Assuntos
Infarto Encefálico/virologia , Tronco Encefálico/irrigação sanguínea , Artérias Cerebrais/virologia , Infecções por HIV/complicações , Herpes Zoster da Orelha Externa/complicações , Vasculite do Sistema Nervoso Central/virologia , Adulto , Angiografia Digital , Anti-Inflamatórios/uso terapêutico , Antivirais/uso terapêutico , Infarto Encefálico/patologia , Infarto Encefálico/fisiopatologia , Tronco Encefálico/patologia , Tronco Encefálico/fisiopatologia , Infartos do Tronco Encefálico/patologia , Infartos do Tronco Encefálico/fisiopatologia , Infartos do Tronco Encefálico/virologia , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/patologia , Líquido Cefalorraquidiano/virologia , Transtornos de Deglutição/patologia , Transtornos de Deglutição/fisiopatologia , Nervo Facial/patologia , Nervo Facial/fisiopatologia , Nervo Facial/virologia , Feminino , Infecções por HIV/diagnóstico , Herpes Zoster da Orelha Externa/fisiopatologia , Herpesvirus Humano 3/isolamento & purificação , Humanos , Imageamento por Ressonância Magnética , Paresia/patologia , Paresia/fisiopatologia , Paresia/virologia , Ponte/irrigação sanguínea , Ponte/patologia , Ponte/fisiopatologia , Resultado do Tratamento , Vasculite do Sistema Nervoso Central/patologia , Vasculite do Sistema Nervoso Central/fisiopatologiaRESUMO
BACKGROUND: Diffusion-weighted (DW) imaging abnormalities often develop in patients after invasive procedures associated with cerebral microembolism. Cerebral microembolism has recently been shown during orthopedic surgery. We here examine the effects of intraoperative microembolism on acute magnetic resonance(MR) imaging in patients undergoing hip and knee replacement. METHODS: We enrolled 24 patients, at least 65 years old, requiring elective knee or hip replacement surgery. MR with DW and axial fluid-attenuated inversion recovery (FLAIR) imaging was performed pre- and postoperatively. All patients were monitored intraoperatively for microemboli. RESULTS: The mean age of patients was 74 years. All patients had intraoperative microemboli. The mean number of emboli detected was 9.9 +/- 18 per surgery. MR imaging was obtained a mean of 3.5 days postoperatively. No DW imaging abnormalities were found after surgery. One patient had new findings on postoperative FLAIR imaging. CONCLUSION: Intraoperative microembolism occurred universally, but did not lead to acute DW imaging abnormalities following knee and hip replacement. Acute imaging abnormalities on FLAIR imaging are rare but may occasionally occur after joint surgery.
Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Imagem de Difusão por Ressonância Magnética , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/etiologia , Idoso , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Estatísticas não ParamétricasRESUMO
BACKGROUND AND PURPOSE: Intra-operative cerebral microembolism may be a factor in the etiology of cognitive decline after orthopedic surgery. We here examine the impact of intra-operative microembolism on cognitive dysfunction after hip and knee replacement surgery. METHODS: We enrolled 24 patients, at least 65 years old, requiring elective knee or hip replacement surgery. A transcranial Doppler shunt study was done to determine study eligibility so that the final study population consisted of 12 consecutive patients with and 12 consecutive patients without a venous-arterial shunt. A standard neuropsychological test battery was administered before surgery, at hospital discharge and 3 months after surgery. All patients were monitored intra-operatively for microemboli. Quality of life data were assessed at 1 year. RESULTS: The mean age of patients was 74 years. All patients had intra-operative microemboli. The mean number of emboli was 9.9+/-18. Cognitive decline was present in 18/22 (75%) at discharge and in 10/22 (45%) at 3 months, despite improved quality of life measures. There was no correlation between cognitive decline and intra-operative microembolism. CONCLUSIONS: Cognitive decline was seen frequently after hip and knee surgery. Intra-operative microembolism occurred universally but did not significantly influence postoperative cognition. Quality of life and functional outcome demonstrated improvement in all cases in spite of cognitive dysfunction.
Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Transtornos Cognitivos/psicologia , Embolia Gordurosa/psicologia , Embolia Intracraniana/psicologia , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/etiologia , Embolia Gordurosa/etiologia , Feminino , Humanos , Embolia Intracraniana/etiologia , Complicações Intraoperatórias/psicologia , MasculinoRESUMO
The Consensus Document on Alternatives to Allogenic Blood Transfusion (AABT) has been drawn up by a panel of experts from 5 scientific societies. The Spanish Societies of Anesthesiology (SEDAR), Critical Care Medicine and Coronary Units (SEMICYUC), Hematology and Hemotherapy (AEHH), Blood Transfusion (SETS) and Thrombosis and Hemostasis (SETH) have sponsored and participated in this Consensus Document. Alternatives to blood transfusion have been divided into pharmacological and non-pharmacological, with 4 modules and 12 topics. The main objective variable was the reduction of allogenic blood transfusions and/or the number of transfused patients. The extent to which this objective was achieved by each AABT was evaluated using the Delphi method, which classifies the grade of recommendation from A (supported by controlled studies) to E (non-controlled studies and expert opinion). The experts concluded that most of the indications for AABT were based on middle or low grades of recommendation, "C", "D", or "E", thus indicating the need for further controlled studies.