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1.
Enferm. foco (Brasília) ; 15: 1-6, maio. 2024. tab, ilus
Article in Portuguese | LILACS, BDENF | ID: biblio-1553952

ABSTRACT

Objetivo: Identificar os eventos adversos no pós-operatório imediato de queiloplastia e/ou palatoplastia em crianças e comparar os eventos identificados aos notificados ao Núcleo de Segurança do Paciente. Métodos: Estudo descritivo, retrospectivo e quantitativo, realizado em um hospital público e terciário brasileiro. Os dados foram coletados por meio da descrição nos registros de enfermagem e comparados aos notificados ao Núcleo de Segurança do Paciente, referente a junho e dezembro de 2019. Os resultados foram submetidos a análise estatística descritiva. Resultados: A amostra constou de 203 crianças, das quais 51% (n=103) apresentaram evento adverso. Foram identificados 176 eventos adversos, de 8 tipos, com prevalência da laringite pós-extubação (n=50; 28%), edema de língua (n=34; 19%) e lesão de comissura labial (n=25; 14%). Destes, apenas 5% (n=9) foram notificados ao Núcleo de Segurança do Paciente. Conclusão: Os eventos adversos prevalentes se relacionaram a cavidade oral e tecidos adjacentes, e a subnotificação foi expressiva. (AU)


Objective: To identify adverse events in the immediate postoperative period of cheiloplasty and/or palatoplasty in children and compare the identified events to those notified to the Patient Safety Center. Methods: Descriptive, retrospective and quantitative study, carried out in a Brazilian public and tertiary hospital. Data were collected through descriptions in nursing records and compared to those notified to the Patient Safety Center, referring to June and December 2019. The results were subjected to descriptive statistical analysis. Results: The sample consisted of 203 children, of which 51% (n=103) had an adverse event. A total of 176 adverse events of 8 types were identified, with prevalence of post-extubation laryngitis (n=50; 28%), tongue edema (n=34; 19%) and labral commissure lesion (n=25; 14%). Of these, only 5% (n=9) were notified to the Patient Safety Center. Conclusion: The prevalent adverse events were related to the oral cavity and adjacent tissues, and underreporting was significant. (AU)


Objetivo: Identificar eventos adversos en el postoperatorio inmediato de queiloplastia y/o palatoplastia en niños y comparar los eventos identificados con los notificados al Centro de Seguridad del Paciente. Métodos: Estudio descriptivo, retrospectivo y cuantitativo, realizado en un hospital público y terciario brasileño. Los datos se recolectaron mediante descripciones en registros de enfermería y se compararon con los notificados al Centro de Seguridad del Paciente, referidos a junio y diciembre de 2019. Los resultados fueron sometidos a análisis estadístico descriptivo. Resultados: La muestra estuvo conformada por 203 niños, de los cuales el 51% (n = 103) tuvo un evento adverso. Se identificaron un total de 176 eventos adversos de 8 tipos, con prevalencia de laringitis posextubación (n=50; 28%), edema de lengua (n=34; 19%) y lesión de la comisura del labrum (n=25; 14%). De estos, solo el 5% (n=9) fueron notificados al Centro de Seguridad del Paciente. Conclusion: Los eventos adversos prevalentes se relacionaron con la cavidad bucal y los tejidos adyacentes y el subregistro fue significativo. (AU)


Subject(s)
Patient Safety , Postoperative Period , Congenital Abnormalities , Child , Drug-Related Side Effects and Adverse Reactions
2.
Braz. j. oral sci ; 23: e241965, 2024. ilus
Article in English | LILACS, BBO | ID: biblio-1527023

ABSTRACT

Aim: This study aims to report the perioperative management of a patient with von Willebrand disease (vWd) who underwent orthognathic surgery. The report follows the guidelines of the Case Report Guidelines (CARE) and focuses on the steps taken to prevent bleeding during the surgical procedure. Methods: A 39-year-old female patient with skeletal Class III was treated with maxillary advancement and mandibular setback. Despite normal test results for ristocetin cofactor activity, measures were taken to prevent bleeding, including atraumatic surgical techniques, use of antifibrinolytic medication, induced hypotension during anesthesia, and preparation of blood products for transfusion during trans and postoperative periods if needed. In the end, these measures were not required. Results: The patient did not experience any bleeding during the surgical procedure or postoperative period, demonstrating the effectiveness of the measures taken to manage their blood dyscrasia. Two years after the surgery, the patient had satisfactory aesthetic and functional results and no evidence of relapse. Conclusion: Thus, this case report demonstrates that vWd does not prevent largescale oral and maxillofacial surgeries such as orthognathic surgery as long as proper precautions are taken pre-, intraand postoperatively


