Advertisement

Thoracic Anesthesia in the Developing World

  • Swapnil Yeshwant Parab
  • Sheila Nainan Myatra
Chapter

Abstract

Patients presenting for thoracic surgeries in the developing world may often suffer from tuberculosis, pyogenic, and parasitic infections. These may be associated with chronic malnourishment and anemia. Patients with empyema may be complicated with an underlying bronchopleural fistula, in whom a history of position-related productive cough should be sought. Thoracic surgery for infectious conditions is more likely to develop intraoperative bleeding. Judicious use of antimicrobial agents, in addition to respiratory physiotherapy, including muscle strengthening exercises, helps to improve the cardiorespiratory status of the patient. Surgical and anesthesia practices are often modified to strike a balance between available resources and optimizing patient outcomes. The choice of lung isolation technique may often depend on the availability of devices and expertise. In the absence of a pediatric bronchoscope, double-lumen tubes are often preferred over bronchial blockers, as they can be inserted blindly and their position can be confirmed by clinical methods.

Keywords

Thoracic anesthesia Anesthesia in the developing world Anesthesia for tuberculosis patients 

Notes

Acknowledgment

We thank Dr. Anila Malde, Professor, Department of Anesthesia, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, India, for her valuable inputs.

We thank Dr. Sandeep Tandon, Dr. Maheema Bhaskar, and Dr. Aparna Iyer, Chest Physicians, Pulmonary Medicine Unit, Tata Memorial Hospital, India, for providing the images.

We thank Dr. Amit Janu, Consultant Radiologist, Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India, for reporting the images.

