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We describe the use of three-dimensional printing to create precise airway models for a patient with Treacher Collins syndrome who presented for bimaxillary temporomandibular joint prostheses, and for whom airway management was predicted to be difficult. The model was based on pre-operative cone beam computed tomography images and printed in the 3D Lab of Hospital Universitario La Paz. Transparent models allowed clear visualisation for simulation and iterative refinement of airway management techniques and aided in risk assessment and instrument sizing. This case report emphasises the utility of this approach in complex airway scenarios.
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BACKGROUND: Research in fluid therapy and perioperative hemodynamic monitoring is difficult and expensive. The objectives of this study were to summarize these topics and to prioritize these topics in order of research importance. METHODS: Electronic structured Delphi questionnaire over three rounds among 30 experts in fluid therapy and hemodynamic monitoring identified through the Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section of the Spanish Society of Anesthesiology and Critical Care. RESULTS: 77 topics were identified and ranked in order of prioritization. Topics were categorized into themes of crystalloids, colloids, hemodynamic monitoring and others. 31 topics were ranked as essential research priority. To determine whether intraoperative hemodynamic optimization algorithms based on the invasive or noninvasive Hypotension Prediction Index versus other management strategies could decrease the incidence of postoperative complications. As well as whether the use of renal stress biomarkers together with a goal-directed fluid therapy protocol could reduce hospital stay and the incidence of acute kidney injury in adult patients undergoing non-cardiac surgery, reached the highest consensus. CONCLUSIONS: The Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section of the Spanish Society of Anesthesiology and Critical Care will use these results to carry out the research.
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Anestesiologia , Monitorização Hemodinâmica , Medicina Transfusional , Adulto , Humanos , Consenso , Técnica Delphi , Hidratação , Cuidados Críticos , HemostasiaRESUMO
BACKGROUND: The optimal regimen for intravenous administration of intraoperative fluids remains unclear. Our goal was to analyze intraoperative crystalloid volume administration practices and their association with postoperative outcomes. METHODS: We extracted clinical data from two multicenter observational studies including adult patients undergoing colorectal surgery and total hip (THA) and knee arthroplasty (TKA). We analyzed the distribution of intraoperative fluid administration. Regression was performed using a general linear model to determine factors predictive of fluid administration. Patient outcomes and intraoperative crystalloid utilization were summarized for each surgical cohort. Regression models were developed to evaluate associations of high or low intraoperative crystalloid with the likelihood of increased postoperative complications, mainly acute kidney injury (AKI) and hospital length of stay (LOS). RESULTS: 7580 patients were included. The average adjusted intraoperative crystalloid infusion rate across all surgeries was to 7.9 (SD 4) mL/kg/h. The regression model strongly favored the type of surgery over other patient predictors. We found that high fluid volume was associated with 40% greater odds ratio (OR 1.40; 95% confidence interval 1.01-1.95, p = 0.044) of postoperative complications in patients undergoing THA, while we found no associations for the other types of surgeries, AKI and LOS CONCLUSIONS: A wide variability was observed in intraoperative crystalloid volume administration; however, this did not affect postoperative outcomes.
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Hidratação , Adulto , Estudos de Coortes , Soluções Cristaloides , Humanos , Estudos Prospectivos , Estudos RetrospectivosAssuntos
Albuminas/uso terapêutico , Hidratação , Choque Séptico/terapia , Albuminas/administração & dosagem , Coloides/uso terapêutico , Soluções Cristaloides , Método Duplo-Cego , Humanos , Soluções Isotônicas/uso terapêutico , Cirrose Hepática/complicações , Estudos Multicêntricos como Assunto , Peritonite/etiologia , Peritonite/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Cloreto de Sódio/uso terapêutico , Amido/uso terapêuticoRESUMO
OBJECTIVE: To assess the types of maintenance fluids used in our hospital, comparing their volume and composition to the standards recommended by the guidelines. MATERIAL AND METHODS: Observational, cross-sectional study. Volume and type of fluid therapy administered during 24h to patients admitted to various hospital departments were recorded. Patients receiving fluid therapy because of water-electrolyte imbalance were excluded. RESULTS: Out of 198 patients registered, 74 (37.4%) were excluded because they did not meet the criteria for inclusion. Mean administered volume was 2,500cc/day. Mean daily glucose dose was 36g per 24h (SD: 31.4). The most frequent combination included normal saline solution (NSS) and glucose 5% (64.4%). Mean daily dose of sodium and chlorine was, respectively, 173mEq (SD: 74.8) and 168mEq (SD: 75), representing a surplus daily dose of +87.4mEq and +85mEq. Potassium, magnesium and calcium daily deficit was, respectively, -50mEq, -22mEq and -21mEq per day. Buffer administration was exceptional, bicarbonate (2.29%), acetate (1.29%), lactate (1.15%) and gluconate (1.10%) being the buffering agents most frequently used. CONCLUSION: NNS is the most frequently used solution. In contrast to excess doses of sodium and chlorine, there is a great deficit of other ions, buffering agents and caloric intake in the fluid therapy regimens that are usually prescribed.
