Assuntos
Anestesia Geral , Broncoscopia , Procedimentos Cirúrgicos Torácicos/métodos , Doenças da Traqueia/diagnóstico , Feminino , Tecnologia de Fibra Óptica , Humanos , Achados Incidentais , Período Intraoperatório , Pessoa de Meia-Idade , Neurilemoma/complicações , Neurilemoma/cirurgia , Doenças da Traqueia/complicaçõesRESUMO
Lung isolation is essential during thoracic surgery, as it allows the thoracic surgeon to visualise and work in the surgical field. The occurrence of hypoxaemia during lung isolation is common, and is even more so in patients with decreased pulmonary functional reserve. The clinical cases are presented of 2 patients with a history of left pulmonary resections (1st left lower lobectomy, 2nd left lower lobectomy and left upper lobe segmentectomy), in which sequential selective lobar blockade was performed with Fuji Uniblocker® endobronchial blocker for performing right lung atypical resections (right upper lobe, middle lobe, and right lower lobe). In our experience the technique was successful, the surgical field was optimal and no intra- or post-operative complications were found. This technique may be an alternative to traditional lung isolation in patients with compromised respiratory function (low functional reserve or previous contralateral lung resections).
Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia , Equipamentos Cirúrgicos , Humanos , Pulmão , Complicações Pós-OperatóriasRESUMO
Arterial catheterization is a simple technique that yields great benefits, such as continuous monitoring of arterial pressure and the possibility of taking repeated samples for analysis. However, it is not free of complications, the main ones being limb ischemia and gas embolism. To reduce the risk of complications, guidelines for insertion and maintenance of arterial catheters have been established. We report two cases of acute hand ischemia secondary to arterial catheterization. Both patients were undergoing surgery for sarcoma-type abdominal cancer and developed acute ischemia of the hand lasting several hours. The predisposing factor in both cases was the existence of a highly advanced sarcoma-type abdominal tumor, probably related to a state of hypercoagulability.
Assuntos
Cateteres de Demora/efeitos adversos , Mãos/irrigação sanguínea , Isquemia/etiologia , Lipossarcoma/complicações , Complicações Pós-Operatórias/etiologia , Artéria Radial/lesões , Neoplasias Retroperitoneais/complicações , Sarcoma/complicações , Neoplasias Gástricas/complicações , Doença Aguda , Idoso , Evolução Fatal , Mãos/patologia , Humanos , Isquemia/patologia , Lipossarcoma/sangue , Lipossarcoma/cirurgia , Masculino , Necrose , Neoplasias Retroperitoneais/sangue , Neoplasias Retroperitoneais/cirurgia , Sarcoma/sangue , Sarcoma/cirurgia , Neoplasias Gástricas/sangue , Neoplasias Gástricas/cirurgia , Trombofilia/etiologiaRESUMO
BACKGROUND/AIMS: We performed a retrospective evaluation of 11 patients in the final stages of hepatic disease with chronic kidney failure, in whom simultaneous double liver-kidney transplantation was performed. METHODOLOGY: In the immediate pre-, intra- and postoperative periods, we assessed metabolic, hemodynamic and coagulation parameters; bicarbonate, calcium and inotropic drug requirements; the incidences during reperfusion of the graft; the surgical technique employed; the need for hemodialysis and/or ultrafiltration; and the survival rate of the patients. RESULTS: Of the 11 cases studied, four patients needed hemodialysis, while only one patient needed ultrafiltration; three patients required both techniques, and no dialysis or ultrafiltration was performed in three patients. The following surgical techniques were employed: Total clamping of the inferior vena cava using an external venovenous bypass in two cases; total clamping of the inferior vena cava without an external venovenous bypass in three cases; and partial clamping of the inferior vena cava with preservation of the retrohepatic cava in six cases. The results showed one death in the first postoperative month and two deaths in the course of subsequent follow-up. The survival rate was 72.7%. CONCLUSIONS: The use of conventional intraoperative hemodialysis and/or ultrafiltration is feasible, useful and achieves good results in patients undergoing double liver-kidney transplantation. Partial clamping of the inferior vena cava at the anhepatic stage appears to reduce the need for ultrafiltration. There is no increase in perioperative mortality in patients who underwent liver transplantation while conserving their renal function.