RESUMO
Ketamine is an anesthetic drug of choice in tropical zones. In addition to excellent pharmocologic properties and low cost, it offers the possibility of using a variety of administration routes and of performing invasive procedures with spontaneous ventilation. Adverse psychodysleptic effects can be prevented by association with midazolam or propofol. Hypersalivation can be prevented with atropine. Recent experience has shown that thanks to its antihyperalgesic effects ketamine can be used for postoperative analgesia at doses ten times lower than for anesthesia.
Assuntos
Analgesia , Anestesia , Ketamina , Humanos , Ketamina/farmacologia , Ketamina/uso terapêuticoRESUMO
Autogenic blood transfusion is indispensable in emergency surgery situations involving severe blood loss. It may also be required in some non-emergency surgical and obstetrical situations. The use of blood-sparing techniques as an alternative to autogenic blood transfusions blood loss can be especially beneficial in tropical settings where the risk of viral transmission is high. The combined use of blood-sparing and autogenic transfusion techniques requires preoperative assessment of transfusion requirements. The expected amount of preoperative blood loss must be determined and compared with the acceptable amount of blood loss for the patient in function of transfusion threshold. Various techniques to reduce the need for autogenic blood transfusion can be used depending on locally available resources. Blood-sparing techniques include treatment to increase the patient's baseline hemoglobin rates, use of cell saving systems for autologous blood transfusion, and/or perioperative transfusion of recuperated blood. In this article these techniques are illustrated in two practical clinical cases.