Subject(s)
Humans , Female , Adult , Postoperative Period , von Willebrand Diseases , Orthognathic Surgery
3.
Rev. bras. ortop ; 58(4): 599-603, July-Aug. 2023. tab, graf
Article in English | LILACS | ID: biblio-1521808

ABSTRACT

Abstract Objective: To identify blood transfusion requirements and postoperative complications in patients undergoing total knee arthroplasty (TKA) with no tourniquet and intraoperative intravenous administration of tranexamic acid. Methods: This retrospective observational study analyzed 49 preopeative and postoperative medical records of patients undergoing TKA. A paired t-test compared changes in hemoglobin (HB) and packed cell volume (PCV), and an independent t-test with Welch correction compared HB and PCV changes between genders. A Spearman correlation test determined associations between age and days of postoperative hospitalization with HB and PCV changes. The significance level adopted was p < 0.05. Results: The patients' mean age was 71.9 ± 6.7 years; most subjects were women (73.5%). The right side (59.2%) was the most affected. Only one participant required a blood transfusion, while three subjects had complications during the postoperative follow-up. No patient had a thromboembolic event. The median length of postoperative hospital stay was 2 days (interquartile range [IQR] = 1.0). There were reductions in HB and PCV levels between the pre-operative and postoperative period, and female patients had a higher HB reduction. Conclusion: TKA with tranexamic acid and no tourniquet did not cause significant postoperative complications or require blood transfusions.


Resumo Objetivo: Identificar a necessidade de transfusão sanguínea e intercorrências inerentes ao pós-operatório de pacientes submetidos à artroplastia total de joelho (ATJ), a partir de manejos realizados sem o uso de torniquete e com administração de ácido tranexâmico endovenoso intra-operatório. Métodos: Trata-se de um estudo observacional retrospectivo, a partir da observação de 49 prontuários médicos de pacientes submetidos à ATJ em pré e pós-operatório. Foi utilizado o teste t pareado para fazer comparações das modificações de hemoglobina (HB) e hematócrito (HT) e o teste t independente com correção de Welch para comparar as modificações de HB e HT entre os sexos. As associações de idade e dias de internação no pós-operatório com as modificações de HB e HT foram testadas pela correlação de Spearman. O nível de significância adotado foi p < 0,05. Resultados: Os pacientes apresentaram idade média de 71,9 ± 6,7 anos. A maioria da amostra foi composta por mulheres (73,5%) e o lado direito (59,2%) foi o mais acometido. Apenas um participante necessitou de transfusão de sangue e três participantes apresentaram intercorrências durante o seguimento pós-operatório. Nenhum paciente apresentou evento tromboembólico. A mediana da duração da internação no pós-operatório foi de dois dias (IIQ= 1,0). Verificaram-se reduções nas dosagens de HB e HT entre o pré e pós-operatório, e pacientes do sexo feminino apresentaram maior redução de HB. Conclusão: ATJ com uso de ácido tranexâmico e sem uso de torniquete não acarretou complicações pós-operatórias ou necessidade de transfusão sanguínea significativas.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Postoperative Period , Tranexamic Acid/therapeutic use , Retrospective Studies , Arthroplasty, Replacement, Knee
4.
Rev. cir. traumatol. buco-maxilo-fac ; 23(1): 31-37, jan.-mar. 2023. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1443856

ABSTRACT

A ressecção é o tratamento de escolha para tratamento do ameloblastoma, este que é o tumor odontogênico mais comuns, excluindo os odontomas. A desregulação de diversos genes no desenvolvimento de dentes pode desempenhar papel em sua histogênese. Alguns eventos adversos podem ocorrer durante seu tratamento pós-operatório. Recidivas ocorrem porque o ameloblastoma tende a se infiltrar entre o trabeculado ósseo esponjoso intacto na periferia do tumor antes que a reabsorção óssea se torne radiograficamente evidente. Consequentemente, a margem real do tumor sempre se estende além da sua imagem radiográfica ou da margem clínica. Deiscência de sutura é uma complicação que pode ocorrer no pós-operatório imediato na qual as bordas da ferida, que estão unidas por uma sutura, acabam se abrindo, aumentando o risco de infecção e dificultando assim a cicatrização. Fratura de placa de reconstrução é um evento possível de ocorrer em tratamentos de grandes defeitos. O estresse causado pela modelagem da placa durante a conformação da placa, além da ação muscular são uns dos fatores que pode fragilizar o metal da placa. Outras complicações podem ocorrer como: assimetrias, parestesia temporária e permanente do nervo alveolar inferior e deficiência estética e funcional. As descrições destes eventos na literatura ajudam aos clínicos conhecer e tentá-lo preveni-lo e com saber tratar... (AU)


