Pleurodesis
Encyclopedia
Pleurodesis is a medical procedure in which the pleural space
is artificially obliterated. It involves the adhesion of the two pleura.
or recurrent pleural effusion
. It can be done chemically or surgically.
, tetracycline, povidone iodine, or a slurry
of talc
can be introduced into the pleural space through a chest drain
. The instilled chemicals cause irritation between the parietal and the visceral layers of the pleura which closes off the space between them and prevents further fluid from accumulating.
Povidone iodine is equally effective and safe as talc, and may be preferred because of easy availability and low cost.
Chemical pleurodesis is a painful procedure, so patients are often premedicated
with a sedative and analgesics. A local anesthetic
may be instilled into the pleural space, or an epidural
catheter may be placed for anesthesia.
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.
Pleural cavity
In human anatomy, the pleural cavity is the potential space between the two pleura of the lungs. The pleura is a serous membrane which folds back onto itself to form a two-layered, membrane structure. The thin space between the two pleural layers is known as the pleural cavity; it normally...
is artificially obliterated. It involves the adhesion of the two pleura.
Uses
Pleurodesis is done to prevent recurrence of pneumothoraxPneumothorax
Pneumothorax is a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. It may occur spontaneously in people without chronic lung conditions as well as in those with lung disease , and many pneumothoraces occur after physical trauma to the chest, blast...
or recurrent pleural effusion
Pleural effusion
Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.-Pathophysiology:...
. It can be done chemically or surgically.
Chemical
Chemicals such as bleomycinBleomycin
Bleomycin is a glycopeptide antibiotic produced by the bacterium Streptomyces verticillus. Bleomycin refers to a family of structurally related compounds. When used as an anticancer agent, the chemotherapeutical forms are primarily bleomycin A2 and B2. It works by causing breaks in DNA...
, tetracycline, povidone iodine, or a slurry
Slurry
A slurry is, in general, a thick suspension of solids in a liquid.-Examples of slurries:Examples of slurries include:* Lahars* A mixture of water and cement to form concrete* A mixture of water, gelling agent, and oxidizers used as an explosive...
of talc
Talc
Talc is a mineral composed of hydrated magnesium silicate with the chemical formula H2Mg34 or Mg3Si4O102. In loose form, it is the widely-used substance known as talcum powder. It occurs as foliated to fibrous masses, its crystals being so rare as to be almost unknown...
can be introduced into the pleural space through a chest drain
Chest tube
A chest tube is a flexible plastic tube that is inserted through the side of the chest into the pleural space. It is used to remove air or fluid , or pus from the intrathoracic space...
. The instilled chemicals cause irritation between the parietal and the visceral layers of the pleura which closes off the space between them and prevents further fluid from accumulating.
Povidone iodine is equally effective and safe as talc, and may be preferred because of easy availability and low cost.
Chemical pleurodesis is a painful procedure, so patients are often premedicated
Premedication
Premedication refer to a drug treatment given to a patient before a medical procedure. These drugs are typically sedative or analgesic....
with a sedative and analgesics. A local anesthetic
Local anesthetic
A local anesthetic is a drug that causes reversible local anesthesia, generally for the aim of having local analgesic effect, that is, inducing absence of pain sensation, although other local senses are often affected as well...
may be instilled into the pleural space, or an epidural
Epidural
The term epidural is often short for epidural analgesia, a form of regional analgesia involving injection of drugs through a catheter placed into the epidural space...
catheter may be placed for anesthesia.
Surgical
Surgical pleurodesis is performed via thoracotomyThoracotomy
Thoracotomy is an incision into the pleural space of the chest. It is performed by a surgeon, and, rarely, by emergency physicians, to gain access to the thoracic organs, most commonly the heart, the lungs, the esophagus or thoracic aorta, or for access to the anterior spine such as is necessary...
or thoracoscopy
Thoracoscopy
Thoracoscopy is a medical procedure involving internal examination, biopsy, and/or resection of disease or masses within the pleural cavity and thoracic cavity...
. This involves mechanically irritating the parietal pleura
Pleural cavity
In human anatomy, the pleural cavity is the potential space between the two pleura of the lungs. The pleura is a serous membrane which folds back onto itself to form a two-layered, membrane structure. The thin space between the two pleural layers is known as the pleural cavity; it normally...
, often with a rough pad. Moreover, surgical removal of parietal pleura is an effective way of achieving stable pleurodesis.