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Hidratação/métodos , Soluções/uso terapêutico , Idoso , Compartimentos de Líquidos Corporais , Soluções Tampão , Estudos Transversais , Soluções Cristaloides , Eletrólitos/administração & dosagem , Eletrólitos/uso terapêutico , Ingestão de Energia , Feminino , Glucose/administração & dosagem , Glucose/uso terapêutico , Departamentos Hospitalares , Humanos , Infusões Intravenosas , Soluções Isotônicas/administração & dosagem , Soluções Isotônicas/uso terapêutico , Masculino , Pessoa de Meia-Idade , Cloreto de Sódio/administração & dosagem , Cloreto de Sódio/uso terapêutico , Soluções/administração & dosagem , Soluções/química , Soluções/farmacocinética , Centros de Atenção TerciáriaRESUMO
Surgery for catecholamine-secreting neuroendocrine tumours poses a high anaesthetic risk that might increase due to coexisting congenital heart diseases, such as a single ventricle and Eisenmenger syndrome. This report emphasises the usefulness of pulse range haemodynamic monitoring over thermodilution in a patient with a single ventricle. In addition, the importance of nitric oxide is stressed in the management of respiratory problems associated to surgical-related pulmonary hypertension. As to the anaesthetic techniques, none is preferred as long as the one chosen has no haemodynamic repercussions.
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Complexo de Eisenmenger , Paraganglioma , Catecolaminas , Hemodinâmica , Humanos , Óxido NítricoRESUMO
Awake craniotomy was the earliest surgical procedure known, and it has become fashionable again. In the past it was used for the surgical management of intractable epilepsy, but nowadays, its indications are increasing, and it is a widely recognized technique for the resection of mass lesions involving the eloquent cortex, and for deep brain stimulation. The procedure is safe, provides excellent results, and saves money and resources. The anesthesiologist should know the principles underlying neuroanesthesia, the technique of scalp blockade, and the sedation protocols, as well as feeling comfortable with advanced airway management. The main anesthetic aim is to keep patients cooperating when required (analgesia-based anesthesia). This review attempts to summarize the most recent evidence from the clinical literature, a long as the number of patients undergoing craniotomies in the awake state are increasing, specifically in the pediatric population.
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Craniotomia/métodos , Bloqueio Nervoso/métodos , Procedimentos Neurocirúrgicos/métodos , Adulto , Manuseio das Vias Aéreas/métodos , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/farmacocinética , Antibioticoprofilaxia , Criança , Sedação Consciente , Estimulação Encefálica Profunda/métodos , Dexmedetomidina/administração & dosagem , Dexmedetomidina/farmacocinética , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/farmacocinética , Entorpecentes/uso terapêutico , Seleção de Pacientes , Cuidados Pré-Operatórios , Couro Cabeludo , VigíliaRESUMO
The growing social problem of drug abuse has increased the likelihood that anesthesiologists will find acute or chronic drug users among patients requiring anesthesia for elective or emergency surgery. We must therefore be aware of the effects drugs have on the organism and their possible pharmacokinetic and pharmacodynamic interactions with anesthetic agents in order to prevent complications during surgery and postoperative recovery. Such knowledge is required for the management of abstinence syndrome or overdose, which pose the greatest potential dangers for the hospitalized drug addict.
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Anestesia , Transtornos Relacionados ao Uso de Substâncias , Anestesia/métodos , Anestesia/normas , Canabinoides , Transtornos Relacionados ao Uso de Cocaína , Alucinógenos , Humanos , Ketamina , Transtornos Relacionados ao Uso de OpioidesRESUMO
More than 50 million individuals are infected by the human immunodeficiency virus (HIV), and it is estimated that as many as 25% of them will require surgery. The anesthesiologist must be familiar with the implications of this disease for multiorgan failure and opportunistic infections. Above all, the effects of antiretroviral agents on anesthetics must be understood. We describe the case of an HIV-infected man at risk for difficult intubation who experienced convulsions in the operating room.
