RESUMO
OBJECTIVES: Correlate arterial lactate levels during the intraoperative period of children undergoing cardiac surgery and the occurrence of complications in the postoperative period. AIM: Arterial lactate levels can indicate hypoperfusion states, serving as prognostic markers of morbidity and mortality in this population. BACKGROUND: Anesthesia for cardiac pediatric surgery is frequently performed on patients with serious abnormal physiological conditions. During the intraoperative period, there are significant variations of blood volume, body temperature, plasma composition, and tissue blood flow, as well as the activation of inflammation, with important pathophysiological consequences. METHODS/MATERIALS: Chart data relating to the procedures and perioperative conditions of the patients were collected on a standardized form. Comparisons of arterial lactate values at the end of the intraoperative period of the patients that presented, or not, with postoperative complications and frequencies related to perioperative conditions were established by odds ratio and nonparametric univariate analysis. RESULTS: After surgeries without cardiopulmonary bypass (CPB), higher levels of arterial lactate upon ICU admission were observed in patients who had renal complications (2.96 vs 1.31 mm) and those who died (2.93 vs 1.40 mm). For surgeries with CPB, the same association was observed for cardiovascular (2.90 mm × 2.06 mm), renal (3.34 vs 2.33 mm), respiratory (2.98 vs 2.12 mm) and hematological complications (2.99 vs 1.95 mm), and death (3.38 vs 2.40 mm). CONCLUSION: Elevated intraoperative arterial lactate levels are associated with a higher morbidity and mortality in low- and medium-risk procedures, with or without CPB, in pediatric cardiac surgery.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Ácido Láctico/sangue , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/epidemiologia , Adolescente , Gasometria , Volume Sanguíneo/fisiologia , Ponte Cardiopulmonar , Criança , Pré-Escolar , Feminino , Doenças Hematológicas/epidemiologia , Doenças Hematológicas/etiologia , Doenças Hematológicas/mortalidade , Humanos , Lactente , Recém-Nascido , Infecções/epidemiologia , Infecções/etiologia , Infecções/mortalidade , Período Intraoperatório , Nefropatias/epidemiologia , Nefropatias/etiologia , Nefropatias/mortalidade , Masculino , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/mortalidade , Razão de Chances , Complicações Pós-Operatórias/mortalidade , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/etiologia , Doenças Respiratórias/mortalidade , Medição de Risco , Equilíbrio HidroeletrolíticoRESUMO
ABSTRACT BACKGROUND AND OBJECTIVES: Peripheral neuropathy is a rare condition with many etiologies. Common symptoms are numbness, paresthesia, weakness and neuropathic pain. Treatment consists in frst-line agents such as anticonvulsants and some antidepressants. Te aim of this study was to report a case of chronic pain refractory to several therapies in a patient with absolute contraindication to the use of all anticonvulsants and antidepressants drugs. CASE REPORT: Female patient, a 40-year-old treated for trigeminal neuralgia with decompression that developed chronic occipital pain refractory to radiofrequency and onset of transient and bilateral T4 sensory and motor polyneuropathy after viral meningitis. In addition, she showed a severe pharmacodermy (Drug Rash with Eosinophilia and Systemic Symptoms- DRESS Syndrome) after using carbamazepine and other anticonvulsants, as well as allergy to all analgesics and opioids except morphine. Epidural puncture with insertion of a catheter was performed aiming at a 5-day test through intermittent epidural morphine bolus to assess the possibility of morphine pump implantation. CONCLUSION: The test was successful and the patient referred to the neurosurgery team. At the 6-month follow-up after the insertion of the morphine intrathecal pump, the strategy has proven to be efective in controlling pain secondary to polyneuropathy.
RESUMO JUSTIFICATIVA E OBJETIVOS: Neuropatia periférica é uma condição rara, de etiologia multifatorial. Dormência, parestesia, redução de força muscular e dor neuropática são sintomas comuns. O tratamento consiste em uso de anticonvulsivantes e antidepressivos. O objetivo deste estudo foi relatar o caso de dor crônica refratária a diversas terapias de uma paciente com contraindicação absoluta para uso de todos os fármacos anticonvulsivantes e antidepressivos. RELATO DO CASO: Paciente do sexo feminino, 40 anos, com história de neuralgia do trigêmeo abordada previamente com cirurgia, com cefaleia occipital crônica refratária à radiofrequência e polineuropatia bilateral T4 sensorial e motora após meningite viral. No curso do tratamento, apresentou grave farmacodermia (Drug Rash with Eosinophilia and Systemic Symptoms - Síndrome DRESS) após o uso de carbamazepina e outros anticonvulsivantes, além de reação alérgica a todos analgésicos e opioides, exceto morfina. Optou-se por analgesia teste por via peridural, durante 5 dias, com bolus intermitentes e diários de morfina para avaliação de possibilidade de implante de bomba de morfina. CONCLUSÃO: O teste foi considerado bem-sucedido e a paciente encaminhada para neurocirurgia. No seguimento de 6 meses após implante de bomba por via subaracnoidea, esta estratégia se mostrou eficaz no controle da dor secundária à polineuropatia.