Financial Support

Nil

Conflicts of Interest

None

References

  1. 1.
    Bainbridge D, Martin J, Arango M, et al., Evidence-based Peri-operative Clinical Outcomes Research (EPiCOR) Group. Perioperative and anesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis. Lancet. 2012; 380:1075–81.Google Scholar
  2. 2.
    Jacob R. Challenges in the practice of thoracic anesthesia in developing countries. In: Slinger P, editor. Progress in thoracic anesthesia. Baltimore: Lippincott Williams and Wilkins; 2004. p. 267–85.Google Scholar
  3. 3.
    European Lung White Book. The burden of lung disease. Available from: http://www.erswhitebook.org/chapters/the-burden-of-lung-disease. Last accessed on 11 May 2017.
  4. 4.
    Ferkol T, Schraufnagel D. The global burden of respiratory disease. Ann Am Thorac Soc. 2014;11(3):404–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Hodges SC, Mijumbi C, Okello M, et al. Anesthesia services in developing countries: defining the problems. Anesthesia. 2007;62:4–11.CrossRefGoogle Scholar
  6. 6.
    Rosseel P, Trelles M, Guilavogui S, et al. Ten years of experience training non-physician anesthesia providers in Haiti. World J Surg. 2010;34:453–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Jochberger S, Ismailova F, Banda D, et al. A survey of the status of education and research in anesthesia and intensive care medicine at the University Teaching Hospital in Lusaka, Zambia. Arch Iran Med. 2010;13:5–12.PubMedGoogle Scholar
  8. 8.
    Dubowitz G, Detlefs S, McQueen KA. Global anesthesia workforce crisis: a preliminary survey revealing shortages contributing to undesirable outcomes and unsafe practices. World J Surg. 2010;34:438–44.CrossRefPubMedGoogle Scholar
  9. 9.
    Edwards J. Taking the pulse of pulse oximetry in Africa. CMAJ. 2012;184:E244–5.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bould MD, Boet S, Riem N, et al. National representation in the anesthesia literature: a bibliometric analysis of highly cited anesthesia journals. Anaesthesia. 2010;65:799–804.CrossRefPubMedGoogle Scholar
  11. 11.
    Babineau TJ, Borlase BC, Blackburn GL. Applied total parental nutrition in the critically ill. In: Rippe JM, Irwin RS, Alpert JS, Fink MP, editors. Intensive Care Medicine. Boston: Little, Brown and Co; 1991. p. 1675.Google Scholar
  12. 12.
    Gillis A, MacDonald B. Deconditioning in the hospitalized elderly. Can Nurse. 2005;101(6):16–20.PubMedGoogle Scholar
  13. 13.
    Administrative Committee on Coordination/Standing Committee on Nutrition, ACC/SCN. Fourth report on the world nutrition situation. New York: United Nations; 2000.Google Scholar
  14. 14.
    Sarkar M, Rajta PN, Khatana J. Anemia in chronic obstructive pulmonary disease: prevalence, pathogenesis, and potential impact. Lung India. 2015;32(2):142–51.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Lee EH, Kim HR, Baek SH, et al. Risk factors of postoperative acute kidney injury in patients undergoing esophageal cancer surgery. J Cardiothorac Vasc Anesth. 2014;28(4):936–42.CrossRefPubMedGoogle Scholar
  16. 16.
    Amin N, Tarwade P, Shetmahajan M, et al. A randomized trial to assess the utility of preintubation adult fiberoptic bronchoscope assessment in patients for thoracic surgery requiring one-lung ventilation. Ann Card Anaesth. 2016;19(2):251–5.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Sato M, Kayashima K. Difficulty in inserting left double-lumen endobronchial tubes at the cricoid level in small-statured women: a retrospective study. Indian J Anesthesia. 2017;61(5):393–7.CrossRefGoogle Scholar
  18. 18.
    Bastien JL, O’Brien JG, Frantz FW. Extraluminal use of the Arndt pediatric endobronchial blocker in an infant: a case report. Can J Anaesth. 2006;53(2):159–61.CrossRefPubMedGoogle Scholar
  19. 19.
    Marciniak B, Fayoux P, Hébrard A, et al. Fluoroscopic guidance of Arndt endobronchial blocker placement for single-lung ventilation in small children. Acta Anaesthesiol Scand. 2008;52(7):1003–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Templeton TW, Downard MG, Simpson CR, et al. Bending the rules: a novel approach to placement and retrospective experience with the 5 French Arndt endobronchial blocker in children <2 years. Paediatr Anaesth. 2016;26(5):512–20.CrossRefPubMedGoogle Scholar
  21. 21.
    Maheshwari A, Sharma N, Mathur P. Successful placement of double lumen endotracheal tube using fluoroscopy. J Anaesthesiol Clin Pharmacol. 2013;29(1):130–1.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Cohen DE, McCloskey JJ, Motas D, et al. Fluoroscopic-assisted endobronchial intubation for single-lung ventilation in infants. Paediatr Anaesth. 2011;21:681–4.CrossRefPubMedGoogle Scholar
