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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Case report
Full Version
Anaesthetic Management for Excision of Right Apical Carcinoma of Lung Encroaching in Thoracic Spine
Correspondence Address :
Jui Ashok Jadhav,
Meghdoot Appartment, M3 Building, Flat No.15, Sawangi Meghe, Wardha-442004, Maharashtra, India.
E-mail: jui.jadhav@gmail.com
Airway management in thoracic surgeries is usually more difficult compared to in any other surgery. One Lung Ventilation (OLV) can be achieved for thoracic surgeries using various approaches like Double Lumen Tube (DLT), Bronchial Blockers (BB) and endobronchial tube. In BB, the procedure needs more precaution because of proneness to movement and displacement than DLT. In case of endobronchial tube, it is impossible to perform bronchoscopy, suction and Continuous Positive Airway Pressure (CPAP) for isolated lung. The present case report is of a 40-year-old male patient, who presented with right intrathoracic tumour encroaching thoracic segment of spinal cord and underwent excision of tumour through thoracotomy and laminectomy approach. Left-sided 37 French DLT was used to achieve OLV. After placing DLT the proper placement was evaluated by bronchoscope.
Bronchial blocker, Bronchoscope, Double lumen tube, One lung ventilation, Thoracic surgeries
A 40-year-old male patient had visited with complaint of bilateral lower limb weakness for three months. On examination, he was of moderate built, weighing 60 kg and a height of 170 cm. Airway evaluation revealed adequate mouth opening with intact teeth and Malampatti Class 2.
Magnetic Resonance Imaging (MRI) spine was suggestive of a spinal cord tumour compressing the cord and extending into the thorax. Contrast Enhanced Computed Tomography (CECT) thorax was done suggestive of infiltrating lesion in the apical segment and upper lobe of the right lung causing erosive destruction of the head and posterior part of the second rib and lateral margin of D2 vertebral body, pedicle, lamina and the spinous process on right side. An excision of the tumour was planned through thoracotomy and laminectomy approach. After induction of anaesthesia the patient was intubated with 37 French left Double Lumen Tube (DLT) as shown in (Table/Fig 1).
Intubation was smooth and proper placement of DLT was evaluated by bronchoscope. The patient was initially ventilated by tracheal and bronchial lumen thereby ventilating both the lungs with tidal volume 500 mL and respiratory rate 16 cycles per minute. The patient was positioned on his left lateral side, and the correct positioning of the DLT was re-evaluated. Before opening the pleura, left One Lung Ventilation (OLV) was initiated with tidal volume of 250 mL, respiratory rate 24 per minute and a peak pressure of 40 cm of H2O. Right lung ventilation was stopped to facilitate successful excision of the tumour. The right lung was insufflated in between with 2 L of oxygen to prevent complete atelectasis of alveoli of the operative right lung. During manoeuvers on the airways, oxygen saturation was maintained up to 95% and simultaneously hypercapnia was established. Then both the lungs were ventilated with the initial ventilator settings to achieve adequate oxygenation and bilateral ventilation. Saturation improved to 98%. Thoracotomy was interrupted in between to perform laminectomy and so both the lungs were ventilated to avoid intraoperative hypoxia.
Successful excision of the tumour was achieved through thoracotomy and laminectomy approach [Table/Fig-2,3]. DLT was removed at the end of the procedure in operation theatre and 8.5 mm cuffed endotracheal tube was placed uneventfully and patient was shifted to recovery room for further observation. Postoperatively, the patient recovered well with out any wound complication. Histopathology of the tumour was suggestive of small cell carcinoma of the lung for which the patient was advised for further management.
Lung isolation is required to achieve adequate exposure of the surgical field and to facilitate visualisation for collapsing the operative lung (1). DLT, Bronchial Blockers (BB) are the two commonly used devices for OLV. The use of DLT is one of the most utilised strategies in lung isolation (2). Airway management in thoracic surgery is very complicated and challenging which therefore mandates extensive skills even for expert anaesthesiologists (3). In this case, OLV was achieved by using DLT. Throughout the procedure, the patient was kept in left lateral position. The use of DLT results in a low risk of movement after positioning and allows for continuous positive airway ventilation to the deflated lung. A BB is a device, which can be inserted down a tracheal tube after tracheal intubation, can also meet the needs of lung isolation. A BB with a spontaneous collapse takes longer to deflate the operative lung and does not provide equivalent surgical exposure compared to DLT (4). Successful excision of tumour through thoracotomy and laminectomy approach was achieved by using left sided 37 French DLT facilitating surgical visualisation by collapsing the operative lung and with low risk of movement after positioning the patient in left lateral position.