RESUMO
BACKGROUND: Anesthesia for pediatric cardiac surgery is systematically performed in severely ill patients under abnormal physiological conditions. In the intraoperative period, there are significant variations in blood volume, body temperature, plasma composition, and tissue blood flow, in addition to activation of inflammation, with important consequences. Serial measurements of blood glucose levels can indicate states of exacerbation of the neuroendocrine-metabolic response to trauma, serving as prognostic markers of morbidity in that population. OBJECTIVE: To correlate perioperative blood glucose levels of children undergoing cardiac surgery with the occurrence of postoperative complications, and to compare intraoperative blood glucose levels according to perioperative conditions. METHODS: Information regarding the surgical/anesthetic procedure and perioperative conditions of patients was collected from the medical records. The mean perioperative blood glucose levels in the groups of patients with and without postoperative complications and the frequencies of perioperative conditions were compared by use of odds ratio and non-parametric univariate analyses. RESULTS: Higher intraoperative blood glucose levels were observed in individuals who had postoperative complications. Prematurity, age group, type of anesthesia, and character of the procedure did not influence the mean intraoperative blood glucose level. The use of extracorporeal circulation (ECC) was associated with higher blood glucose levels during surgery. In procedures with ECC, higher blood glucose levels were observed in individuals who had infectious and cardiovascular complications. In surgeries without ECC, that association was observed with infectious and hematological complications. CONCLUSION: Higher intraoperative blood glucose levels are associated with higher morbidity in the postoperative period of pediatric cardiac surgery.
Assuntos
Glicemia/análise , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Circulação Extracorpórea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Anestesia/efeitos adversos , Anestesia/classificação , Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/mortalidade , Criança , Pré-Escolar , Métodos Epidemiológicos , Feminino , Humanos , Lactente , Recém-Nascido , Período Intraoperatório , Masculino , Complicações Pós-Operatórias/classificação , PrognósticoRESUMO
BACKGROUND AND OBJECTIVES: There are deficiencies on Intensive Medicine (IM) teaching in most of medical undergraduate schools. Those deficiencies may imply damages on their clinical competence. The objective of this study was to analyze current status of IM teaching and the medical undergraduate student interest in this speciality. METHODS: A cross-sectional study was performed in 2005. We applied a self-reported questionnaire to enrolled students between the sixth and the last semesters of two medical schools from Salvador-Bahia. The questionnaire contained questions about students' interest and knowledge on IM, and opinion on IM teaching in their schools. RESULTS: We studied 570 students. Most of them (57.5%) had never realized a clerkship in intensive care unit (ICU) despite classifying its usefulness as high (mean of 4.14 ± 1.05, in a scale from 1 to 5). IM interest was high or very high in 53.7% of sample. Almost all students (97%) thought that IM topics should be more explored at their curriculum. Only 42.1% reported to be able to assess a critical care patient and this assurance was higher among students with previous clerkship in ICU (p < 0.001). Shock, cardiopulmonary resuscitation and sepsis were the most interesting topics in ICU for students' opinion. CONCLUSIONS: This study revealed a high interest in IM among medical undergraduate students. However, most had never practice a clerkship in ICU, demonstrating to be an important factor on undergraduate student performance faced to a critical care patient.
RESUMO
FUNDAMENTO: Anestesia para cirurgia cardíaca pediátrica é sistematicamente realizada em pacientes graves sob condições fisiológicas anormais. No intraoperatório, existem variações significativas da volemia, temperatura corporal, composição plasmática e fluxo sanguíneo tecidual, além de ativação da inflamação, com consequências importantes. Medidas seriadas da glicemia podem indicar estados de exacerbação da resposta neuroendocrinometabólica ao trauma servindo como marcadores prognóstico de morbidade nessa população. OBJETIVO: Correlacionar os níveis de glicemia do período perioperatório de crianças submetidas a cirurgia cardíaca com a ocorrência de complicações no pós-operatório e comparar os níveis intraoperatórios de glicemia de acordo com as condições perioperatórias. MÉTODOS: Informações referentes ao procedimento anestésico-cirúrgico e condições perioperatórias dos pacientes foram coletadas em prontuário. Comparações das médias dos valores perioperatórios da glicemia nos grupos de pacientes que apresentaram, ou não, complicações pós-operatórias e as frequências referentes às condições perioperatórias foram estabelecidas conforme cálculo da razão de chances e em análises univariáveis não paramétricas. RESULTADOS: Valores mais elevados de glicemia intraoperatória foram observados nos indivíduos que apresentaram complicações pós-operatórias. Prematuridade, faixa etária, tipo de anestesia e caráter do procedimento não apresentaram influência na média glicêmica do intraoperatório. O emprego de Circulação Extracorpórea (CEC) esteve associado a maiores valores de glicemia durante a cirurgia. Nos procedimentos com CEC, maiores níveis glicêmicos foram observados nos indivíduos que evoluíram com infecção e complicações cardiovasculares, nas cirurgias sem CEC essa mesma associação ocorreu com complicações infecciosas e hematológicas. CONCLUSÃO: Níveis intraoperatórios mais elevados de glicemia estão associados com maior morbidade no pós-operatório de cirurgia cardíaca pediátrica.