  23. 23.
    Alliaume B, Coddens J, Deloof T. Reliability of auscultation in positioning of double-lumen endobronchial tubes. Can J Anaesth. 1992;39(7):687–90.CrossRefPubMedGoogle Scholar
  24. 24.
    Lichtenstein DA, Lascols N, Prin S, et al. The “lung pulse”: an early ultrasound sign of complete atelectasis. Intensive Care Med. 2003;29(12):2187–92.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Parab SY, Divatia JV, Chogle A. A prospective comparative study to evaluate the utility of lung ultrasonography to improve the accuracy of traditional clinical methods to confirm position of left sided DLT in elective thoracic surgeries. Indian J Anaesth. 2015;59(8):476–81.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Saporito A, Lo Piccolo A, Franceschini D, et al. Thoracic ultrasound confirmation of correct lung exclusion before one-lung ventilation during thoracic surgery. J Ultrasound. 2013;16(4):195–9.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Ponsonnard S, Karoutsos S, Gardet E, et al. Value of lung sonography to control right-sided double lumen endotracheal tube location. J Anesth Clin Res. 2014;5:453.Google Scholar
  28. 28.
    Araki K, Nomura R, Urushibara R, et al. Displacement of the double-lumen endobronchial tube can be detected by bronchial cuff pressure change. Anesth Analg. 1997;84(6):1349–53.CrossRefPubMedGoogle Scholar
  29. 29.
    Bahk JH, Oh YS. A new and simple maneuver to position the left-sided double-lumen tube without the aid of fiberoptic bronchoscopy. Anesth Analg. 1998;86(6):1271–5.PubMedGoogle Scholar
  30. 30.
    Zong ZJ, Shen QY, Lu Y, et al. A simple blind placement of the left-sided double-lumen tubes. Medicine (Baltimore). 2016;95(45):e5376.CrossRefGoogle Scholar
  31. 31.
    Pain & Policy Studies Group. Availability of opioid analgesics in Asia: consumption trends, resources, recommendations. Madison: University of Wisconsin Pain and Policy Studies Group/WHO Collaborating Center for Policy and Communications in Cancer Care. Prepared for 17th Study Programme for Overseas Experts on Drug Abuse and Narcotics Control; Tokyo, Japan, 26 June, 2002 (Monograph).Google Scholar
  32. 32.
    Bennett DS, Carr DB. Opiophobia as a barrier to the treatment of pain. J Pain Palliat Care Pharmacother. 2002;16(1):105–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Faponle AF, Soyannwo OA, Ajayi IO. Postoperative pain therapy: a survey of prescribing patterns and adequacy of analgesia in Ibadan, Nigeria. Cent Afr J Med. 2001;47:70–4.PubMedGoogle Scholar
  34. 34.
    Global tuberculosis report 2016. Geneva: World Health Organisation (WHO); 2016.Google Scholar
  35. 35.
    Ferrara G, Murray M, Winthrop K, et al. Risk factors associated with pulmonary tuberculosis: smoking, diabetes and anti-TNFα drugs. Curr Opin Pulm Med. 2012;18:233–40.CrossRefPubMedGoogle Scholar
  36. 36.
    Sotgiu G, Matteelli A, Migliori GB, et al. Diabetes and tuberculosis: what else beyond? Int J Tuberc Lung Dis. 2015;19:1127–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Hermans S, Horsburgh CR Jr, Wood RA. Century of tuberculosis epidemiology in the northern and southern hemisphere: the differential impact of control interventions. PLoS One. 2015;10:e0135179.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    CDC. Emergence of mycobacterium tuberculosis with extensive resistance to second-line drugs – worldwide, 2000–2004. MMWR Morb Mortal Wkly Rep. 2006;55:301–5.Google Scholar
  39. 39.
    CDC. Notice to readers: revised definition of extensively drug-resistant tuberculosis. MMWR Morb Mortal Wkly Rep. 2006;55:1176.Google Scholar
  40. 40.
    Albert RK, Petty TL. Endobronchial tuberculosis progressing to bronchial stenosis; fiberoptic bronchoscopic manifestations. Chest. 1976;70(4):537–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Pomerantz M. Surgery for the management of mycobacterium tuberculosis and nontuberculous mycobacterial infections of the lung. In: Shields TW, Lo Cicero J, Ponn RB, et al., editors. General thoracic surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 1251–61.Google Scholar
  42. 42.
    Jacobaeus HC. The cauterization of adhesions in artificial pneumothorax treatment of pulmonary tuberculosis under thoracoscopic control. Proc R Soc Med. 1923;16:45–62.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Xu HB, Jiang RH, Li L. Pulmonary resection for patients with multidrug-resistant tuberculosis: systematic review and meta-analysis. J Antimicrob Chemother. 2011;66:1687–95.CrossRefPubMedGoogle Scholar
