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1.
World J Surg ; 39(11): 2622-9, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26195243

RESUMO

INTRODUCTION: The burden of disease and mortality associated with inguinal hernia in Africa, especially in sub-Saharan Africa, is very high. The purpose of this study is to show that International Cooperation work in the field of hernia repair is effective; it minimizes the delay in hernia repairs in the targeted population, and can prevent a large number of disability-adjusted life years (DALYs). MATERIALS AND METHODS: As a part of an International Cooperation program, a total of 990 black patients with inguinal hernias were studied, in whom hernioplasty was performed using polypropylene mesh. The type of hernia and surgical technique were studied. Indicators of scientific and technical quality, indicators of efficiency and of effectiveness were analyzed. The results on the usefulness of interventions were calculated as avoided DALYs. RESULTS: Surgery was performed on 926 patients with a total of 1033 hernia repairs. 87.2 % of the repairs were made with mesh. There was no mortality in the series, complications were minor, and 85.7 % of patients remained less than 24 h in the center. There was a 2.8 % of recurrence, with a follow-up 58.7 % of the patients in the first year. 5014 DALYs were avoided, and the average of the avoided DALYs per patient was of 5.41. CONCLUSIONS: Hernia repair with mesh in low development countries is a procedure with low morbidity and high effectiveness that can prevent a large number of DALYs.


Assuntos
Hérnia Inguinal/cirurgia , Cooperação Internacional , África Subsaariana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Telas Cirúrgicas
2.
World J Surg ; 38(9): 2212-6, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24728536

RESUMO

BACKGROUND: Endemic goiter remains a serious public health problem and 75 % of people affected live in underdeveloped countries where treatment is difficult for various reasons. The aim of this article is to report our experience in African countries with the management and surgical treatment of endemic goiter, performed in a nonhospital setting and without general anesthesia in the context of a collaborative development project by experienced endocrine surgeons. METHODS: Fifty-six black African patients with a goiter were studied. Those in poor general health, the elderly, patients with either small goiters or clinical hyperthyroidism, and those presenting with an acute episode of malaria were excluded from the study. Cervical epidural anesthesia with spontaneous ventilation was used and a partial thyroidectomy was performed. The technique used, its immediate complications, and early and late follow-up were analyzed. RESULTS: Surgery was performed on 31 patients with grades 3 and 4 goiter without mortality and a morbidity rate of 11.9 %, with 97 % of all complications being minor. There were no instances of dysphonia or symptomatic hypocalcemia and the mean stay was 1.57 days (range 1.25-1.93). Follow-up in the first year was 71 % and no case of severe or recurrent hypothyroidism was detected. CONCLUSIONS: Surgery without general anesthesia performed in a nonhospital setting in underdeveloped countries in patients with goiter is a viable option with good results and low morbidity.


Assuntos
Anestesia Epidural , Países em Desenvolvimento , Bócio Endêmico/cirurgia , Instalações de Saúde , Tireoidectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Epidural/efeitos adversos , Anestesia Geral , Camarões , Feminino , Humanos , Hipotireoidismo , Tempo de Internação , Masculino , Mali , Pessoa de Meia-Idade , Morbidade , Tireoidectomia/efeitos adversos , Adulto Jovem
3.
J Neurosurg Anesthesiol ; 11(3): 206-8, 1999 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10414678

RESUMO

The management of patients with chronic renal failure (CRF) undergoing cerebral aneurysm surgery has been documented on only a few occasions. We report a 58-year-old man with CRF and subarachnoid hemorrhage (SAH) due to aneurysm rupture. We describe the patient's perioperative anesthetic management, discussing the current methods for maintaining an appropriate cerebral perfusion pressure and for preventing rehemorrhage from the aneurysm. We suggest that heparin-aided hemodialysis be avoided in these cases.


