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1.
J Clin Anesth ; 92: 111271, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-37820520

RESUMO

It is well recognized that amyloid protein can infiltrate many regions of the body. This can include the peripheral nerves, the liver, kidney, spleen, the gastrointestinal tract, and most importantly the myocardium. The amyloid proteins that cause cardiomyopathy may come from genetically altered liver genes (transthyretin amyloid, ATTR) or from the bone marrow with malignant plasma cells (light chain amyloid, AL) generating the aberrant protein. These two types of amyloidosis cause significant damaging effects on both the myocardial cells as well as the conduction system of the heart. The resultant changes can produce dyspnea and exercise intolerance which is thought to be secondary to diastolic dysfunction and reduced stroke volume. This subclinical decompensation poses a significant problem for members of a care team as it often goes unrecognized. In the operating room patients are exposed to dramatic hemodynamic changes and may have difficult airways, autonomic dysfunction, and conduction abnormalities. Although the topic of amyloidosis is well described in cardiology literature, it is underdiagnosed. The purpose of this review is to describe some of the pathophysiology behind the principle proteins that cause cardiac amyloidosis and to comprehensively describe perioperative considerations for anesthesia providers.


Assuntos
Amiloidose , Cardiomiopatias , Humanos , Anestesiologistas , Amiloidose/complicações , Amiloidose/diagnóstico , Cardiomiopatias/etiologia , Amiloide/metabolismo , Rim
2.
J Surg Case Rep ; 2023(7): rjad383, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37434719

RESUMO

Bronchopleural fistulas (BPFs) are a dreaded complication following pulmonary surgery. Endobronchial valves (EVs), with endobronchial sealant (ES), instilled with robotic bronchoscopy (RB), allow occlusion of BPF, avoiding surgery. The patient was a 71-year-old woman with a history of chronic obstructive pulmonary disease and bronchiectasis who underwent bilateral lung transplantation and wedge resection of the right middle lobe and left lingula. A BPF was discovered on postoperative day (POD) 21. Conservative measures with chest tubes failed, and robotic-assisted bronchoscopy aided in reaching the bronchial segment and instilling ES, and EV was deployed with the conventional bronchoscope. The pneumothorax was cleared 12 days later, and on POD 56, she was discharged. The RB procedure was successful, with no pneumothorax or BPF symptoms after a median follow-up of POD 284. Robotic endobronchial closure of BPF with EV and ES is an effective treatment option avoiding invasive surgeries.

3.
Minerva Anestesiol ; 86(2): 165-171, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31630511

RESUMO

BACKGROUND: Protein-containing liquids may delay gastric emptying and increase risk of aspiration. Commercial whey protein nutritional drinks (WPNDs) are advertised as "clear liquid nutritional drinks" and can be mistaken for protein-free, carbohydrate-based clear liquids. We used gastric ultrasonography to compare gastric emptying of a protein-free, carbohydrate-based clear liquid with that of a WPND in healthy volunteers. METHODS: We recruited 19 adult (age ≥18 years) volunteers with a body mass index less than 40 kg/m2 and without a history of diabetes mellitus, dysphagia, prior gastric surgery, or allergy to the ingredients of apple juice (AJ) or a WPND. After fasting for eight hours, the volunteers randomly received 474 mL of AJ or a WPND. Gastric ultrasonographic measurements were obtained at baseline and at 0, 30, 60, and 120 minutes after ingestion of the liquid. RESULTS: We enrolled 19 volunteers. At 120 minutes after consumption, volunteers who ingested a WPND had a larger estimated gastric volume (GV) than volunteers who ingested AJ (median [interquartile range], 101.3 [70.0-137.4] vs. 50.6 [43.9-81.8] mL; P=.08). By using the 2-sample t test and an α level of .05, we determined that the study had 40% power to detect a significant difference in GV. Future studies need to include 24 participants per group to detect a significant difference. CONCLUSIONS: Although consumption of a WPND was associated with a larger estimated GV in this pilot study, a larger study is necessary to conclude whether patients must fast longer than two hours after consumption of a WPND.


