Ultrasound Assessment of Diaphragmatic Dysfunction in Regional Anesthesia
Study Details
Study Description
Brief Summary
Awake thoracic surgery is a feasible and safe alternative to general anesthesia for pulmonary biopsy in interstitial lung disease patients, but there is still no evidence as to its superiority in terms of outcome. However, there is extensive literature about the effect of anesthetic drugs and surgery on diaphragmatic function. Furthermore, in thoracic surgery, diaphragmatic dysfunction was associated with a higher occurrence of postoperative pulmonary complications.
To assess the impact of general anesthesia on diaphragmatic function, the investigators conducted an observational prospective trial. The investigators measured both diaphragmatic excursion and Thickening Fraction at baseline and 12 hours after surgery together with pulmonary function tests and gas exchange data.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Awake thoracic surgery is a feasible and safe alternative to general anesthesia for pulmonary biopsy in interstitial lung disease patients, but there is still no evidence as to its superiority in terms of outcome.
However, there is extensive literature about the effect of anesthetic drugs and surgery on diaphragmatic function. Furthermore, in thoracic surgery, diaphragmatic dysfunction was associated with a higher occurrence of postoperative pulmonary complications.
To assess the impact of general anesthesia on diaphragmatic function, the investigators conducted an observational prospective trial. The investigators measured both diaphragmatic excursion and Thickening Fraction at baseline and 12 hours after surgery together with pulmonary function tests and gas exchange data.
The investigators divided our population into two groups: one group of patients undergoing awake thoracic surgery with epidural anesthesia, and the other group undergoing general anesthesia.
Forty-one patients were recruited and the Thickening Fraction percentage, calculated as (End Inspiratory thickness-End Expiratory thickness)/End Expiratory thickness, was evaluated by means of an ultrasound-assisted method, using a high frequency (10 MHz) linear probe.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Regional awake anesthesia In non-intubated patients, an epidural catheter was placed at T5-T6. An anesthetic load of 0,5 mg/kg of ropivacaine was administered to reach anesthesia of the thoracic wall. Adjunctive local anesthetic infiltration of the incision site was performed by the surgeon with 2% lidocaine and 7,5% Ropivacaine. The cumulative dose of anesthetics drugs was computed as not to exceed the recommended dosage. To improve patient comfort through the procedure, sedation with Target Controlled Infusion of propofol (using Schnider algorithm) and low dose remifentanil (0,05 mcg/kg/min) was also administered. |
Procedure: Regional awake anesthesia
We want to assess the impact of regional anesthesia on diaphragmatic function in patients undergoing Video-assisted thoracoscopic surgery pulmonary biopsy in interstitial lung disease
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| General anesthesia Either epidural block or an interfascial plane block of the thoracic wall, such as serratus anterior plane block or erector spinae plane block, were performed. Patients were then anesthetized with Propofol plus opiates (usually remifentanil) and muscle paralysis was achieved with Rocuronium. |
Outcome Measures
Primary Outcome Measures
- Diaphragmatic maximal function [12 hours]
Measured with diaphragmatic excursion
Secondary Outcome Measures
- Pain scores [24 hours]
Numeric rate scale
- Postoperative Nausea and Vomiting [24 hours]
Presence/absence of Postoperative Nausea and Vomiting
Eligibility Criteria
Criteria
Inclusion Criteria:
- Patients scheduled for lung biopsy from February 2019 to September 2020
Exclusion Criteria:
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pregnancy,
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Body Mass Index >35,
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Inability to provide informed consent,
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American Society of Anesthesiologists physical status classification score of IV
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Recommended postoperative ICU care
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | AOU Città della Salute e della Scienza di Torino | Turin | Italy | 10100 |
Sponsors and Collaborators
- University of Turin, Italy
Investigators
- Study Chair: Luca Brazzi, Professor, University of Torino
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- DULORATHO