Resection is the treatment of choice for treating ameloblastoma, which is the most common odontogenic tumor, excluding odontomas. The dysregulation of several genes in the development of teeth may play a role in their histogenesis. Some adverse events may occur during your postoperative treatment. Relapses occur because ameloblastoma tends to infiltrate between intact cancellous bone trabeculae at the pe riphery of the tumor before bone resorption becomes radiographi cally evident. Consequently, the actual tumor margin always extends beyond its radiographic image or clinical margin. Suture dehiscence is a complication that can occur in the immediate postoperative period in which the edges of the wound, which are joined by a suture, end up opening, increasing the risk of infection and thus hindering healing. Reconstruction plate fracture is a possible event to occur in large de fect treatments. The stress caused by the modeling of the plate during the formation of the plate, in addition to muscle action, are one of the factors that can weaken the plate metal. Other complications may occur, such as: asymmetries, temporary and permanent paresthesia of the inferior alveolar nerve and aesthetic and functional deficiency. The descriptions of these events in the literature help clinicians to Resection is the treatment of choice for treating ameloblastoma, which is the most common odontogenic tumor, excluding odontomas. The dysregulation of several genes in the development of teeth may play a role in their histogenesis. Some adverse events may occur during your postoperative treatment. Relapses occur because ameloblastoma tends to infiltrate between intact cancellous bone trabeculae at the pe riphery of the tumor before bone resorption becomes radiographi cally evident. Consequently, the actual tumor margin always extends beyond its radiographic image or clinical margin. Suture dehiscence is a complication that can occur in the immediate postoperative period in which the edges of the wound, which are joined by a suture, end up opening, increasing the risk of infection and thus hindering healing. Reconstruction plate fracture is a possible event to occur in large de fect treatments. The stress caused by the modeling of the plate during the formation of the plate, in addition to muscle action, are one of the factors that can weaken the plate metal. Other complications may occur, such as: asymmetries, temporary and permanent paresthesia of the inferior alveolar nerve and aesthetic and functional deficiency. The descriptions of these events in the literature help clinicians to know and try to prevent them and to know how to treat them... (AU)


La resección es el tratamiento de elección para tratar el ameloblastoma, que es el tumor odontogénico más común, excluyendo los odontomas. La desregulación de varios genes en el desarrollo de los dientes puede desempeñar un papel en su histogénesis. Algunos eventos adversos pueden ocurrir durante su tratamiento postoperatorio. Las recaídas ocurren porque el ameloblastoma tiende a infiltrarse entre las trabéculas del hueso esponjoso intacto en la periferia del tumor antes de que la reabsorción ósea sea evidente en las radiografías. En consecuencia, el margen tumoral real siempre se extiende más allá de su imagen radiográfica o margen clínico. La dehiscencia de sutura es una complicación que puede ocurrir en el postoperatorio inmediato en el que los bordes de la herida, que están unidos por una sutura, acaban abriéndose, aumentando el riesgo de infección y dificultando así la cicatrización. La fractura de la placa de reconstrucción es un evento posible que ocurre en los tratamientos de defectos grandes. Los esfuerzos que provoca el modelado de la placa durante la conformación de la placa, además de la acción muscular, son uno de los factores que pueden debilitar la placa metálica. Pueden presentarse otras complicaciones como: asimetrías, parestesias temporales y permanentes del nervio alveolar inferior y deficiencia estética y funcional. Las descripciones de estos eventos en la literatura ayudan a los clínicos a conocerlo y tratar de prevenirlo y saber cómo tratarlo... (AU)


Subject(s)
Humans , Male , Female , Postoperative Period , Recurrence , Odontogenic Tumors
5.
J. coloproctol. (Rio J., Impr.) ; 43(3): 235-242, July-sept. 2023. tab, ilus
Article in English | LILACS | ID: biblio-1521151

ABSTRACT

Introduction: The introduction of Enhanced Recovery After Surgery led to increasing twenty-four hours discharge pathways, for example in laparoscopic cholecystectomy and bariatric surgery. However, implementation in colorectal surgery still must set off. This systematic review assesses safety and feasibility of twenty-four hours discharge in colorectal surgery in terms of readmission and complications in current literature. Secondary outcome was identification of factors associated with success of twenty-four hours discharge. Methods: Pubmed and EMBASE databases were searched to identify studies investigating twenty-four hours discharge in colorectal surgery, without restriction of study type. Search strategy included keywords relating to ambulatory management and colorectal surgery. Studies were scored according to MINORS score. Results: Thirteen studies were included in this systematic review, consisting of six prospective and seven retrospective studies. Number of participants of the included prospective studies ranged from 5 to 157. Median success of discharge was 96% in the twenty-four hours discharge group. All prospective studies showed similar readmission and complication rates between twenty-four hours discharge and conventional postoperative management. Factors associated with success of twenty-four hours discharge were low ASA classification, younger age, minimally invasive approach, and relatively shorter operation time. Conclusions: Twenty-four hours discharge in colorectal surgery seems feasible and safe, based on retro- and prospective studies. Careful selection of patients and establishment of a clear and adequate protocol are key items to assure safety and feasibility. Results should be interpreted with caution, due to heterogeneity. To confirm results, an adequately powered prospective randomized study is needed. (AU)