Assuntos
Esvaziamento Gástrico , Estômago/diagnóstico por imagem , Adulto , Bebidas , Carboidratos , Método Duplo-Cego , Jejum , Feminino , Humanos , Masculino , Projetos Piloto , Ultrassonografia , Proteínas do Soro do Leite , Adulto Jovem
4.
A A Pract ; 12(1): 1-4, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29985844

RESUMO

Gastric ultrasound is emerging as a tool that can be used to assess gastric content and volume in patients with an unknown fasting history. This information can impact the choice of anesthetic technique or the timing of surgery due to the presumed risk of aspiration. Currently, no data are available regarding the use of gastric ultrasound for patients who have had prior gastric operations, despite the increasing number of patients undergoing bariatric surgery. Our experience suggests that a patient with a prior Roux-en-Y gastric bypass may present with altered anatomy, rendering gastric ultrasound an ineffective technique to assess the volume of ingested food or liquid.


Assuntos
Derivação Gástrica/efeitos adversos , Conteúdo Gastrointestinal/diagnóstico por imagem , Estômago/anatomia & histologia , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/cirurgia , Sistemas Automatizados de Assistência Junto ao Leito , Estômago/diagnóstico por imagem , Estômago/cirurgia
5.
Springerplus ; 4: 480, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26361581

RESUMO

PURPOSE: Intraoperative transesophageal echocardiography (TEE) has commonly been used for evaluating cardiac function and monitoring hemodynamic parameters during complex surgical cases. Anesthesiologists may be dissuaded from using TEE in orthotopic liver transplantation (OLT) out of concern about rupture of esophageal varices. Complications associated with TEE in OLT were evaluated. METHODS: We retrospectively reviewed charts and TEE videos of all OLT cases from January 2003 through December 2013 at Mayo Clinic (Jacksonville, Florida). RESULTS: Of the 1811 OLTs performed, we identified 232 patients who underwent intraoperative TEE. Esophageal variceal status was documented during presurgical esophagogastroduodenoscopy in 230 of the 232 patients. Of these, 69 (30.0 %), had no varices; 113 (49.1 %), 41 (17.8 %), and 7 (3.0 %) had grades I, II, and III varices, respectively. Two patients (0.9 %) had no EGD performed because of acute liver failure. During OLT, 1 variceal rupture (0.4 %) occurred after placement of an oral gastric tube and TEE probe; the patient required intraoperative variceal banding. Most patients had preexisting coagulopathy at the time of probe placement. The mean (SD) laboratory test results were as follows: prothrombin time, 21.7 (6.6) seconds; international normalized ratio, 1.9 (1.3); partial thromboplastin time, 43.8 (13.3) seconds; platelet, 93.7 (60.8) × 1000/µL; and fibrinogen, 237.8 (127.6) mg/dL. CONCLUSION: TEE was a relatively safe procedure with a low incidence of major hemorrhagic complications in patients with documented esophagogastric varices and coagulopathy undergoing OLT. It appeared to effectively disclose cardiac information and allowed rapid reaction for proper patient management.

6.
J Clin Monit Comput ; 29(1): 121-5, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24748550

RESUMO

Transesophageal echocardiography of the spine has been difficult to perform, and high-quality images have been difficult to obtain with earlier available technology. New capabilities in hardware and software reconstruction may allow more reliable clinical data to be obtained. We describe an initial successful attempt to image the adult spinal canal, its contents, and in situ instrumentation. This report is a retrospective review of two patients in whom transesophageal echocardiography (TEE) was used to image the thoracic spine. The thoracic spine was identified and imaged with real-time 2-D and 3-D technology with location of the thoracic aorta and slight insertion and withdrawal of the TEE probe until the intervertebral discs alignment was optimized. Images of the spinal cord anatomy and its vascular supply, as well as indwelling epidural catheters were easily identified. 2-D and 3-D imaging was performed and images were recorded in digital imaging and communications in medicine format. 3-D reconstruction of images was possible with instantaneous 3-D imaging from multiple 2-D electrocardiogram-gated image acquisitions using the Phillips TEE IE-33 imaging platform. The central neuraxial cavity, including the spinal cord and the spinal nerve roots, was easily visualized, and motion of the cord was seen in a phasic pattern (with respiratory variation); cerebrospinal fluid surrounding the spinal cord was documented. The epidural space and local anesthetic drug administration through the epidural catheter were visualized, with the epidural catheter seen lying adjacent to the epidural tissue as a bright hyperechoic line. Pulsed-wave Doppler determined a biphasic pattern of blood flow in the anterior spinal artery through pulse mapping of the anatomic area. New, advanced imaging hardware and software generate clinically useful imaging of the thoracic spine in 2-D and 3-D using TEE. We believe this technology holds promise for future diagnostic and therapeutic interventions in the operating room that were previously unavailable.


