RESUMO
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 , OxigênioRESUMO
The emergence of epidemic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in December 2019 in Wuhan, China causing Coronavirus Disease 2019 (COVID-19) and its rapid expansion around the world, leading to a global pandemic of dimensions not observed at least since the "Spanish influenza" pandemic in 1917-18, has had great consequences at all levels, including social, health and economic spheres. This pandemic situation forces us, as health care workers, to redefine our medical and surgical actions to adapt them to this new reality. It is important, when the rules of the game change, to rethink and to reevaluate if the balance between risk and benefit have moved to a different point of equilibrium, and if our indications of certain surgical interventions need to be redefined. In this article we try to answer the doubts that arise about the suitability of the NI-VATS technique and assess whether its use in these new pandemic circumstances might add advantages, especially in relation to minimize the risks of virus contagion between patients and all healthcare personnel during the surgical procedure, as well as the known advantages described in many articles the last ten years.
RESUMO
The contributions of remifentanil to anesthesia for heart surgery is described. The pharmacokinetic properties are described along with our clinical experience with the various modes and doses of perfusion for induction as well as during and after surgery.
Assuntos
Anestésicos Intravenosos , Procedimentos Cirúrgicos Cardíacos , Piperidinas , Analgésicos/farmacologia , Analgésicos/uso terapêutico , Anestesia por Condução/métodos , Anestesia Geral/métodos , Anestesia por Inalação/métodos , Anestesia Intravenosa/métodos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/farmacologia , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/farmacocinética , Anestésicos Intravenosos/farmacologia , Circulação Extracorpórea , Meia-Vida , Hemodinâmica/efeitos dos fármacos , Humanos , Éteres Metílicos/administração & dosagem , Éteres Metílicos/farmacologia , Infarto do Miocárdio/prevenção & controle , Miocárdio/metabolismo , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Fármacos Neuromusculares não Despolarizantes/farmacologia , Consumo de Oxigênio/efeitos dos fármacos , Dor Pós-Operatória/tratamento farmacológico , Piperidinas/administração & dosagem , Piperidinas/farmacocinética , Piperidinas/farmacologia , Complicações Pós-Operatórias/prevenção & controle , Propofol/administração & dosagem , Propofol/farmacologia , Remifentanil , Sevoflurano , Estresse Fisiológico/fisiopatologia , Sistema Nervoso Simpático/efeitos dos fármacosAssuntos
Raquianestesia/efeitos adversos , Meningites Bacterianas/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Adolescente , Raquianestesia/métodos , Líquido Cefalorraquidiano/microbiologia , Diagnóstico Diferencial , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Leucocitose/etiologia , Masculino , Meningite Asséptica/diagnóstico , Meningites Bacterianas/etiologia , Seio Pilonidal/microbiologia , Seio Pilonidal/cirurgia , Complicações Pós-Operatórias/etiologia , Espaço Subaracnóideo , SupuraçãoAssuntos
Atracúrio/análogos & derivados , Miastenia Gravis , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Atracúrio/administração & dosagem , Inibidores da Colinesterase/uso terapêutico , Contraindicações , Humanos , Cuidados Intraoperatórios , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Miastenia Gravis/tratamento farmacológico , Miastenia Gravis/etiologia , Brometo de Piridostigmina/uso terapêutico , Timoma/complicações , Neoplasias do Timo/complicaçõesRESUMO
We report the case of a 27-year old man given a left lateral thoracotomy for emergency repair of the aortic isthmus, which had partially ruptured as a consequence of chest trauma. The patient also suffered serious trauma to the right lung, such that selective ventilation of that lung had to be applied with the left lung collapsed to allow the surgeon access to the descending aorta. Rapid decrease in SpO2 occurred, with excessively high airway pressures, requiring reinstatement of conventional ventilation of both lungs and interruption of surgery. Conventional ventilation was then replaced by high frequency jet ventilation to both lungs. That technique, combined with intermittent inflation of the left lung (inclined), provided sufficient oxygen as well as a wide and sufficiently immobile surgical field.