Subject(s)
Patient Discharge , Colorectal Neoplasms/surgery , Length of Stay , Postoperative Complications , Postoperative Period
6.
Distúrb. comun ; 35(1): e56371, 01/06/2023.
Article in Portuguese | LILACS | ID: biblio-1436170

ABSTRACT

Introdução: Alterações na tireoide e a tireoidectomia podem levar à sintomatologia vocal e emocional.Objetivo: Correlacionar sintomas vocais e traços de ansiedade e depressão pré e pós-tireoidectomia. Métodos: Estudo observacional, longitudinal. Participaram 20 pacientes submetidos à tireoidectomia, ao exame visual laríngeo e à Escala de Sintomas Vocais (ESV) e Escala Hospitalar de Ansiedade e Depressão (HADS) no pré-operatório, pós 1 semana e pós 3 meses, com média de idade de 54,5 anos, maior prevalência do sexo feminino (85%) e tireoidectomia parcial (70%). Resultados: Os pacientes autorreferiram sintomas vocais em todos os momentos, com maior frequência após uma semana e diferença significativa entre o domínio físico pré e pós 1 semana. Na HADS, observou-se maior escore total no pré-operatório e diferença significante nos três momentos, em todos os domínios, com maior diferença entre pré e pós 1 semana. Houve correlação positiva fraca entre os domínios limitação, emocional e escore total da ESV com a subescala de ansiedade pós 1 semana, entre o escore total da ESV e o escore total da HADS e correlação positiva moderada entre os domínios limitação e emocional da ESV com o escore total da HADS após uma semana. Conclusão: Pacientes submetidos à tireoidectomia autopercebem sintomas vocais e traços de grau leve de ansiedade tanto no pré quanto pós 1 semana e após 3 meses de cirurgia com pior autorreferência após uma semana. Quanto maior a autorreferência de sintomas vocais, mais traços de ansiedade o paciente pode apresentar. (AU)


Introduction: Thyroid alterations and thyroidectomy can lead to vocal and emotional symptoms.Purpose: To correlate vocal symptoms and anxiety and depression traits pre and post-thyroidectomy. Methods: Observational, longitudinal study. Participants were 20 patients who underwent thyroidectomy, laryngeal visual examination and the Voice Symptom Scale (VoiSS) and Hospital Anxiety and Depression Scale (HADS) preoperatively, 1 week and 3 months after, with a mean age of 54.5 years, higher prevalence of female gender (85%) and partial thyroidectomy (70%). Results: The patients self-reported vocal symptoms at all times, more frequently after one week and a significant difference between the physical domain pre and post 1 week. In HADS, there was a higher total score in the preoperative period and a significant difference in the three moments, in all domains, with a greater difference between pre and post 1 week. There was a weak positive correlation between the limitation, emotional and total score of the ESV domains with the anxiety subscale after 1 week, between the total score of the ESV and the total score of the HADS, and a moderate positive correlation between the limitation and emotional domains of the ESV with the HADS total score after one week. Conclusion: Patients undergoing thyroidectomy self-perceived vocal symptoms and mild anxiety traits both before and after 1 week and after 3 months of surgery with worse self-report after one week. The greater the self-report of vocal symptoms, the more traces of anxiety the patient may present. (AU)