Assuntos
Ecocardiografia Transesofagiana/métodos , Medula Espinal/patologia , Anestésicos/administração & dosagem , Cateterismo , Espaço Epidural/patologia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional , Disco Intervertebral/patologia , Monitorização Intraoperatória/métodos , Projetos Piloto , Estudos Retrospectivos , Software , Medula Espinal/diagnóstico por imagem , Vértebras Torácicas/patologia
7.
Iowa Orthop J ; 30: 211-4, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21046001

RESUMO

Fat embolus has been known to occur during major orthopedic surgery. In many cases, fat embolus syndrome is a postoperative complication of long bone orthopedic surgery, particularly femoral fractures occurring after trauma. Changes in intraoperative cardiopulmonary function have been reported in a subset of these patients, and they are associated with the degree of embolization occurring with manipulation or cementing of prostheses in the fractured femur. Intraoperative cardiovascular collapse has been reported, and this cardiac event is temporally associated with intramedullary manipulations such as reaming or cementing. We present a rare case of fatal intraoperative fat embolization diagnosed with trans-esophageal echocardiography.


Assuntos
Artroplastia de Quadril , Embolia Gordurosa/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Idoso de 80 Anos ou mais , Ecocardiografia Transesofagiana , Evolução Fatal , Feminino , Humanos , Período Intraoperatório
8.
J Arthroplasty ; 25(7): 1034-40, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19879724

RESUMO

A prospective exploratory study of fat emboli in patients undergoing total knee arthroplasty was performed in patients randomly assigned to surgery with computer-assisted navigation or standard technique. Transesophageal echocardiography of the right atrium was recorded for 5 consecutive 1-minute intervals after tourniquet deflation. Emboli were graded on a scale of 0 to 3 based on embolism size, amount of atrium filled, and duration of embolic shower, creating an overall score of 0 to 9. The mean (SD, range) of the 5 overall scores for each total knee arthroplasty was 6.00 (0.76, 4.6-7.4) for computer-assisted navigation (22 patients) and 6.42 (0.97, 4.6-7.9) for standard technique (22 patients) (P=.14), with a 95% confidence interval for the difference of -0.11 to 0.95. We conclude that any difference in extent of emboli between the 2 surgical techniques is unlikely to be of clinical significance.


Assuntos
Artroplastia do Joelho/métodos , Embolia Gordurosa/diagnóstico por imagem , Embolia Gordurosa/epidemiologia , Cirurgia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Ecocardiografia Transesofagiana , Embolia Gordurosa/etiologia , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco
9.
J Anesth ; 23(3): 466-8, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19685139

RESUMO

Two-dimensional ultrasound guidance is used commonly for regional anesthetic techniques. This report describes the novel use of three-dimensional, ultrasound-guided, continuous interscalene regional analgesia, which was used in a 36-year-old woman undergoing left total elbow arthroplasty. Possible advantages of this novel technology over current two-dimensional methods include a larger area of available scan information that enables multiple planes of view without having to reposition the ultrasound probe, and three-dimensional visualization of local anesthetic deposition perineurally. Current technological limitations include an upper frequency of 7 MHz, which decreases the resolution of superficial scanning.


Assuntos
Plexo Braquial/diagnóstico por imagem , Imageamento Tridimensional , Bloqueio Nervoso , Dor Pós-Operatória/tratamento farmacológico , Adulto , Anestésicos Locais , Artroplastia , Cotovelo/cirurgia , Feminino , Dependência de Heroína/complicações , Humanos , Procedimentos Ortopédicos , Ultrassonografia
10.
J Anesth ; 22(4): 404-11, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19011780

RESUMO

The anesthesia information management system (AIMS) will be part of the future of healthcare. An electronic medical records system or AIMS will provide clear and concise information and have the potential to integrate information across the entire hospital system, improve quality of care, reduce errors, decrease risks, and improve revenue capture. The practice of anesthesia requires a medical record system that can capture data in real time. In this article, we describe challenges that must be overcome to establish an efficient electronic medical record system for anesthesiology.


Assuntos
Anestesia , Documentação/métodos , Sistemas de Informação , Guias como Assunto , Humanos , Monitorização Intraoperatória , Estados Unidos
12.
Anesth Analg ; 105(1): 272-4, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17578987

RESUMO

Two-dimensional ultrasound guidance has been used as an adjunct for neural blockade. With the development of newer ultrasound technology, three-dimensional ultrasound imaging is now available and may offer improved visualization of anatomic structures and relationships. We describe the successful blockade of the popliteal nerve with three-dimensional ultrasound guidance and image description.


