In the absence of CP, the esophagus was lateral to the cricoid in more than 50% of the sample. CP further displaced both the esophagus and the larynx laterally.

No abstract

Serum bupivacaine concentrations during continuous extrapleural infusionPurpose: To determine the rate of increase in serum bupivacaine concentration during continuous extrapleural infusion. Methods: After thoracotomy for Iobectomy under general anaesthesia, nine patients had an extrapleural catheter inserted, before chest closure, in a costovertebral gutter constructed surgically by lifting the parietal pleura. Bupivacaine 0.5% with epinephrine 1:200,000 was injected through the catheter as 0.3 ml-kg t bolus followed by 0. I ml.kg J.hr ~ for live days. Serum bupivacaine (free and total), albumin, alpha-I acid gtycoprotein concentrations were measured 15 min after injection and at 24 hr intervals for five days. Bupivacaine concentrations were determined by column liquid chromatography using solid phase extraction. Serum alpha-I acid glycoprotein concentration was determined by nephelometry on QM 300 protein analyzer. Serum albumin concentration was determined by bromocresol green dye binding procedure on Hitachi 717 Autoanalyzer. Results: A continuous elevation in total serum bupivac~ne was observed, with an average value of 0.75 Hg.ml on day 1 to 2.77/Jg-ml -~ on day 4 (P<0.05). There was no increase in postoperative free serum bupivacaine concentration; average value of 177 pcg'ml ~ on day I and 249 pcg.ml-~ on day 4 (P =0.92). Postoperative serum alpha-I acid glycoprotein concentration showed a steady rise with an average value of 0.94 Hg-ml ~ on day I and t.47 ~g-ml ' on day 4 (P<0.05). No change was observed in post-operative serum albumin with an average value of 31.4 g.I + on day I and 31.3 g.N on day 4. Conclusion: Continuous extrapleural infusion of bupivacaine over live days after thoracotomy is associated with a steady increase in total serum bupivacaine concentration and no elevation in free serum bupivacaine concentration.Objectif : DEterminer la vitesse de raccumulation s&ique de la bupivaca'ine pendant une perfusion extrapleurale continue. M&hodes : AprEs une thoracotomie pour Iobectomie sous anesthEsie gEnErale, on a insErE avant la fermeture de la plaie un catheter extrapleural ~ neuf patients dans une goutti&e costovertEbrale cr6Ee chirurgicalement par soulcSvement la plEwe pariEtale. De la bupivacaine 0,5% adrEnalinEe h 1:200,000 en bolus de 0,3 ml-kg ~ suivi d'une perfusion de 0,

A comparison of thoracic and lumbar epidural techniques for postthoracoabdominal esophagectomy analgesiaPurpose: To compare thoracic epidural analgesia (TEA) using a bupivacaine/[entanyl mixture and lumbar epidural analgesia (LEA) with morphine, in respect to the time to extubation and the quality of post-operative analgesia, in patients having thoracoabdominal esophagectomy. Methods: Twenty two patients scheduled for elective thoracoal:x:lominal esophagectomy were randomized to TEA or LEA. Postoperatively, the TEA group received Patient Controlled Epidural Analgesia (PCEA) with bupivacaine 0.12596 and 5/./g'ml Bt fentanyl, and the LEA group received PCEA with 0.2/ag'ml Bl morphine. A blinded observer assessed criteria for tracheal extubation and the time of tracheal extubation was recorded. Early extubation was defined as tracheal extubation within four hours postoperatively. Visual analogue pain scores at rest (Static Visual Analogue Pain Scores, SVAPS) and with movement (Dynamic Visual Analogue Pain Scores, DVAPS) were recorded at I , 6, 12, 18 and 24 hr post-extubation. Failure of the epidural protocol (FEP) was defined as a request for additional analgesia. Results: Tracheal extubation was achieved in 70% of the LEA and 100~ of the TEA at four hours postoperatively (P=NS). However, the TEA group achieved earlier extubation times when assessed with log rank testing (P = 0.01 ). By six hours postextubation FEP had occurred in 50% of the LEA group but in none of the TEA group (P = 0.0 I). Mean SVAPS and DVAPS were lower in the TEA than in the LEA group at all measured times (P < 0.01).Conclusion: This study has demonstrated superior pain control in patients undergoing thoraco-abdominal esophagectomy treated with TEA than with LEA, particularly for pain with movement. Tracheal extubation occurred earlier in the TEA group, but this difference was not significant at four hours postoperatively.