Assuntos
Anestesia Geral , Aneurisma Roto/cirurgia , Aneurisma Intracraniano/cirurgia , Falência Renal Crônica/complicações , Anticoagulantes , Pressão Sanguínea/fisiologia , Circulação Cerebrovascular/fisiologia , Contraindicações , Heparina , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Bloqueio Neuromuscular , Diálise Renal , Hemorragia Subaracnóidea/prevenção & controle , Hemorragia Subaracnóidea/cirurgia
4.
J Neurosurg Anesthesiol ; 13(2): 79-82, 2001 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11294462

RESUMO

Patients receiving chronic anticonvulsant therapy have been reported to show resistance to certain nondepolarizing neuromuscular blockers. In this study, the effects of chronic phenytoin therapy on the onset, duration, and recovery of rocuronium action was assessed. Thirty-six patients scheduled for various neurosurgical procedures were studied: 18 receiving chronic phenytoin therapy (Group I) and 18 controls (Group II). Rocuronium 0.6 mg/kg (2 x DE95) was administered after induction of general anesthesia with 4-6 mg/kg thiopental sodium and 3-5 microg/kg intravenous (IV) fentanyl. Maintenance anesthesia consisted of N2O in O2, 0.5% end-tidal isoflurane, and a fentanyl infusion. Neuromuscular block was monitored with acceleromyography of the adductor pollicis-brevis muscle by using a TOF-GUARD Biometer monitor (Biometer International A/S, Odense, Denmark). According to the amplitude of the first response of train-of-four, neither the lag time nor the onset time differed between the two groups. However, the recovery index was significantly shorter in patients chronically treated with phenytoin (mean recovery index: control group, 8.3 +/- 1.7 minutes; phenytoin group, 6.7 +/- 2.3 minutes; P < .05). In addition, the times of recovery to 10%, 25%, 75%, and 90% of the baseline response were also significantly shorter in the phenytoin group than in the control group. We conclude that the duration of action of rocuronium and the recovery index were affected by chronic phenytoin therapy.


Assuntos
Androstanóis , Anestesia , Anticonvulsivantes/efeitos adversos , Bloqueio Neuromuscular , Fármacos Neuromusculares não Despolarizantes , Fenitoína/efeitos adversos , Adulto , Interações Medicamentosas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miografia , Procedimentos Neurocirúrgicos , Rocurônio
5.
Neurocirugia (Astur) ; 14(3): 216-21, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12872170

RESUMO

OBJECTIVE: Pneumocephalus is a well-known complication of surgical procedures performed with the patients placed in the sitting position. Its incidence and intensity were prospectively studied in 90 consecutive patients undergoing a posterior fossa procedure in this position. Various anesthetic agents, with different effects on cerebral hemodynamics, were used. MATERIAL AND METHODS: Patients were randomly assigned to one of three groups. In group 1 (n=30), anesthesia was induced and maintained with propofol. In group 2 (n=30), anesthesia was induced with thiopental and maintained with isoflurane. In group 3 (n=30), anesthesia was induced with thiopental and maintained with nitrous oxide and low-dose isoflurane. All patients received a load dose and an infusion of fentanyl. A cerebral computed tomography scan was performed to all patients 8 hours after surgery for detecting the presence and location of intracranial air. The size of pneumocephalus was ascertained using the formula for calculating the volume of a spheroid: v = PI / 6. x. y. z. Preoperative diagnosis, existence of shunted or non-shunted hydrocephalus, type and duration of the surgical procedure, detection of intraoperative venous air embolism, and appearance of new neurological symptoms in the postoperative period, were recorded. RESULTS: All patients included in the study developed postoperative pneumocephalus. There were no significant differences (P = 0.133) in the estimated volume of intracranial air between the groups (group 1, volume = 38.3 -/+ 35.4 ml; group 2, volume = 48.9 -/+ 36.3 ml; group 3, volume = 31.5 -/+ 28.4 ml). Only two patients in the group 2 manifested symptoms of neurological involvement due to the pressure exerted by the intracranial air. CONCLUSIONS: Despite the hypothetical diverse effects of the three anesthetic techniques used in this series on cerebral hemodynamics, our results suggest that none of them has a substantial effect on the amount of intracranial air detected after posterior fossa procedures performed in seated individuals. To the best of our knowledge this is the first report that addresses in a prospective manner the effects of several habitual anesthetic techniques on the development of pneumocephalus in patients submitted to posterior fossa procedures performed in the sitting position.


