ISAAC DE FARIA SOARES RODRIGUES
Projetos de Pesquisa
Unidades Organizacionais
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
4 resultados
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- Laryngeal Mask as the Primary Airway Device During Laryngotracheal Surgery: Data From 108 Patients(2020) SCHWEIGER, Thomas; RODRIGUES, Isaac de Faria Soares; ROESNER, Imme; SCHNEIDER-STICKLER, Berit; EVERMANN, Matthias; DENK-LINNERT, Doris -Maria; HAGER, Helmut; KLEPETKO, Walter; HOETZENECKER, KonradBackground. Airway management during repair of laryngotracheal stenosis is demanding, and there is currently no accepted standard of care. Recently an increasing number of airway centers have started to use a laryngeal mask until the airway is surgically exposed and cross-table ventilation can be initiated. However detailed data on this approach are missing in the literature. Methods. Patients receiving laryngotracheal surgery from November 2011 until October 2018 were retrospectively included in this single-center study, except for patients who presented with a preexisting tracheostomy at time of surgery. Airway management uniformly consisted of laryngeal mask ventilation until cross-table ventilation was established. Clinical variables, perioperative complications, and airway complications were analyzed. Results. One hundred eight patients (65 women, 43 men) receiving tracheal resection (n = 50), cricotracheal resection (n = 49), or single-stage laryngotracheal reconstruction (n = 9) were included in the analysis. Of the included patients 23 (21.3%) had malignant disease and 85 (78.7%) a benign pathology. In the subgroup of patients with subglottic disease 85.1% had high-grade stenosis (Myer-Cotton III degrees). Airway management with a laryngeal mask was successful in all except 1 patient (99.1%). Mean pulse oximetry and mean end-tidal CO2 during laryngeal mask ventilation was 98.7% +/- 2.4% and 34.8 +/- 7.6 mm Hg, respectively. At the end of surgery 95 patients (88%) were successfully weaned from the respirator using the laryngeal mask. Conclusions. The laryngeal mask as the primary airway device is feasible and safe in patients undergoing laryngotracheal surgery even in cases with high-grade stenosis. (C) 2020 by The Society of Thoracic Surgeons
bookPart Afecções congênitas de traqueia e brônquios(2021) MINAMOTO, Hélio; RODRIGUES, Isaac de Faria Soares; CARDOSO, Paulo Francisco Guerreiro- Functional outcome after single-stage laryngotracheal reconstruction with rib cartilage grafting(2022) SCHWEIGER, Thomas; ROESNER, Imme; RODRIGUES, Isaac de Faria Soares; EVERMANN, Matthias; FRICK, Anna Elisabeth; DENK-LINNERT, Doris-Maria; KLEPETKO, Walter; HOETZENECKER, KonradObjective: Single-stage laryngotracheal reconstruction (SSLTR) provides a definite surgical treatment for patients with complex glotto-subglottic stenosis. To date, the influence of SSLTR on the functional outcome after surgery has not been analyzed. Methods: A retrospective analysis of all patients receiving a SSLTR between November 2012 and October 2019 was performed. Preoperatively and 3 months postoperatively, patients received a full functional evaluation, including spirometry; voice measurements (eg, fundamental frequency; dynamic range, singing voice range, and perceptual voice evaluation using the Roughness-BreathinessHoarseness [RBH] score, and fiberoptic endoscopic evaluation of swallowing [FEES]). Results: A total of 15 patients with a mean age of 45 +/- 17 years underwent SSTLR. Two (13%) patients were men and 13 (87%) were women. The majority of patients (67%) had undergone previous surgical or endoscopic treatment attempts that had failed. At the 3-month follow-up visit, none of the patients had signs of penetration or aspiration in their swallowing examination. Voice measurements revealed a significantly lower fundamental voice frequency (201.0 Hz vs 155.5 Hz; P = .006), whereas voice range (19.1 semitones vs 14.9 semitones; P = .200) and dynamic range (52.5 dB vs 53.o dB; P = .777) was hardly affected. The median RBH score changed from R1 B0 H1 to R2 B1 H2. In spirometry, breathing capacity increased significantly (peak expiratory flow, 44% vs 87% [P < .001] and mean expiratory flow at 75% of vital capacity, 48% vs 90% [P < .001]). During a median followup of 32.5 months (range, 7-88 months), none of the patients developed re-stenosis. Conclusions: For complex glotto-subglottic stenoses, durable long-term airway patency together with reasonable voice quality and normal deglutition can be achieved by SSLTR.
- Posterior laryngofissure using a surgical contact diode laser: an experimental feasibility study(2019) MENEZES, Arteiro Queiroz; CARDOSO, Paulo Francisco Guerreiro; NAGAO, Christopher Kengo; MINAMOTO, Helio; BIBAS, Benoit Jacques; RODRIGUES, Isaac de Faria Soares; OTOCH, Jose Pinhata; DOLHNIKOFF, Marisa; CANZIAN, Mauro; MANCINI, Marilia Wellichan; PEGO-FERNANDES, Paulo ManuelTo evaluate the feasibility of a 980-nm contact diode laser (CDL) as a method for creating a posterior laryngofissure in live pigs. Twenty-eight Landrace pigs (15-20 kg) were anesthetized, intubated, ventilated, and submitted to a cervical tracheostomy. An anterior and posterior midline longitudinal laryngofissure incision was created according to randomization-control (n = 4), posterior laryngofissure with a scalpel blade; electrocautery (n = 12), posterior laryngofissure by electrocautery (10, 15, 20, 25 W powers); CDL (n = 12), posterior laryngofissure by the CDL (10, 15, 20, 25 W peak powers in pulsed mode). Larynx and proximal trachea were excised, prepared for histopathology, and digital morphometric analysis. Measurements in and within each group were analyzed (Kruskal-Wallis and Dunn test) with a level of significance of p < 0.05. Incision width was not different between the groups, as well as in the powers used in CDL (p = 0.161) and electrocautery group (p = 0.319). The depth of the incisions was smaller in the Laser group compared to control (p = 0.007), and in the electrocautery compared to control (p = 0.026). Incision area was smaller in CDL compared with the control (p = 0.027), and not different between laser and electrocautery groups (p = 0.199). The lateral thermal damage produced by electrocautery was the largest, with a significant difference between laser and electrocautery (p = 0.018), and between electrocautery and control (p = 0.004), whereas the comparison between laser and control showed no significant differences (p = 0.588). The posterior laryngofissure incision using a 980-nm CDL is feasible resulting in smaller incisional area and less lateral thermal damage.