Switching from two-lung ventilation to OLV is a challenging task. The changes observed during OLV are increase in shunt fraction, impaired oxygenation and hypoxaemia. Hypoxaemia during OLV is predicted from measurements of lung fraction, distribution of perfusion between the lungs, whether right or left lung is ventilated and whether the operation is performed in supine or lateral decubitus position (5).
In the present case, patient presented with the tumour in the apical segment of upper lobe of right lung causing erosive destruction of the head and posterior part of second rib and lateral margin of D2 vertebral body and spinous process on the right side. Patient was taken for excision of tumour through thoracotomy and laminectomy approach. In the index case, two different surgical procedures thoracotomy and laminectomy were performed as a single planned surgical intervention, and was achieved with DLT (Table/Fig 4).
It emphasises that in thoracic surgery, in the face of anatomical variables, it is vital to understand the various airway management devices as well as be able to use the bronchoscope to handle all of the problems that may arise. The proper placement of DLT initially was evaluated by clinical auscultation of both the lungs, and was confirmed by fiberoptic bronchoscope (6).
As the patient was also presented with thoracic spine tumour, he was kept in left lateral position throughout the procedure. Intraoperative monitoring was done with pulse oximetry, End Tidal carbondioxide (ETCo2), Electrocardiogram (ECG), Central Venous 2Pressure (CVP) monitoring and arterial line. In a study done by Jain S et al., they used somatosensory evoked potential for monitoring during surgery as spine involvement was extensive (7). The patient was initially ventilated by tracheal lumen, thereby ventilating both the lungs. On surgeons request right lung ventilation was stopped for the surgeon to perform successful thoracotomy. In order to prevent intraoperative hypoxia and atelectasis of alveoli of right lung it was insufflated with two litres of oxygen in between.
Left-sided DLT is more commonly used than right DLT due to some important anatomical variations. The left mainstem bronchus is much longer than the right one. Therefore, there is a greater margin of safety while positioning a left-sided DLT. The right upper lobe bronchus takes off from the right main bronchus 1.5-2 centimeters below the carina, therefore with right DLT there are high chances that the right upper lobe bronchus of getting occluded (8). Left-sided DLT was used, which was preferable and indicated for performing right thoracotomy of patient with right upper lobe lung tumour extending the thoracic region.
The use of BB seems to be another unusual and alternative way thereby avoiding tube replacement at the end of procedure (9). However, there are certain disadvantages of BBs because of small lumen, lungs inflate and deflate slowly, difficulty in insertion and more difficult to apply CPAP to the non dependent lung. In the study done by Logato MJ et al., thoracic epidural catheter was placed for intraoperative and postoperative analgesia (10). But in the present case, there was no scope of placing epidural catheter for epidural analgesia in this patient due to the encroachment of intrathoracic tumour into thoracic spine.
Intraoperative placement of DLT provided an advantage of continuous positive airway ventilation to the deflated lung. As thoracotomy was interrupted by laminectomy, sufficient time was there to ventilate both the lungs and significant intraoperative hypoxia was prevented. This manoeuver was in the favor of on-table tracheal extubation, but anticipating the functional impairment of lung in view of thoracic spinal cord tumour involvement, extubation was avoided. In operative room after paralysing the patient with intravenous vecuronium 6 mg, DLT was replaced with 8.5 mm cuffed endotracheal tube. Ventilation continued and patient was shifted to Intensive Care Unit (ICU) for further observation. Postoperative analgesia was achieved by intravenous opioid fentanyl. Patient recovered well without any wound complication. In the study done by Mudarth M et al., postoperative analgesia for thoracotomy was achieved by continuous erector spinae plane block (11).
In OLV, even the complete atelectasis of one lung does not hamper gas exchange to a considerable extent so this makes possible the wider use of OLV ventilation for intrathoracic surgeries. This unique surgery allowed us to achieve insufflation as well as ventilation of operative lung during laminectomy, thereby avoiding intraoperative hypoxia.
DOI: 10.7860/JCDR/2023/60676.17709
Date of Submission: Oct 09, 2022
Date of Peer Review: Dec 21, 2022
Date of Acceptance: Jan 20, 2023
Date of Publishing: Apr 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 09, 2022
• Manual Googling: Jan 03, 2023
• iThenticate Software: Jan 16, 2023 (9%)
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