Can lung volumes and capacities be used as an outcome measure for phrenic nerve recovery after cardiac surgeries? (original) (raw)
Effect of Vagal Nerve Protection on Heart Rate in Patients Undergoing Minimally Invasive Lobectomy
2021
OBJECTIVES: As a common malignant tumor worldwide, lung cancer receives substantial attention from specialists. Surgery occupies an important position in lung cancer treatment, particularly early treatment. To better improve quality of life for patients after surgery, we report our surgical approach to protect vagal nerve branches during lung cancer surgery, especially the thoracic branch, which is important to maintain a suitable heart rate after surgery.METHODS: We selected 40 patients who underwent lobectomy and systematic dissection of mediastinal lymph nodes during the same period. Patients were divided into two groups: the control group (traditional surgery) and the experimental group (surgery with vagal nerve/vagal branch protection). During surgery, vagal nerve function was preserved as much as possible.RESULTS: There were no significant differences in operation time, intraoperative bleeding, postoperative pain, and discharge time between the two groups. Heart rate at discha...
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2009
The aim of this prospective study was to assess whether the removal of the radial artery (RA) caused any alteration in the function or power of hand on postoperative 15th day. The study group included 25 patients with objective or subjective complaints on postoperative 15th day regarding harvest site following coronary bypass surgery by using RA. Patients were examined for bilateral forearm function (soft touch and pin-prick neural sensation, handgrip power). The ulnar artery and palmar arcus Doppler measurements such as peak systolic and end-diastolic velocity, and radius of the arteries have been measured both at rest and following handgrip test. The operated arm was evaluated and compared with the opposite arm. Wilcoxon test was used to compare continuous variables. Among 18 patients complained a loss of sense in the RA excised arm, the sensory defects were documented in 5. Among 7 patients presented with a feel of strength loss, handgrip power revealed a nonsignificant decrease ...
A prospective study of phrenic nerve damage after cardiac surgery in children
Intensive Care Medicine, 2008
Objective: To gather detailed data on the incidence of phrenic nerve damage (PND) following cardiac surgery in children, the risk factors for its development, its effect on morbidity and its prognosis. Design: Prospective electrophysiological measurement of phrenic nerve latency in 310 children before and after cardiac surgery. Setting: Tertiary paediatric cardiac surgical centre. Measurements and results: Our findings were fourfold. Firstly, the incidence of PND in our group of patients was 20%, significantly higher than estimates using indirect methods of assessment. Secondly, PND increased the duration of ventilation by a median of 76 h (20 vs. 96 h; p < 0.001), and late post-operative deaths (before hospital discharge) occurred in 12.9% of patients compared to 2.4% among patients with a normal post-operative phrenic latency. Thirdly, the risk factors that were independently predictive of the development of PND were the site of the surgery and the patient's age. Patients who required surgery at both the lung hilum and the pericardium were more likely to develop PND than patients with only one of those sites, or when neither was involved, and children less than 18 months old were more likely to develop PND than older children. Lastly, the natural history of PND following surgery appears to be good. In our follow-up to 3 months, approximately one third recovered within 1 month and a further third (overall) recovered by 3 months. Conclusions: We conclude that the incidence of PND is much higher than currently recognised, and has a very significant effect on postoperative morbidity and mortality. Most children who survive the postoperative period will recover nerve function within 3 months.
The Annals of Thoracic Surgery, 2004
The purpose of this study was to determine the incidence of neurologic hand complications after radial artery harvesting and to compare the harmonic scalpel versus conventional cold scalpel technique. From 1995 to 2000, 786 radial arteries were harvested from 782 patients for coronary artery bypass grafting. From 1995 to 1997, the conventional cold scalpel technique was used (422 patients), and from 1998 to 2000, the harmonic scalpel was used (360 patients). Mean follow-up was 4.2 +/- 2.1 years and was 90% complete. Symptoms included thumb weakness or numbness, tingling, or pain in the hand. The incidence of neurologic hand complications was similar with both techniques (11.2% +/- 3.5% cold, 11.0% +/- 3.6% harmonic, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.95), and in 19% (13 of 67 with symptoms) there was complete resolution within 1 year. Symptoms persisted long-term in 9.0% +/- 3.2% cold scalpel and 9.0% +/- 3.3% harmonic scalpel patients (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.81), but were considered a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;constant and significant source of discomfort&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; in only 0.6% +/- 0.9% cold scalpel and 1.4% +/- 1.3% harmonic scalpel patients (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.41). The incidence of adverse neurologic outcomes causing significant long-term discomfort in the hand was low using either the cold scalpel or harmonic scalpel technique. However, a significant number of patients had neurologic hand symptoms in both groups, and this should be included when discussing operative risks with the patient.
Harvesting the Radial Artery: Does It Affect Early Postoperative Hand Function?
The Heart Surgery Forum, 2005
Background: The radial artery (RA) is increasingly being used as a conduit for coronary artery bypass grafting. Previous studies have demonstrated that there is no significant deterioration in hand function in the long term. The aim of this study was to assess whether removal of the RA caused any alteration in the function or power of the hand 5 days postoperatively that would affect the patient's ability for self care on returning home. Methods: A consecutive series of 37 patients undergoing RA harvesting was assessed over a period of 12 months from August 2000 to July 2001 as part of a prospective controlled trial. Grip power and fine motor skills in the operated hand were assessed preoperatively with an elasticated grip strength tester and an 18-hole peg board. This test was repeated 5 days postoperatively. The results were analyzed with a paired-sample t test to assess whether there was a significant difference between preoperative and postoperative hand function. Results: T...