  44. 44.
    Somocurcio JG, Sotomayor A, Shin S, et al. Surgery for patients with drug-resistant tuberculosis: report of 121 cases receiving community-based treatment in Lima, Peru. Thorax. 2007;62:416–21.CrossRefPubMedGoogle Scholar
  45. 45.
    Shiraishi Y, Nakajima Y, Katsuragi N, et al. Resectional surgery combined with chemotherapy remains the treatment of choice for multidrug-resistant tuberculosis. J Thorac Cardiovasc Surg. 2004;128:523–8.CrossRefPubMedGoogle Scholar
  46. 46.
    Masoud Dara. The role of surgery in the treatment of pulmonary TB and multidrug- and extensively drug resistant TB. Available from: http://www.euro.who.int/__data/assets/pdf_file/0005/259691/The-role-of-surgery-in-the-treatment-of-pulmonary-TB-and-multidrug-and-extensively-drug-resistant-TB.pdf?ua=1. Last accessed on 27 May 2017.
  47. 47.
    Bai L, Hong Z, Gong C, et al. Surgical treatment efficacy in 172 cases of tuberculosis-destroyed lungs. Eur J Cardiothorac Surg. 2012;41:335–40.CrossRefPubMedGoogle Scholar
  48. 48.
    Ozgül MA, Turna A, Yildiz P, et al. Risk factors and recurrence patterns in 203 patients with hemoptysis. Tuberk Toraks. 2006;54:243–8.PubMedGoogle Scholar
  49. 49.
    Kerti CA, Miron I, Cozma GV, et al. The role of surgery in the management of pleuropulmonary tuberculosis– seven years’ experience at a single institution. Interact Cardiovasc Thorac Surg. 2009;8:334–7.CrossRefPubMedGoogle Scholar
  50. 50.
    Jensen PA, Lambert LA, Iademarco MF, et al. Guidelines for preventing the transmission of mycobacterium tuberculosis in healthcare settings. Centers for Disease Control and Prevention. 2005. c2012. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm. Last accessed on 26 May 2017.
  51. 51.
    Forget EJ, Menzies D. Adverse reactions to first-line antituberculous drugs. Expert Opin Drug Saf. 2006;5(2):231–49.CrossRefPubMedGoogle Scholar
  52. 52.
    Pairolero PC, Deschamps C, Allen MS, et al. Postoperative empyema. Chest Surg Clin North Am. 1992;2:813–20.Google Scholar
  53. 53.
    Ferguson AD, Prescott RJ, Selkon JB, et al. The clinical course and management of thoracic empyema. Q J Med. 1996;89:285–9.CrossRefGoogle Scholar
  54. 54.
    Maskell NA, Batt S, Hedley EL, et al. The bacteriology of pleural infection by genetic and standard methods and its mortality significance. Am J Respir Crit Care Med. 2006;174:817–23.CrossRefPubMedGoogle Scholar
  55. 55.
    Rocco G, Descamps C, Deslariers J. Fibrothorax and decortication. In: Patterson GA, editor. Pearson’s thoracic and esophageal surgery. 3rd ed. Philadelphia: Churchill Livingston; 2008. p. 1170–85.CrossRefGoogle Scholar
  56. 56.
    Kuhajda I, Zarogoulidis K, Tsirgogianni K, et al. Lung abscess-etiology, diagnostic and treatment options. Ann Transl Med. 2015;3(13):183.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Herth F, Ernst A, Becker HD. Endoscopic drainage of lung abscesses: technique and outcome. Chest. 2005;127(4):1378–81.PubMedGoogle Scholar
  58. 58.
    Shen H, Lu FL, Wu H, et al. Management of tension pneumatocele with high-frequency oscillatory ventilation. Chest. 2002;121:284–7.CrossRefPubMedGoogle Scholar
  59. 59.
    Fujii AM, Moulton S. VATS management of an enlarging multicysticpneumatocele. J Perinatol. 2008;28(6):445–7.CrossRefPubMedGoogle Scholar
  60. 60.
    Morar R, Feldman C. Pulmonary echinococcus. Eur Respir J. 2003;21:1069–77.CrossRefPubMedGoogle Scholar
  61. 61.
    Thumler J, Munoz A. Pulmonary and hepatic echinococcus in children. Pediatr Radiol. 1978;7:164–71.CrossRefPubMedGoogle Scholar
  62. 62.
    Aletras H, Symbas PN. Hydatid disease of the lung. In: Shields TW, LoCicero J, Ponn RB, editors. General thoracic surgery. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2000. p. 1113.Google Scholar
  63. 63.
    Date A, Zachariaih N. Saprophytic mycosis with pulmonary echinococcosis. J Trop Med Hyg. 1995;98:404–6.Google Scholar
  64. 64.
    Kuzucu A, Soysal O, Ozgel M, et al. Complicated hydatic cysts of the lung: clinical and therapeutic issues. Ann Thorac Surg. 2004;77:1200–4.CrossRefPubMedGoogle Scholar
  65. 65.
    Jacob R, Sen S. The anesthetic management of a deliberately created bronchoatmospheric fistula in bilateral pulmonary hydatids. Paediatr Anaesth. 2001;11:733–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Swapnil Yeshwant Parab
    • 1
  • Sheila Nainan Myatra
    • 1
  1. 1.Department of Anesthesiology, Critical Care and PainTata Memorial HospitalMumbaiIndia

Personalised recommendations