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Mechanical Pleurodesis

A mechanical pleurodesis is performed manually by a surgeon who gently strokes the surface of the lung with a piece of gauze. This roughens up the pleura so that when the abrasion heals, the lung adheres to the chest wall. Sometimes the procedure is done in combination with some type of chemical pleurodesis, such as talc (below). In general, LAM experts prefer mechanical pleurodesis without talc for patients with LAM since lung transplantation can be more difficult after talc or pleurectomy.

Chemical Pleurodesis
A chemical pleurodesis involves instilling a chemical irritant into the pleural space, which causes adhesion between the chest wall and the lining of the lung. Chemical pleurodesis can be done either through a chest tube, while youre awake in a hospital room, or it can be done under general anesthesia via surgery. Sometimes a combination of chemical and mechanical pleurodesis is used.

Talc pleurodesis: One of the most common methods of chemical pleurodesis is performed using surgical talc and a chest tube. In fact, if a patient already has a chest tube in place, a talc procedure is often recommended. When the air has been expelled, a talc slurry is instilled through the chest tube into the chest cavity. Alternatively, during surgery, talc can be blown into the chest cavity using a bulb syringe, a method called talc poudrage. The talc acts as a sclerosing agent, that is, something that causes the pleura lining of the lung and the pleura lining of the chest wall to stick together. Suction is used after this procedure to remove any remaining air in the pleural space. Talc pleurodesis or poudrage often produces a burning sensation in the chest as the area heals, but this procedure tends to be very effective, and its also less expensive than surgery.

Surgical
Surgical pleurodesis is performed via thoracotomy or thoracoscopy. This involves mechanically irritating the parietal pleura, often with a rough pad. Moreover, surgical removal of parietal pleura is an effective way of achieving stable pleurodesis.

Other Chemicals: In addition to talc, other chemical irritants such as doxycycline and bleomycin can be used. Note;

The patient was then laid on her left lateral decubitus position for 5 minutes and then turned into the right lateral decubitus position for 5 minutes and then the chest tube was unclamped.

Preparation:
-Obtain informed consent from the patient -Patient is assessed and found to be in good condition and a good candidate for conscious sedation. -Vital signs are taken and must be stable. -The patient is then given initially 0.5 mg of Versed and 2 mg of morphine IV. -After a couple of minutes, she was assessed and found to be awake but calm, so then the chest tube was clamped and then through the chest tube a solution of 120 mL of normal saline containing 5 g of talc and 40 mg of lidocaine were then put into her right chest taking care that no air would go in to create a pneumothorax. -She was then laid on her left lateral decubitus position for 5 minutes and then turned into the right lateral decubitus position for 5 minutes and then the chest tube was unclamped.

-The patient was given additional 0.5 mg of Versed and 0.5 mg of Dilaudid IV achieving a state where the patient was comfortable but readily responsive. The chest tube was unclamped. Now, the patient is left to rest and she will get a chest x-ray in the morning.