BACKGROUND: Anesthesia for pediatric cardiac surgery is systematically performed in severely ill patients under abnormal physiological conditions. In the intraoperative period, there are significant variations in blood volume, body temperature, plasma composition, and tissue blood flow, in addition to activation of inflammation, with important consequences. Serial measurements of blood glucose levels can indicate states of exacerbation of the neuroendocrine-metabolic response to trauma, serving as prognostic markers of morbidity in that population. OBJECTIVE: To correlate perioperative blood glucose levels of children undergoing cardiac surgery with the occurrence of postoperative complications, and to compare intraoperative blood glucose levels according to perioperative conditions. METHODS: Information regarding the surgical/anesthetic procedure and perioperative conditions of patients was collected from the medical records. The mean perioperative blood glucose levels in the groups of patients with and without postoperative complications and the frequencies of perioperative conditions were compared by use of odds ratio and non-parametric univariate analyses. RESULTS: Higher intraoperative blood glucose levels were observed in individuals who had postoperative complications. Prematurity, age group, type of anesthesia, and character of the procedure did not influence the mean intraoperative blood glucose level. The use of extracorporeal circulation (ECC) was associated with higher blood glucose levels during surgery. In procedures with ECC, higher blood glucose levels were observed in individuals who had infectious and cardiovascular complications. In surgeries without ECC, that association was observed with infectious and hematological complications. CONCLUSION: Higher intraoperative blood glucose levels are associated with higher morbidity in the postoperative period of pediatric cardiac surgery.
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Glicemia/análise , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Circulação Extracorpórea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Anestesia/efeitos adversos , Anestesia/classificação , Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/mortalidade , Métodos Epidemiológicos , Período Intraoperatório , Prognóstico , Complicações Pós-Operatórias/classificaçãoRESUMO
JUSTIFICATIVA E OBJETIVOS: Acredita-se que existe uma deficiência no ensino de Medicina Intensiva (MI) na graduação da maioria das escolas médicas, levando a um prejuízo na formação acadêmica de futuros médicos. O objetivo deste estudo foi analisar o ensino e o grau de interesse em MI por estudantes de Medicina de Salvador-BA. MÉTODO: Estudo transversal realizado em 2005 entre estudantes do 6º ao 12º semestres de duas escolas médicas baianas. Utilizou-se um questionário auto-aplicável composto de questões objetivas sobre interesse, habilidades e conhecimentos dos estudantes sobre MI, bem como a sua opinião sobre o ensino dessa especialidade em sua faculdade. RESULTADOS: Foram entrevistados 570 estudantes. A maioria (57,5 por cento) nunca realizou estágio em unidades de terapia intensiva (UTI). Contudo, a utilidade deste para o futuro profissional de um médico foi classificada como alta (média de 4,14 ± 1,05, numa escala de 1 a 5) pelos entrevistados. O interesse em MI foi considerado alto ou muito alto por 53,7 por cento da amostra. Quase todos os alunos (97 por cento) acreditam que tópicos de MI devam ser mais explorados em seus currículos. Apenas 42,1 por cento sentiam-se seguros em avaliar um paciente gravemente enfermo, sendo essa segurança maior entre aqueles que já realizaram estágios em UTI (p < 0,001). Os tópicos de MI de maior interesse foram choque, reanimação cardiopulmonar e sepse. CONCLUSÕES: O presente estudo revelou um alto interesse em Medicina Intensiva entre estudantes de Medicina da Bahia. Contudo, a maioria nunca realizou estágio em UTI, o que demonstrou ser importante fator na segurança do médico em formação frente ao paciente gravemente enfermo.
BACKGROUND AND OBJECTIVES: There are deficiencies on Intensive Medicine (IM) teaching in most of medical undergraduate schools. Those deficiencies may imply damages on their clinical competence. The objective of this study was to analyze current status of IM teaching and the medical undergraduate student interest in this speciality. METHODS: A cross-sectional study was performed in 2005. We applied a self-reported questionnaire to enrolled students between the sixth and the last semesters of two medical schools from Salvador-Bahia. The questionnaire contained questions about students' interest and knowledge on IM, and opinion on IM teaching in their schools. RESULTS: We studied 570 students. Most of them (57.5 percent) had never realized a clerkship in intensive care unit (ICU) despite classifying its usefulness as high (mean of 4.14 ± 1.05, in a scale from 1 to 5). IM interest was high or very high in 53.7 percent of sample. Almost all students (97 percent) thought that IM topics should be more explored at their curriculum. Only 42.1 percent reported to be able to assess a critical care patient and this assurance was higher among students with previous clerkship in ICU (p < 0.001). Shock, cardiopulmonary resuscitation and sepsis were the most interesting topics in ICU for students' opinion. CONCLUSIONS: This study revealed a high interest in IM among medical undergraduate students. However, most had never practice a clerkship in ICU, demonstrating to be an important factor on undergraduate student performance faced to a critical care patient.