Assuntos
Sistemas Computacionais , Imageamento Tridimensional/métodos , Bloqueio Nervoso/métodos , Nervo Tibial/diagnóstico por imagem , Idoso , Feminino , Humanos , Ultrassonografia
13.
Mayo Clin Proc ; 79(11): 1417-22, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15544021

RESUMO

Providing care for persons with dementia presents several serious challenges. Among these is the possibility that a person with dementia will become lost in the community and face the risk of injury or death. Caregivers often cite anxiety about this possibility as a reason for placing their loved ones in a professional-care setting. Our case study and review of research show that all persons with dementia are at risk, regardless of age, past behavior, and sex. Thus, health care providers have an important role to play in educating caregivers about this risk and assisting them in preventing or responding to such situations. In addition, health care providers should ensure that their respective professional-care facilities have appropriate measures in place to prevent and respond to these eventualities. Finally, health care providers can educate local law enforcement personnel about dementia in general and more specifically about research-based strategies for searching for persons with dementia who have become lost in the community.


Assuntos
Demência , Caminhada/psicologia , Idoso , Humanos , Masculino , Pesquisa , Características de Residência , Risco , Fatores de Tempo
14.
Anesth Analg ; 98(6): 1640-1643, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15155317

RESUMO

UNLABELLED: Neurologic assessment after thoracic aortic aneurysm repair is important for detecting and treating late onset paraplegia. Traditional methods of pain control, such as patient-controlled IV analgesia and epidural analgesia, may interfere with neurologic assessment. We present a case of a patient who received continuous thoracic paravertebral analgesia that provided excellent analgesia while preserving the ability to monitor neurologic function. IMPLICATIONS: We provided postoperative continuous paravertebral analgesia in a patient after thoracoabdominal aneurysm repair requiring postoperative neurologic assessment. Paravertebral analgesia provides unilateral analgesia with fewer neurologic and hemodynamic side effects than central neuraxial blockade and should be considered for management of patients undergoing thoracic aortic aneurysm repair.


Assuntos
Analgesia Epidural/métodos , Analgésicos/administração & dosagem , Aneurisma da Aorta Abdominal/tratamento farmacológico , Aneurisma da Aorta Torácica/tratamento farmacológico , Idoso , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Feminino , Humanos , Vértebras Torácicas/efeitos dos fármacos , Vértebras Torácicas/cirurgia
15.
Reg Anesth Pain Med ; 28(4): 354-8, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12945033

RESUMO

BACKGROUND AND OBJECTIVE: Digital ischemia and necrosis caused by Raynaud's phenomenon in patients with connective tissue diseases may not respond to medical therapy and may have major adverse effects on quality of life. We describe the use of continuous ambulatory regional anesthesia for diagnosis and treatment before peripheral sympathectomy in a patient with secondary Raynaud's phenomenon. CASE REPORT: A 55-year-old man with progressive systemic sclerosis and secondary Raynaud's phenomenon presented with severe pain and digital necrosis that were refractory to maximal medical treatment and thoracic sympathectomy. Continuous ambulatory regional analgesia increased digital temperature from 32.3 degrees C at baseline to 34.4 degrees C after 80 minutes. An increase in digital flow was documented by Doppler ultrasound measurements made ventrally at the point of greatest pulsation of the radial artery. Subsequent peripheral sympathectomy resulted in restoration of nutrient flow with healing of ulcers and alleviation of pain. CONCLUSIONS: Continuous ambulatory regional anesthesia appears effective as a treatment bridge for vasospasm and ischemia associated with secondary Raynaud's phenomenon. The enhancement of peripheral blood flow achieved with the regional anesthetic technique suggests that surgical peripheral sympathectomy may provide long-term benefits.


Assuntos
Anestesia por Condução , Dedos/patologia , Doença de Raynaud/complicações , Esclerodermia Localizada/complicações , Simpatectomia , Dedos/irrigação sanguínea , Humanos , Isquemia , Masculino , Pessoa de Meia-Idade , Necrose , Dor/etiologia , Manejo da Dor , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Esclerodermia Difusa/complicações , Úlcera Cutânea/etiologia , Úlcera Cutânea/terapia , Ultrassonografia
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