Assuntos
Anestésicos Intravenosos/administração & dosagem , Fossa Craniana Posterior/cirurgia , Fentanila/uso terapêutico , Óxido Nitroso/administração & dosagem , Pneumocefalia/etiologia , Complicações Pós-Operatórias , Postura , Propofol/administração & dosagem , Adolescente , Adulto , Criança , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Pneumocefalia/diagnóstico por imagem , Estudos Prospectivos , Tomografia Computadorizada por Raios X
10.
J Appl Toxicol ; 17(3): 179-83, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9250539

RESUMO

The relationship between isoflurane environmental concentrations in operating rooms and the corresponding isoflurane concentration in the exhaled air of the operating personnel at the end of the exposure has been investigated. Isoflurane was retained in an adsorbent cartridge and after thermal desorption the concentration was estimated by gas chromatography. Significant correlation between environmental and exhaled air isoflurane concentrations allowed the establishment of a biological exposure index and biological exposure limits corresponding to proposed atmospheric threshold values.


Assuntos
Testes Respiratórios/métodos , Monitoramento Ambiental/métodos , Isoflurano/análise , Exposição Ocupacional/análise , Ar , Anestésicos Inalatórios/análise , Humanos , Salas Cirúrgicas , Análise de Regressão
11.
Anesth Analg ; 92(6): 1473-6, 2001 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-11375828

RESUMO

We sought to determine the analgesic efficacy, opioid-sparing effects, and tolerability of propacetamol, an injectable prodrug of acetaminophen, in combination with morphine administered by patient-controlled analgesia (PCA) after spinal fusion surgery. Forty-two patients undergoing spinal stabilization surgery were randomized into two groups, which were given either an IV placebo or an IV injection of 2 g propacetamol every 6 h for 3 days after surgery. The postoperative opioid analgesic requirement was assessed with a PCA device used to self-administer morphine. Pain relief was evaluated by a visual analog pain scale and by verbal rating scores of pain relief at 8-h intervals for up to 72 h after surgery. The cumulative dose of morphine at 72 h was smaller in the Propacetamol group than in the Placebo group (60.3 +/- 20.5 vs 112.2 +/- 39.1 mg; P < 0.001). The pain scores were significantly lower in the Propacetamol group measured at two intervals of the study, although visual analog scale pain intensity scores were smaller than 3 in both groups. Most patients in the Placebo group obtained a greater degree of sedation on postoperative Day 3 (P < 0.05). This study demonstrates the usefulness of propacetamol as an adjunct to PCA morphine in the treatment of postoperative pain after spinal fusion.


Assuntos
Acetaminofen/análogos & derivados , Acetaminofen/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Fusão Vertebral , Acetaminofen/administração & dosagem , Acetaminofen/efeitos adversos , Adulto , Analgesia Controlada pelo Paciente , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/efeitos adversos , Analgésicos Opioides/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Estudos Prospectivos
12.
Br J Anaesth ; 80(4): 516-8, 1998 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9640162

RESUMO

We report two young patients who had repeated neurosurgical procedures and who were thought to be at risk of developing Creutzfeldt-Jakob disease (CJD). The first patient had been given a lyophilized dural graft in the course of removal of a cerebellar medulloblastoma 15 yr previously. The second patient had received pituitary-derived growth hormone for treatment of growth hormone deficiency, secondary to a third ventricle teratoma, exised 13 yr earlier. The presence of cerebellar symptoms together with being recipients of growth hormone or dural graft of cadaveric extraction arose suspicion of a diagnosis of CJD in both individuals. Precautions in the anaesthetic and surgical management of these two patients are discussed, and pertinent literature is reviewed briefly.