Introducción: Cambios en la tiroides y tiroidectomía pueden provocar síntomas vocales y emocionales. Objetivo: Correlacionar síntomas vocales y rasgos de ansiedad y depresión antes y después de tiroidectomía. Metodos: Estudio observacional/longitudinal. Participaron 20 pacientes que se les realizó tiroidectomía, examen visual laríngeo, Escala de Síntomas Vocales (ESV) y Escala Hospitalaria de Ansiedad y Depresión (HADS) en preoperatorio, 1 semana y 3 meses después, con edad media de 54,5 años, prevalencia del género femenino (85%) y tiroidectomía parcial (70%). Resultados: Los pacientes informaron síntomas vocales en todo momento, con mayor frecuencia después de una semana y una diferencia significativa entre el dominio físico antes y después de 1 semana. En HADS, hubo mayor puntaje total en el preoperatorio y diferencia significativa en los tres momentos, con mayor diferencia entre pre y post 1 semana. Hubo una correlación positiva débil entre limitación, emocional y total de los dominios de la ESV con la subescala de ansiedad después de 1 semana, entre el total de la ESV y e total de la HADS, y una correlación positiva moderada entre la puntuación de limitación y dominios emocionales de la ESV con la puntuación total de HADS después de una semana. Conclusión: Los pacientes sometidos a tiroidectomía autopercibieron síntomas vocales y rasgos de ansiedad leve tanto antes como después de 1 semana y después de 3 meses de la cirugía con peor autoinforme después de una semana. Cuanto mayor es el autoinforme de síntomas vocales, más rastros de ansiedad puede presentar el paciente. (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Anxiety , Thyroidectomy/psychology , Voice Disorders/psychology , Depression , Postoperative Period , Thyroid Diseases , Voice , Preoperative Period
7.
Cuad. Hosp. Clín ; 64(1): 52-57, jun. 2023.
Article in Spanish | LILACS | ID: biblio-1444500

ABSTRACT

Introducción: La infección del sitio operatorio (ISO), es una de las principales complicaciones en la cirugía de la peritonitis generalizada por apendicitis aguda (PGAA). La mejor opción entre cierre primario (CP) y diferido (CD) de la laparotomía, aún es materia de controversia. El objetivo de este estudio fue determinar asociación entre tipo de cierre y desarrollo de ISO en pacientes con PGAA. Material y método: Ensayo clínico con asignación aleatoria (ECA) Se reclutó a pacientes con PGAA sin exclusión de sexo ni edad, e intervenidos quirúrgicamente en el Servicio de Cirugía del Hospital Obrero Nº 1 (La Paz, Bolivia) entre julio de 2019 y noviembre de 2021; y se les asignó de forma aleatoria a CP y CD; con un seguimiento mínimo de 30 días postoperatorio. Se aplicó estadística descriptiva (cálculo de porcentajes, de medidas de tendencia central y de dispersión); y posteriormente, se aplicaron estadísticas analíticas para estudiar asociación entre variables (test exacto de Fisher para variables categóricas y t de student para variables continuas). Se determinaron RA, RR, OR NNT y sus respectivos IC95%. Resultados: Se incluyeron 100 pacientes, divididos en 59 con CP y 41 con CD, con promedio de edad, peso, estatura e IMC de 43±13,1 años, 71±8,5 kilogramos, 1,61±0,8 metros y 27,6±3,2 respectivamente. La ISO fue de 29,8% y 4,7% en los grupos de CP y CD respectivamente. La incidencia de ISO para el CD fue de 0,05 (5%) y de 0,30 (30%) para el CP. Para los seromas, el RA para el CD es de 0,27 y para el CP de 0,55. El Número Necesario a Tratar (NNT) fue 3,97 (IC95%: 2,75-5,19). No hubo mortalidad. Conclusión: El CD se asocia a menor incidencia de ISO.


Introduction: Surgical site infection (SSI) is one of the main complications in surgery for generalized peritonitis due to acute appendicitis (GPAA). The best option between primary (PC) and delayed (CD) laparotomy closure is still a matter of controversy. The objective of this study was to determine the association between the type of closure and the development of SSI in patients with GPAA. Material and method: Randomized Clinical trial. Patients with GPAA were recruited without exclusion of sex or age, and underwent surgery in the Surgery Service of Hospital Obrero No. 1 (La Paz, Bolivia) between July 2019 and November 2021; they were randomly assigned to PC and DC; with a minimum follow-up of 30 days postoperatively. Descriptive statistics were applied (calculation of percentages, measures of central tendency, and dispersion); and subsequently, analytical statistics were applied to study the association between variables (Fisher's exact test for categorical variables and Student's T test for continuous variables). AR, RR, OR, NNT and their respective 95% CI were determined. Results: 100 patients were included, divided into 59 with PC and 41 with CD, with average age, weight, height, and BMI of 43±13.1 years, 71±8.5 kilograms, 1.61±0.8 meters and 27.6±3.2 respectively. The SSI was 29.8% and 4.7% in the PC and DC groups respectively. The incidence of SSI for DC was 0.05 (5%) and 0.30 (30%) for PC. For seromas, the AR for DC is 0.27 and for PC 0.55. The Number Needed to Treat (NNT) was 3.97 (95% CI: 2.75-5.19). There was no mortality. Conclusion: DC is associated with a lower incidence of SSI.


