic nerve paralysis. The impact of hemi-diaphragmatic function impairment on clinical outcomes is yet to be established. Summary: Existing diaphragm-sparing brachial plexus regional anesthesia techniques used for shoulder and clavicle surgery may help minimize pulmonary complications by preserving lung function, especially in patients prone to respiratory compromise. Used as an anesthetic technique, they can reduce the risk of exposure of healthcare teams to aerosol-generating medical procedures (AGMPs), albeit posing an increased risk for hemi-diaphragmatic paralysis. Reducing the incidence of phrenic nerve involvement and obtaining opioid-sparing analgesia without jeopardizing efficacy should be prioritized goals of regional anesthesia practice during the COVID-19 pandemic. Mención de responsabilidad : Cubillos, Javier; Girón-Arango, Laura; Muñoz-Leyva, Felipe Referencia : Curr Opin Anaesthesiol. 2020 Oct;33(5):685-691. DOI (Digital Object Identifier) : 10.1097/ACO.0000000000000911 PMID : 32826625 En línea : https://journals.lww.com/co-anesthesiology/Abstract/2020/10000/Diaphragm_sparing [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5129

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Phrenic nerve stimulation during neck dissection for advanced thyroid cancer involving level IV: is it worth doing it? / Carlos Simón Duque Fisher ; Juan Pablo Dueñas Muñoz ; Andrés Felipe Londoño Bustamante  

Público ISBD Título : Phrenic nerve stimulation during neck dissection for advanced thyroid cancer involving level IV: is it worth doing it? Tipo de documento : documento electrónico Autores : Carlos Simón Duque Fisher, ; Juan Pablo Dueñas Muñoz, ; Andrés Felipe Londoño Bustamante, Fecha de publicación : 2017 Títulos uniformes : Updates in Surgery Idioma : Inglés (eng) Palabras clave : Phrenic nerve  nerve monitoring  vagus nerve  diaphragm muscle paralysis Resumen : During thyroidectomy and neck dissection surgery for advanced or recurrent metastatic thyroid cancer under intraoperative monitoring, we used the available technology to assess the feasibility of such an intervention to monitor those patients with phrenic nerves at risk. A retrospective review of patients operated on from January 2009 to December 2015 by a single surgeon (CSD) was conducted. Patients who had neck and mediastinal dissection, with or without total thyroidectomy, due to advanced or recurrent metastatic disease to the neck were selected. The procedures were done under intraoperative nerve monitoring using nerve monitoring systems (NIM 2.0 or 3.0; Medtronic, Jacksonville, FL, USA). A total of 19 patients were included in the study, with a mean age of 57.6 years ± 16.3 and a male/female ratio of 10:9. Overall, all patients had an intact phrenic nerve at the conclusion of the surgery. One patient had an aggressive tumor that precluded sacrifice of the left recurrent laryngeal nerve and ipsilateral thoracic duct. The procedure was complicated by a temporary impairment of the diaphragm contraction with intraoperative nerve monitoring as well as a chyle fistula. This was due to the manipulation of the tissue surrounding the phrenic nerve. Intraoperative nerve monitoring of the phrenic nerve offers the surgeon a “potential” method of ensuring phrenic nerve integrity in cases of advanced thyroid cancers with gross level IV metastatic disease. Further prospective studies are needed to assess the risks of this intervention and evaluate the method of recording diaphragm contraction movement Mención de responsabilidad : Carlos S Duque, Juan P Dueñas, Marcela Marulanda, Diana Pérez, Andres Londoňo, Soham Roy, Mai Al Khadem Referencia : Updates Surg. 2017 Mar;69(1):83-87. DOI (Digital Object Identifier) : 10.1007/s13304-016-0411-y PMID : 28194664 En línea : https://link.springer.com/article/10.1007%2Fs13304-016-0411-y Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4045 Phrenic nerve stimulation during neck dissection for advanced thyroid cancer involving level IV: is it worth doing it? [documento electrónico] / Carlos Simón Duque Fisher, ; Juan Pablo Dueñas Muñoz, ; Andrés Felipe Londoño Bustamante,  . - 2017. Obra : Updates in Surgery Idioma : Inglés (eng) Palabras clave : Phrenic nerve  nerve monitoring  vagus nerve  diaphragm muscle paralysis Resumen : During thyroidectomy and neck dissection surgery for advanced or recurrent metastatic thyroid cancer under intraoperative monitoring, we used the available technology to assess the feasibility of such an intervention to monitor those patients with phrenic nerves at risk. A retrospective review of patients operated on from January 2009 to December 2015 by a single surgeon (CSD) was conducted. Patients who had neck and mediastinal dissection, with or without total thyroidectomy, due to advanced or recurrent metastatic disease to the neck were selected. The procedures were done under intraoperative nerve monitoring using nerve monitoring systems (NIM 2.0 or 3.0; Medtronic, Jacksonville, FL, USA). A total of 19 patients were included in the study, with a mean age of 57.6 years ± 16.3 and a male/female ratio of 10:9. Overall, all patients had an intact phrenic nerve at the conclusion of the surgery. One patient had an aggressive tumor that precluded sacrifice of the left recurrent laryngeal nerve and ipsilateral thoracic duct. The procedure was complicated by a temporary impairment of the diaphragm contraction with intraoperative nerve monitoring as well as a chyle fistula. This was due to the manipulation of the tissue surrounding the phrenic nerve. Intraoperative nerve monitoring of the phrenic nerve offers the surgeon a “potential” method of ensuring phrenic nerve integrity in cases of advanced thyroid cancers with gross level IV metastatic disease. Further prospective studies are needed to assess the risks of this intervention and evaluate the method of recording diaphragm contraction movement Mención de responsabilidad : Carlos S Duque, Juan P Dueñas, Marcela Marulanda, Diana Pérez, Andres Londoňo, Soham Roy, Mai Al Khadem Referencia : Updates Surg. 2017 Mar;69(1):83-87. DOI (Digital Object Identifier) : 10.1007/s13304-016-0411-y PMID : 28194664 En línea : https://link.springer.com/article/10.1007%2Fs13304-016-0411-y Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4045

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