Assuntos
Anestesia Geral/métodos , Síndrome de Creutzfeldt-Jakob/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Procedimentos Neurocirúrgicos , Adolescente , Contaminação de Medicamentos , Dura-Máter/transplante , Hormônio do Crescimento/efeitos adversos , Humanos , Masculino , Esterilização
13.
Eur J Anaesthesiol ; 20(11): 891-6, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14649341

RESUMO

BACKGROUND AND OBJECTIVE: Intraperitoneal administration of a local anaesthetic in combination with an opioid, for the relief of postoperative pain, has already been reported except after laparoscopic cholecystectomy. This study was aimed at assessing the analgesic effect of the intraperitoneal administration of bupivacaine and morphine in patients undergoing laparoscopic cholecystectomy. METHODS: At the end of laparoscopic cholecystectomy, in a double-blind, randomized manner, one of the following injections was given intraperitoneally. There were 30 patients in each group: Group 1, physiological saline 30 mL; Group 2, bupivacaine 0.25% 30 mL; Group 3, bupivacaine 0.25% 30 mL plus morphine 2 mg. In addition, Group 2 received 2 mg intravenous (i.v.) morphine in 2 mL saline, and Groups 1 and 3, 2 mL saline intravenously. Patients' postoperative pain was evaluated using a visual analogue scale and a verbal rating score. The postoperative analgesic requirement was assessed by the total dose of metamizol administered by an i.v. patient-controlled analgesia (PCA) device. Pain, vital signs, supplemental analgesic consumption and side-effects were recorded for all patients for 24 h. RESULTS: There were no differences between the three groups regarding pain scores (at rest and coughing) during the study except in the first 2 h, when scores were lower for patients receiving intraperitoneal bupivacaine plus i.v. morphine (P < 0.05). Supplemental consumption of metamizol was significantly lower (P < 0.05) in Group 3 than in Group 1 during the first 6 h after surgery. However, the cumulative doses of metamizol were also lower in Group 2 than in Groups 1 and 3 over the entire study (2025 +/- 1044 mg vs. 4925 +/- 1238 and 4125 +/- 1276mg; P < 0.05). CONCLUSIONS: In patients undergoing laparoscopic cholecystectomy, the intraperitoneal administration of morphine plus bupivacaine 0.25% reduced the analgesic requirements during the first 6 postoperative hours compared with the control group. However, the combination of intraperitoneal bupivacaine 0.25% and i.v. morphine was more effective for treatment of pain after laparoscopic cholecystectomy.


Assuntos
Bupivacaína/uso terapêutico , Colecistectomia/efeitos adversos , Laparoscopia/efeitos adversos , Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Adulto , Analgesia Controlada pelo Paciente , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Análise de Variância , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Bupivacaína/administração & dosagem , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Injeções Intraperitoneais , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Medição da Dor , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
14.
Br J Anaesth ; 80(5): 599-601, 1998 May.
Artigo em Inglês | MEDLINE | ID: mdl-9691861

RESUMO

Extradural drainage systems connected to a vacuum device for preventing postoperative haematoma formation are often used in neurosurgical practice. Cardiovascular complications, including bradycardia or low arterial pressure caused by intracranial hypotension, have been described associated with their use. We have investigated the relationship between the negative pressure applied to extradural drainage systems and intracranial pressure (ICP), and analysed the effects of negative pressure of the drains on systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressures and on heart rate (HR). We studied prospectively 15 patients undergoing neurosurgery for supratentorial tumours or aneurysms. Transient decreases in ICP (P < 0.001) and HR (P < 0.001), with no clinical effects, were observed after connecting the vacuum device to the drain. There were no significant changes in SAP, DAP or MAP.


Assuntos
Encéfalo/cirurgia , Hemodinâmica/fisiologia , Pressão Intracraniana/fisiologia , Cuidados Pós-Operatórios/efeitos adversos , Adulto , Idoso , Pressão Sanguínea/fisiologia , Hemorragia Cerebral/prevenção & controle , Feminino , Frequência Cardíaca/fisiologia , Hematoma/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Sucção/efeitos adversos
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