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Cardiac surgical patients often have associated comorbidities that can impede normal wound healing; however, statin therapy has the potential to improve this process through augmentation of the normal inflammatory response. Outcomes included a 30% earlier rate of wound epithelialization and an 80% greater wound-breaking strength combined with faster wound healing rates (13.0 days vs 18.7 days, p < 0.0001). Inhibition of farnesyl pyrophosphate may hold a key role in the mediation of such advantageous effects. This systematic review suggests that there is sufficient evidence to warrant completion of a human trial to assess the effects of statins on wound healing. [ABSTRACT FROM AUTHOR]

Thoracic surgical oncology is a time-sensitive, high-resource, complex surgical speciality to which coronavirus has posed a unique challenge. In response to the evolving situation in mainland Europe, our department rapidly established a coronavirus disease 2019–free site to maintain elective cancer surgery. This necessitated a strict admission pathway and perioperative patient management. It resulted in the maintenance of a high-volume, high-quality thoracic surgical oncology program with no coronavirus disease 2019–positive cases to date. Maintaining satisfactory training levels among surgical and anesthetic trainees has also been achieved. We suggest that this model could be adapted to local resource capabilities. [ABSTRACT FROM AUTHOR]

Transfusion-related acute lung injury is a potentially fatal complication of blood and plasma transfusion; however, the incidence relating to platelet use in cardiac surgery is uncommon. In the presence of normal left ventricular function, an acute increase in pulmonary capillary permeability leads to a high protein content pulmonary edema, which leads to a dramatic reduction in pulmonary function due to acute lung injury and also intravascular fluid depletion. The clinical picture is acute and the condition is associated with considerable mortality. Although the exact mechanism of transfusion-related acute lung injury is unknown, it may be due to an antibody-mediated reaction caused by preformed leukocyte antibodies or activation of inflammatory mediators. The signs, diagnosis, and therapeutic interventions are discussed with reference to a case report. [Copyright &y& Elsevier]

PROcedure SPECific Postoperative Pain ManagemenT (PROSPECT) guidelines recommend erector spinae plane (ESP) block or paravertebral block (PVB) for postoperative analgesia after video-assisted thoracoscopic surgery (VATS). However, there are few trials comparing the effectiveness of these techniques on patient-centric outcomes, and none evaluating chronic postsurgical pain (CPSP). Furthermore, there are no available trials comparing ultrasound-guided ESP with surgically placed PVB in this patient cohort. We conducted a two-centre, prospective, randomised, double-blind, controlled trial, comparing anaesthesiologist-administered, ultrasound-guided ESP catheter with surgeon-administered, video-assisted PVB catheter analgesia among 80 adult patients undergoing VATS. Participants received a 20 ml bolus of levobupivacaine 0.375% followed by infusion of levobupivacaine 0.15% (10–15 ml h−1) for 48 h. Primary outcome was Quality of Recovery-15 score (QoR-15) at 24 h. Secondary outcomes included QoR-15 at 48 h, peak inspiratory flow (ml s−1) at 24 h and 48 h, area under the pain verbal response score vs time curve (AUC), opioid consumption, Comprehensive Complication Index, length of stay, and CPSP at 3 months after surgery. Median (25–75%) QoR-15 at 24 h was higher in ESP (n =37) compared with PVB (n =37): 118 (106–134) vs 110 (89–121) (P =0.03) and at 48 h: 131 (121–139) vs 120 (111–133) (P =0.03). There were no differences in peak inspiratory flow, AUC, Comprehensive Complication Index, length of hospital stay, and opioid consumption. Incidence of CPSP at 3 months was 12 (34%) for ESP and 11 (31%) for PVB (P =0.7). Compared with video-assisted, surgeon-placed paravertebral catheter, erector spinae catheter improved overall QoR-15 scores at 24 h and 48 h but without differences in pain or opioid consumption after minimally invasive thoracic surgery. NCT04729712. [ABSTRACT FROM AUTHOR]