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Síndrome da Imunodeficiência Adquirida/complicações , Epilepsia Tônico-Clônica/etiologia , Complicações Intraoperatórias/etiologia , Intubação Gastrointestinal/efeitos adversos , Edema Pulmonar/etiologia , Neoplasias Tonsilares/cirurgia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/fisiopatologia , Doença Aguda , Fármacos Anti-HIV/farmacocinética , Doenças do Sistema Nervoso Autônomo/etiologia , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Diagnóstico Diferencial , Interações Medicamentosas , Epilepsia Tônico-Clônica/induzido quimicamente , Humanos , Complicações Intraoperatórias/induzido quimicamente , Lidocaína/efeitos adversos , Lidocaína/farmacocinética , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Segunda Neoplasia Primária/complicações , Segunda Neoplasia Primária/cirurgia , Edema Pulmonar/diagnóstico , Sarcoma de Kaposi , Neoplasias Tonsilares/complicações , Tonsilectomia , TraqueotomiaAssuntos
Injúria Renal Aguda/diagnóstico , Mioglobinúria/etiologia , Complicações Pós-Operatórias/diagnóstico , Rabdomiólise/diagnóstico , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/prevenção & controle , Injúria Renal Aguda/urina , Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Artéria Femoral/cirurgia , Hidratação , Humanos , Isquemia/complicações , Perna (Membro)/irrigação sanguínea , Masculino , Complicações Pós-Operatórias/urina , Rabdomiólise/etiologia , Rabdomiólise/terapia , Rabdomiólise/urinaAssuntos
Cateterismo Venoso Central/efeitos adversos , Testes Diagnósticos de Rotina , Hematoma/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia Torácica , Veia Subclávia/lesões , Idoso de 80 Anos ou mais , Colostomia , Evolução Fatal , Feminino , Hematoma/etiologia , Humanos , Perfuração Intestinal/complicações , Perfuração Intestinal/cirurgia , Pneumopatias/etiologia , Insuficiência de Múltiplos Órgãos/etiologia , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Neoplasias do Colo Sigmoide/cirurgia , Veia Subclávia/diagnóstico por imagem , Deiscência da Ferida Operatória , Tomografia Computadorizada por Raios XRESUMO
Rhabdomyolysis is a clinical syndrome characterized by the breakdown and later necrosis of skeletal muscle, leading to the release of various intracellular components into the blood stream. The clinical expression of rhabdomyolysis ranges from asymptomatic to severe forms involving multiorgan failure with electrolyte imbalance, respiratory distress syndrome, acute renal failure and disseminated intravascular coagulation. Diagnosis is based on a finding of elevated serum levels of components that are normally found within the muscle cell, chiefly muscle enzymes and myoglobin. Acute kidney failure, one of the main consequences of rhabdomyolysis, occurs in 4% to 33% of cases. Treatment requires prompt volume replacement with crystalloids. In spite of successful resuscitation and prophylaxis against myoglobulin-induced renal failure, 1 out of every 3 patients develops kidney damage and requires continuous replacement therapy.
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Injúria Renal Aguda/etiologia , Isquemia/complicações , Músculo Esquelético/irrigação sanguínea , Rabdomiólise/complicações , Injúria Renal Aguda/fisiopatologia , Injúria Renal Aguda/terapia , Alcoolismo/complicações , Terapia Combinada , Síndromes Compartimentais/complicações , Soluções Cristaloides , Coagulação Intravascular Disseminada/etiologia , Hidratação , Humanos , Soluções Isotônicas/uso terapêutico , Insuficiência de Múltiplos Órgãos/etiologia , Complicações Pós-Operatórias , Soluções para Reidratação/uso terapêutico , Terapia de Substituição Renal , Rabdomiólise/induzido quimicamente , Rabdomiólise/diagnóstico , Rabdomiólise/terapia , Ferimentos e Lesões/complicaçõesRESUMO
Magnesium is involved in many physiological processes and in the pathophysiology of many diseases that affect surgical patients. The incidence of hypomagnesemia in the perioperative setting is high and is sometimes underestimated, with important prognostic implications. Magnesium also has a variety of therapeutic indications in postoperative recovery care, obstetrics, cardiology, heart surgery, pain treatment, anesthesia, pneumology, etc. Magnesium's role in the organism and its pharmacological properties continue to be studied and new situations in which the ion plays a relevant part are being suggested. It has become essential for the anesthesiologist to understand the pharmacological, clinical, and physiological properties of magnesium. The present review aims to give a simple but complete overview of the physiological importance of the magnesium ion, the perioperative changes that occur, and its therapeutic applications in numerous clinical contexts.
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Período de Recuperação da Anestesia , Anestesia , Complicações Intraoperatórias , Magnésio/metabolismo , Doenças Metabólicas , Complicações Pós-Operatórias , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Magnésio/farmacologia , Magnésio/fisiologia , Magnésio/uso terapêutico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapiaRESUMO
Endotracheal intubation and mechanical ventilation have traditionally been employed in patients with acute respiratory insufficiency. However, this form of management can have serious adverse effects, mainly infections and barotrauma. Noninvasive ventilation (NIV) has been shown to be an effective alternative, as it reduces both the frequency of complications and cost of care. In fact, NIV is currently the first choice treatment for acute respiratory insufficiency in patients who have chronic obstructive pulmonary disease or who are immunocompromised. It is also commonly applied in patients with asthma, pneumonia, and acute cardiogenic pulmonary edema. Correct indication and training in use of NIV equipment is necessary to ensure success and facilitate patient tolerance.
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Respiração Artificial/instrumentação , Respiração Artificial/métodos , Doença Aguda , Desenho de Equipamento , Humanos , Máscaras , Seleção de Pacientes , Respiração Artificial/efeitos adversos , Insuficiência Respiratória/terapiaRESUMO
AIDS concerns anaesthetic practice for various reasons. First, this syndrome can affect different organs that have anaesthetic implications. Second, drugs usually taken by the patient can interact with anaesthetic agents. And last, the risk of infection for health workers must be taken into account, as well as the procedure to follow after accidental injures.