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1.
Rev. esp. anestesiol. reanim ; 66(5): 277-287, mayo 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187472

RESUMO

El síndrome vasopléjico constituye un estado de vasodilatación sistémica refractaria al uso de vasopresores en presencia de gasto cardíaco normal. En el presente artículo se revisará la definición, fisiopatología, factores predisponentes el enfoque diagnóstico y terapéutico del mismo. Su ocurrencia es frecuente en el perioperatorio de cirugía cardíaca y se asocia a incrementos en morbimortalidad. Se llevó a cabo una búsqueda en las bases de datos LILACS, MEDLINE y GOOGLE SCHOLAR abarcando los artículos relevantes durante los últimos 18 años. Se debe identificar los pacientes de riesgo en aras de realizar un diagnóstico y tratamiento precoz con vasopresores con diferentes mecanismos de acción


Vasoplegic syndrome is a state of vasopressor resistant systemic vasodilation in the presence of a normal cardiac output. Its definition, pathophysiology, risk factors, diagnosis and therapeutic approach will be reviewed in this paper. It occurs frequently during cardiac surgery and is associated with high morbidity and mortality. A search in the LILACS, MEDLINE, and GOOGLE SCHOLAR databases was conducted to find the most relevant papers during the last 18 years. Prompt identification and diagnosis of patients at risk must be undertaken in order to implement an optimal therapeutic approach. This latter includes early treatment with vasopressors with different mechanisms of action


Assuntos
Humanos , Vasoplegia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Complicações Pós-Operatórias , Vasoconstritores/uso terapêutico , Fatores de Risco , Circulação Extracorpórea/efeitos adversos , Diagnóstico Diferencial , Ecocardiografia Transesofagiana/métodos
2.
Rev. esp. anestesiol. reanim ; 61(5): 246-253, mayo 2014.
Artigo em Espanhol | IBECS | ID: ibc-121220

RESUMO

Objetivo. Investigamos la incidencia y los factores de riesgo asociados al desarrollo de vasoplejía en el postoperatorio inmediato y a las 24 h en pacientes sometidos a cardiocirugía con circulación extracorpórea. La mayoría de los factores de riesgo evidenciados provienen de estudios retrospectivos. Métodos. Entre noviembre de 2011 y mayo de 2012 estudiamos prospectivamente 188 pacientes consecutivos operados de cardiocirugía con circulación extracorpórea. Excluimos intervenciones quirúrgicas de urgencia y de alta complejidad. Evaluamos la vasoplejía en el postoperatorio inmediato y a las 24 h, definida como presiones arteriales medias inferiores a 50 mmHg y perfusión de noradrenalina superior a 0,08 μg/kg/min, monitorizadas con gasto cardiaco y resistencias vasculares sistémicas. Todos se sometieron al mismo protocolo anestésico, tratamiento hemodinámico y de circulación extracorpórea. Resultados. El 48% presentaron vasoplejía en el postoperatorio inmediato y un 34% a las 24 h. Los factores de riesgo para el desarrollo de vasoplejía fueron el uso de inhibidores de la enzima convertidora de la angiotensina, presentar una presión arterial media < 50 mmHg a la entrada en circulación extracorpórea, el tiempo de pinzamiento aórtico y la temperatura mínima durante la circulación extracorpórea. Y 24 h se correlacionó con el uso de inhibidores de la enzima convertidora de la angiotensina y el tiempo de circulación extracorpórea. Conclusión. La incidencia de vasoplejía en estos pacientes es elevada. El uso preoperatorio de inhibidores de la enzima convertidora de la angiotensina y la presión arterial media a la entrada de circulación extracorpórea son factores de riesgo potencialmente controlables, o si el paciente se presenta con ellos, prever el tratamiento o la prevención de la vasoplejía (AU)


Objective. The incidence and risk factors for vasoplegia in the early postoperative period and at 24 h are investigated in patients subjected to cardiopulmonary bypass surgery. Vasoplegia following cardiac surgery with cardiopulmonary bypass is associated with a high morbimortality. The risk factors described emerged from retrospective, non-controlled studies. Methods. Observational prospective study of 188 consecutive patients subjected to cardiac surgery with cardiopulmonary bypass in a single hospital between November 2011 and May 2012. Emergency surgery or complex procedures were excluded. Vasoplegia was assessed during the immediate postoperative period, and at 24 h after surgery, and was defined as a mean arterial pressure below 50 mmHg, and the need for a noradrenaline perfusion of more than 0.08 μg/kg/min, monitored by cardiac output and systemic vascular resistances. The anaesthetic and cardiopulmonary bypass protocols, as well as haemodynamic management, were the same in all patients. Results. Almost half (48%) of patients had vasoplegia in the immediate postoperative period, and 34% at 24 h. Risk factors for immediate vasoplegia development were preoperative use of angiotensin converting enzyme inhibitor drugs, a mean arterial pressure < 50 mmHg immediately after beginning cardiopulmonary bypass, duration of aortic clamping as well as the cardiopulmonary bypass, and minimum temperature in cardiopulmonary bypass. Vasoplegia at 24 h after surgery was correlated to preoperative angiotensin converting enzyme inhibitor drug treatment and cardiopulmonary bypass duration. Conclusion. The incidence of vasoplegia after cardiac surgery with cardiopulmonary bypass is high during the first 24 postoperative hours. Preoperative treatment with angiotensin converting enzyme inhibitor and the mean arterial pressure at the beginning of cardiopulmonary bypass are the more easily controllable risk factors. In patients arriving to surgery with those drugs, treatment or prevention of vasoplejia should be planned (AU)


Assuntos
Humanos , Masculino , Feminino , Vasoplegia/complicações , Vasoplegia/diagnóstico , Vasoplegia/cirurgia , Cirurgia Torácica/métodos , Cirurgia Torácica/organização & administração , Circulação Extracorpórea/métodos , Circulação Extracorpórea/normas , Circulação Extracorpórea , /uso terapêutico , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Estudos Prospectivos , Vasodilatadores/uso terapêutico
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