Subject(s)
Humans , Postoperative Period , Peritonitis
8.
Rev. bras. ortop ; 58(1): 121-126, Jan.-Feb. 2023. tab
Article in English | LILACS | ID: biblio-1441339

ABSTRACT

Abstract Objective The COVID-19 pandemic led to an unprecedented pause in elective surgeries, including shoulder arthroplasty. We sought to determine whether clinical and/or demographic differences would be seen between patients who presented for shoulder arthroplasty during the pandemic compared with the previous year (2019). Methods Institutional records were queried for patients who underwent shoulder replacement between March 1 and July 1 of 2019 and 2020. Demographics, range of motion, surgical duration, hospitalization time, discharge disposition, and postoperative management were analyzed. Results The mean duration of surgery was 160 ± 50 minutes in 2020 and 179 ± 54 minutes in 2019 (p= 0.13). The mean hospitalization time was 36 ± 13 hours in 2020 and 51 ± 40 hours in 2019 (p= 0.04). In 2019, 96% of the patients participated in physical therapy, while 71% did it in 2020 (p= 0.003). A total of 100% of the 2019 patients and 86% of the 2020 patients participated in an in-person postoperative follow-up (p= 0.006). The 2019 patients reported for an office visit on average 14 ± 11 days after surgery; the 2020 patients waited 25 ± 25 days to return for a follow-up (p= 0.10). Range of motion, age, American Society of Anesthesiologists (ASA) scores, and complication rates did not differ between the cohorts. Conclusion Patients presenting for surgery during the initial phase of the pandemic were demographically and clinically similar to 2019 patients. However, the length of stay was significantly reduced during the COVID-19 pandemic. Postoperative follow-up and physical therapy were delayed in 2020, but this did not lead to differences in complication or readmission rates compared with those of the 2019 cohort. Level of EvidenceIII.


Resumo Objetivo A pandemia de COVID-19 causou uma pausa sem precedentes em cirurgias eletivas, inclusive artroplastia de ombro. Procuramos determinar as possíveis diferenças clínicas e/ou demográficas entre os pacientes que realizaram artroplastia de ombro durante a pandemia em comparação com o ano anterior (2019). Métodos Os registros institucionais foram consultados para obtenção de informações sobre pacientes submetidos a artroplastia de ombro entre 1° de março a 1° de julho de 2019 e 2020. Dados demográficos, amplitude de movimento, duração da cirurgia, tempo de hospitalização, condições à alta e manejo pós-operatório foram analisados. Resultados O tempo médio de cirurgia foi de 160 ± 50 minutos em 2020 e de 179 ± 54 minutos em 2019 (p= 0,13). O tempo médio de internação foi de 36 ± 13 horas em 2020 e de 51 ± 40 horas em 2019 (p= 0,04). Em 2019, 96% dos pacientes fizeram fisioterapia, enquanto 71% o fizeram em 2020 (p= 0,003). Todos os pacientes de 2019 e 86% dos pacientes de 2020 participaram do acompanhamento pós-operatório presencial (p= 0,006). Os pacientes de 2019 retornaram para a consulta médica em média 14 ± 11 dias após a cirurgia; os pacientes de 2020 retornaram para o acompanhamento em 25 ± 25 dias (p= 0,10). A amplitude de movimento, a idade, a pontuação da American Society of Anesthesiologists (ASA, na sigla em inglês) e as taxas de complicações não diferiram entre as coortes. Conclusão Os pacientes submetidos a cirurgia na fase inicial da pandemia eram demográfica e clinicamente semelhantes aos pacientes de 2019. No entanto, o tempo de internação diminuiu de forma significativa durante a pandemia de COVID-19. O acompanhamento pós-operatório e a fisioterapia foram adiados em 2020, mas isso não levou a diferenças nas taxas de complicações ou de reinternações em comparação às da coorte de 2019. Nível de EvidênciaIII.


Subject(s)
Humans , Postoperative Period , Elective Surgical Procedures , Perioperative Period , Arthroplasty, Replacement, Shoulder , COVID-19
9.
Braz. J. Anesth. (Impr.) ; 73(1): 91-100, Jan.-Feb. 2023. tab, graf
Article in English | LILACS | ID: biblio-1420641

ABSTRACT

Abstract Background Postoperative cough may occur after tracheal intubation, but it is indistinct which drug is best at diminishing these events. Additionally, airway reflexes are commonly accompanied by severe hemodynamics responses during emergence. Objectives To evaluate the role of topical airway anesthesia on immediate post-extubation cough/bucking and extubation time. Methods Randomized clinical trials from MEDLINE, EMBASE, CENTRAL, and LILACS published until December 23, 2020 were included. Our primary outcome was postoperative cough/bucking incidence which was compared between local anesthetics and controls. Extubation times were likewise considered. Predisposition appraisal and subgroup, affectability investigations were likewise performed. Results The pooled analysis found a 45% reduction in cough incidence after treatment with topical airway local anesthetic (RR = 0.55; 95% CI: 0.42 to 0.72; p< 0.001). The number needed to treat (NNT) was 4.61. The intervention showed no differences in reduction of the extubation time (mean difference = -0.07; 95% CI: -0.14 to 0.28; p= 0.49). Conclusion Topical airway anesthesia demonstrated better than placebo or no medication in reducing immediate post-extubation cough/bucking. Further studies could have this objective to combine the different ways to perform better outcomes for patients.


