title: Novel approach for talc pleurodesis by dedicated catheter through flexi-rigid thoracoscope under local anesthesia.
abstract: For pleurodesis, talc administered by poudrage is usually insufflated blindly from a single port of entry using the standard method with a small-diameter rigid thoracoscope. In order to visually perform talc poudrage from a single port, we introduced a catheter technique through a flexi-rigid thoracoscope. Patients with uncontrolled and symptomatic pleural effusion requiring pleurodesis underwent flexi-rigid thoracoscopy under local anesthesia for talc poudrage. A dedicated catheter with 2.1-mm inner diameter was connected to a talc atomizer and inserted through the working channel of the flexi-rigid thoracoscope to insufflate talc into the pleural cavity under visualization. Nine patients were included in this study. Three patients were >75 years old, and two were Karnofsky performance status 50. Three patients received propofol for sedation and six were not sedated. Mean operative time was 30.8 min for all patients, and 21.3 min for cases without sedation. All procedures were performed easily under clear visualization with no major complications or catheter obstructions. This novel approach for talc pleurodesis using a catheter was well-tolerated and seems feasible for patients with uncontrolled pleural effusion. We consider this technique useful even for difficult cases, such as elderly patients or those with relatively low performance status.
authors.affiliation: Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Ishida
authors.forename: Miho
authors.initials: M
authors.lastname: Nakamura
authors.forename: Teruomi
authors.initials: T
authors.lastname: Miyazawa
authors.forename: Philippe
authors.initials: P
authors.lastname: Astoul
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D057785:Catheters; D004867:Equipment Design; D005260:Female; D006801:Humans; D007327:Insufflation; D007564:Japan; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000628:therapy*; D018700:Pleurodesis / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D013627:Talc / Q000008:administration & dosage*; D020708:Thoracoscopes; D013906:Thoracoscopy / Q000009:adverse effects / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D013627:Talc; D015742:Propofol