European Journal of Cardio-Thoracic Surgery, 2005
Objective: Radial artery (RA) is now used widely as a conduit of choice in coronary artery bypass grafting. Although RA removal is considered safe in the presence of adequate collateral arterial supply, there is still a considerable suspicion on the functional status of the forearm and hand. However, a neurological dysfunction may occur owing to either surgical trauma or ischemic neuropathy. This study was aimed to investigate the functional outcome of the donor forearm nerves of the patients who underwent coronary artery bypass grafting surgery with RA conduits. Methods: A consecutive series of 50 patients who underwent coronary artery bypass graft surgery with one or two RA grafts were investigated in the study. Motor and sensory functions of donor forearm nerves were measured by ENMG studies, pre-and postoperatively at the third week and sixth month of the operation. The conduction velocities, distal latencies and amplitudes of action potentials for motor and sensorial conductions of radial, ulnar and median nerves were measured in each ENMG examination. Neurologic status of the donor forearm and hand was assessed by the same neurologist who performed a detailed neurologic physical examination and ENMG studies. Results were statistically compared using one-way ANOVA test. Results: The incidence of any neurologic symptoms was 32% in early postoperative period. All reported neurologic complaints were associated with sensory conduction deceleration in ENMG investigations of related nerves. In postoperative assessment, median nerve sensory-motor, and ulnar nerve motor conduction records were slightly lower than the preoperative values, but no statistical difference was observed. Pre-and postoperative radial nerve motor and sensory conduction records were statistically similar (PO0.05). Conclusions: We advocate that removal of RA does not lead to any major neurologic hand complications in the presence of adequate collateral arterial blood supply. ENMG studies confirmed minimal conduction alterations with no statistical significance, even if neurologic symptoms were stated.
Interactive cardiovascular and thoracic surgery, 2006
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether radial arterial harvest with a harmonic scalpel produced a lower incidence of complications or was superior to conventional harvest with the diathermy or scissors and clip techniques. Two hundred and forty-seven papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses were tabulated. We identified 10 studies, 2/5 studies report faster harvesting with the harmonic scalpel, 6 studies report reduced requirement for surgical clips, 2 papers report less spasm, 2/4 studies reported less numbness, and 2 studies reported no electron microscopic differences. Three studies looked at angiography or flow, with one equivocal, one in favour of harmonic and one in favour of scis...
European Journal of Cardio Thoracic Surgery Official Journal of the European Association For Cardio Thoracic Surgery, 2013
OBJECTIVES: Phrenic nerve injury after paediatric heart surgery is associated with significant morbidity. Surgical plication of the diaphragm is believed to be beneficial to the patient, with difficult weaning from ventilation; however, the optimal timing remains unclear. We aimed to compare the outcome after two different strategies for treating hemidiaphragmatic paresis. METHODS: A retrospective analysis of all patients with paresis of the diaphragm between 2000 and 2010 was performed, with special attention to the rate of reintubations, ventilation and intensive care unit (ICU) stay and the rate of plication. In 2005, the strategy for treating diaphragmatic paresis in our institution changed from conservative treatment with plication after multiple extubation efforts towards an aggressive one with plication after a single unsuccessful extubation. We compared the outcome of all patients and that of the newborns separately from the two periods. RESULTS: During the study period, 148 patients with diaphragmatic paresis were diagnosed and included. Median age at the cardiac operation was 7 months (1 day-18 years), ventilation time ranged from 4 h to 41 days (median 7 days), 42 (28.4%) of the patients required at least one reintubation and ICU stay ranged from 2 to 63 days (median 11 days). A total of 63 plications were performed-5 (9%) before 2004 and 58 (62%) after 2005, P < 0.001. There were no significant differences in the ventilation time-6 (1-40) vs 8 (0-41) days, P = 0.36, reintubation rate-28 vs 29%, P = 0.85 and ICU stay-10 (3-63) vs 12 (2-55) days, P = 0.41 between both groups. The newborn patients, treated with the different strategies, also did not differ significantly in their outcome: ventilation time-12 (2-40) vs 11.5 (3-34) days, P = 0.38; reintubation rate-43 vs 41%, P = 0.62; ICU stay-16 (6-63) vs 15 (7-55) days, P = 0.55. CONCLUSIONS: Changing the strategy for phrenic nerve injury after paediatric heart surgery towards a more aggressive one with early plication of the diaphragm was not associated with the better outcome. Prospective randomized studies are needed to determine the optimal management of this complication.
Phrenic nerve injury in infants and children undergoing cardiac surgery
Heart, 1991
Fifty infants and 50 children less than 15 years undergoing palliative or corrective cardiac surgery in the Brompton Hospital between March and October 1988 had direct percutaneous stimulation of the phrenic nerve before and after operation. Ten patients, six under 1 year of age and four over, developed unilateral phrenic nerve injury. In those aged less than 1 year recovery after operation was prolonged because their diaphragmatic palsy made it difficult to wean them from the ventilator. Older children had symptoms but their rate of recovery did not seem to be affected by the phrenic nerve injury. Phrenic nerve damage was no more frequent after a lateral thoracotomy than after a median sternotomy. There was no significant association with the type of operation performed, the experience of the surgeon, the use of bypass or topical ice, the duration of bypass, circulatory arrest or aortic cross clamping, or the age of the patient at the time of operation. In patients who had cardiopulmonary bypass the risk of injury was significantly higher in those who had undergone previous operation. The 10% frequency of phrenic nerve injury determined in this prospective study was higher than that seen in earlier retrospective reports.