Subject(s)
Humans , Cough/prevention & control , Intubation, Intratracheal , Postoperative Period , Airway Extubation , Anesthesia, General , Anesthesia, Local , Anesthetics, Local
10.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (12): 878-885, 2023.
Article in Chinese | WPRIM | ID: wpr-1011064

ABSTRACT

Objective:To compare the perioperative efficacy and safety of postoperative oral glucocorticoid and glucocorticoid stent implantation in patients with chronic rhinosinusitis with nasal polyps(CRSwNP) undergoing functional endoscopic sinus surgery(FESS). Methods:Sixty patients with bilateral CRSwNP with similar degree of lesions were selected and divided into three groups: conventional surgical treatment group(20 cases), glucocorticoid stent group(20 cases), and oral glucocorticoid group(20 cases). All three groups underwent routine FESS, patients in the sinus glucocorticoid stent group receiving sinus glucocorticoid stent placed in the ethmoid sinuses(one on each side) during surgery, and patients in the oral glucocorticoid group received postoperative oral methylprednisolone at a dose of 0.4 mg/kg per day for 7 days, followed by a tapering of 8 mg per week to 8 mg followed by maintenance therapy for 1 week, for a total of 3-4 weeks. Visual analog scale(VAS) scores were used to evaluate nasal congestion, rhinorrhea, olfaction, and facial pressure symptoms before surgery, as well as at 2, 4, 8, and 12 weeks after surgery. Nasal endoscopic Lund-Kennedy scores were recorded, and adverse reactions such as stent detachment, stent-related allergic reactions, sleep disorders, edema, gastrointestinal symptoms, rash/acne, behavioral/cognitive changes, weight gain, limb pain, and infection risk were documented. Results:The nasal congestion symptom scores at 2, 4, 8, and 12 weeks after surgery were significantly lower than those before operationin all three groups, and the differences were statistically significant(P<0.05). The sinus glucocorticoid stent group exhibited significantly lower nasal congestion symptom scores at 4 and 8 weeks after surgery compared to the conventional surgical treatment group. The rhinorrhea symptom scores at 2, 8, and 12 weeks after surgery were significantly lower than preoperative scores in all three groups. Additionally, the sinus glucocorticoid stent group had significantly lower rhinorrhea scores than the conventional surgical treatment group at 2 weeks postoperatively. Concerning olfaction, the sinus glucocorticoid stent group showed a significant reduction in scores at 12 weeks postoperatively, while the oral glucocorticoid group exhibited significant improvement starting from 8 weeks after surgery. There were no statistically significant differences in nasal congestion, rhinorrhea, facial pressure, and olfaction scores between the sinus glucocorticoid stent and oral glucocorticoid groups at 2, 4, 8, and 12 weeks postoperatively. Nasal endoscopy scores revealed lower polyp scores and edema at 2, 4, 8, and 12 weeks postoperatively for all three groups compared to preoperative scores. The conventional surgical treatment group exhibited a significant reduction in nasal secretion scores starting from 8 weeks after surgery, while both the sinus glucocorticoid stent and oral glucocorticoid groups showed significant reductions starting from 2 weeks postoperatively, with scores significantly lower than those of the conventional surgical treatment group at 2 weeks. Scab/scar scores in the conventional surgical treatment group significantly decreased from 8 weeks after surgery, while both the sinus glucocorticoid stent and oral glucocorticoid groups exhibited significant reductions starting from 4 weeks. No statistically significant differences were observed in endoscopy scores(including polyps, edema, nasal secretion, scars, and scabs) between the sinus glucocorticoid stent and oral glucocorticoid groups at 2, 4, 8, and 12 weeks postoperatively. Regarding adverse reactions, no postoperative complications related to sinus glucocorticoid stent were observed in the sinus glucocorticoid stent group. In the oral glucocorticoid group,1 patient experienced irritability, and 1 patient experienced weight gain. Conclusion:The glucocorticoid stent implantation has comparable effects to oral glucocorticoid in improving postoperative nasal symptoms, reducing nasal mucosal edema, scar formation, and nasal secretion in patients with CRSwNP undergoing FESS, with a better safety profile.


