Assuntos
Dexmedetomidina , Hipotensão , Complicações Pós-Operatórias , Humanos , Dexmedetomidina/uso terapêutico , Dexmedetomidina/administração & dosagem , Hipotensão/induzido quimicamente , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/induzido quimicamente , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Idoso , Cuidados Intraoperatórios/métodos , Idoso Fragilizado , Feminino , Idoso de 80 Anos ou mais , MasculinoRESUMO
INTRODUCTION: Pulmonary atelectasis is common in patients undergoing laparoscopic abdominal surgery under general anaesthesia, which increases the risk of perioperative respiratory complications. Alveolar recruitment manoeuvres (ARM) are used to open up the lung parenchyma with atelectasis, although the duration of their benefit has not been clearly established. The aim of this study was to determine the effectiveness of an ARM in laparoscopic colon surgery, the duration of response over time, and its haemodynamic impact. METHODS: Twenty-five patients undergoing laparoscopic colon surgery were included. After anaesthetic induction and initiation of surgery with pneumoperitoneum, an ARM was performed, and then optimal PEEP determined. Respiratory mechanics and gas exchange variables, and haemodynamic parameters, were analysed before the manoeuvre and periodically over the following 90â¯min. RESULTS: Three patients were excluded for surgical reasons. The alveolar arterial oxygen gradient went from 94.3 (62.3-117.8) mmHg before to 60.7 (29.6-91.0) mmHg after the manoeuvre (P < .05). This difference was maintained during the 90â¯min of the study. Dynamic compliance of the respiratory system went from 31.3â¯ml/cmH2O (26.1-39.2) before the manoeuvre to 46.1â¯ml/cmH2O (37.5-53.5) after the manoeuvre (P < .05). This difference was maintained for 60â¯min. No significant changes were identified in any of the haemodynamic variables studied. CONCLUSION: In patients undergoing laparoscopic colon surgery, performing an intraoperative ARM improves the mechanics of the respiratory system and oxygenation, without associated haemodynamic compromise. The benefit of these manoeuvres lasts for at least one hour.
Assuntos
Laparoscopia , Alvéolos Pulmonares , Humanos , Laparoscopia/métodos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Atelectasia Pulmonar/etiologia , Atelectasia Pulmonar/prevenção & controle , Respiração com Pressão Positiva/métodos , Colo/cirurgia , Hemodinâmica , Cuidados Intraoperatórios/métodos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Estudos Prospectivos , Pneumoperitônio Artificial/métodos , Mecânica Respiratória/fisiologiaRESUMO
Tubeless anaesthesia has become widespread in videothoracoscopic surgery, even in major procedures such as lobectomies. There are several advantages in avoiding general anaesthesia and one-lung mechanical ventilation, such as faster recovery and shorter hospital stays. However, hypoxaemia and hypercapnia are the most reported causes of conversion to general anaesthesia. High Flow Oxygen Therapy (HFOT) generates flow-dependent positive end-expiratory pressure, improves oxygenation and also carbon dioxide washout by flow-dependent dead space flushing. For this reason, intraoperative HFOT may reduce the rate of conversion to general anaesthesia. We report our experience with intraoperative HFOT in a 71-year-old female with lung adenocarcinoma undergoing VATS upper left lobectomy.
Assuntos
Pulmão , Oxigenoterapia , Feminino , Humanos , Idoso , Oxigenoterapia/métodos , Anestesia Geral , Cirurgia Torácica Vídeoassistida/métodos , OxigênioAssuntos
Analgesia Epidural , Analgesia Obstétrica , Dor no Peito/etiologia , Feminino , Humanos , Medição da Dor , GravidezRESUMO
Serum lactate is a non-specific marker of tissue hypoperfusion. Elevated serum lactate is used in the differential diagnosis of acute intestinal ischemia. Although this practice is controversial, in the absence of other validated markers lactate is still used because of its high sensitivity. We present the cases of two patients who developed acute mesenteric ischemia as a post-surgical complication. The patients reported moderate abdominal pain -a non-specific symptom in the postoperative context- and tests showed progressively increasing serum lactate levels, which facilitated suspicion and subsequent diagnostic confirmation through an imaging test. These cases highlight the physiopathological importance of lactate elevation in the perioperative context and of performing a differential diagnosis of its possible causes, including mesenteric ischemia. Although the outcome was negative in the first case, early suspicion allowed us to make an effective diagnosis and administer appropriate treatment in the second patient.
Assuntos
Isquemia Mesentérica , Dor Abdominal , Biomarcadores , Humanos , Ácido Láctico , Isquemia Mesentérica/diagnósticoRESUMO
Serum lactate is a non-specific marker of tissue hypoperfusion. Elevated serum lactate is used in the differential diagnosis of acute intestinal ischemia. Although this practice is controversial, in the absence of other validated markers lactate is still used because of its high sensitivity. We present the cases of two patients who developed acute mesenteric ischemia as a post-surgical complication. The patients reported moderate abdominal pain -a non-specific symptom in the postoperative context- and tests showed progressively increasing serum lactate levels, which facilitated suspicion and subsequent diagnostic confirmation through an imaging test. These cases highlight the physiopathological importance of lactate elevation in the perioperative context and of performing a differential diagnosis of its possible causes, including mesenteric ischemia. Although the outcome was negative in the first case, early suspicion allowed us to make an effective diagnosis and administer appropriate treatment in the second patient.