Subject(s)
Humans , Nasal Polyps/complications , Glucocorticoids/therapeutic use , Cicatrix/complications , Sinusitis/complications , Postoperative Period , Endoscopy , Rhinorrhea , Edema/complications , Weight Gain , Chronic Disease , Rhinitis/complications , Treatment Outcome
11.
Acta Academiae Medicinae Sinicae ; (6): 549-555, 2023.
Article in Chinese | WPRIM | ID: wpr-1008102

ABSTRACT

Objective To compare the surgical safety of elderly hospitalized patients in different age groups undergoing general surgery,and provide references for preoperative evaluation and treatment decision-making.Methods The inpatients ≥ 60 years old in the department of general surgery were selected from a national multi-center survey conducted from January to June in 2015 and from January to June in 2016.The patient characteristics and postoperative outcomes were described,and the risk factors for adverse postoperative outcomes of patients in different age groups were explored.Results The elderly patients (≥75 years old) accounted for 17.33%.The non-elderly patient (< 75 years old) group and the elderly patient (≥75 years old) group had significant differences in the proportions of patients with three or more chronical diseases (13.18% vs.5.36%,P<0.001),emergency surgery (16.64% vs.7.62%,P<0.001),American Society of Anesthesiologists score≥3 (48.68% vs.27.28%,P<0.001),and postoperative return to the intensive care unit(33.64% vs.12.00%,P<0.001).The occurrence of postoperative infectious complications showed no significant difference between the two age groups (7.29% vs.6.40%,P=0.410),while severe complications differed between the two groups (6.51% vs.2.60%,P<0.001).Besides,emergency surgery was a common independent risk factor for the two age groups.Conclusions Advanced age is not a contraindication to surgery of elderly patients.With consideration to patient's physical conditions and available surgical resources,elderly patients can still benefit from surgery.


Subject(s)
Humans , Middle Aged , Aged , Postoperative Complications/epidemiology , Postoperative Period , Risk Factors
12.
Chinese Journal of Hepatology ; (12): 524-531, 2023.
Article in Chinese | WPRIM | ID: wpr-986163

ABSTRACT

Objective: To investigate the factors influencing total bilirubin elevation and its correlation with UGT1A1 gene polymorphism in the early postoperative period of transjugular intrahepatic portosystemic shunt (TIPS). Methods: 104 cases with portal hypertension and esophageal variceal hemorrhage (EVB) treated with elective TIPS treatment were selected as the study subjects and were divided into a bilirubin-elevated group and a normal bilirubin group according to the total bilirubin elevation level during the early postoperative period. Univariate analysis and logistic regression were used to analyze the factors influencing total bilirubin elevation in the early postoperative period. PCR amplification and first-generation sequencing technology were used to detect the polymorphic loci of the UGT1A1 gene promoter TATA box, enhancer c.-3279 T > G, c.211G > A, and c.686C > A. Logistic regression was used to analyze the correlation of four locus alleles and genotypes with elevated total bilirubin in the early postoperative period. Results: Among the 104 cases, 47 patients were in the bilirubin elevated group, including 35 males (74.5%) and 12 females (25.5%), aged (50.72 ± 12.56) years. There were 57 cases in the normal bilirubin group, including 42 males (73.7%) and 15 females (26.3%), aged (51.63 ± 11.10) years. There was no statistically significant difference in age (t = -0.391, P = 0.697) and gender (χ(2) = 0.008, P = 0.928) between the two groups of patients. Univariate analysis revealed that preoperative alanine transaminase (ALT) level (χ(2) = 5.954, P = 0.015), total bilirubin level (χ(2) = 16.638, P < 0.001), MELD score (χ(2) = 10.054, P = 0.018), Child-Pugh score (χ(2) = 6.844, P = 0.022), and postoperative portal vein branch development (χ(2) = 6.738, P = 0.034) were statistically significantly different between the two groups. Logistic regression analysis showed that preoperative ALT level, total bilirubin level, and portal vein branch development after TIPS were correlated with the elevated total bilirubin in the early postoperative period. The polymorphism of the c.211G > A locus of the UGT1A1 gene correlation had elevated total bilirubin in the early postoperative period of TIPS. The risk of elevated total bilirubin was increased in the population carrying allele A (P = 0.001, OR = 4.049) in the early postoperative period. Allelic polymorphisms in the TATA box promoter region and enhancer c.-3279 T > G and c.686C > A had no statistically significant difference between the bilirubin-elevated group and the normal bilirubin group. Conclusion: The preoperative ALT level, total bilirubin level, and portal vein branch development are correlated with the elevated total bilirubin in early postoperative patients. The polymorphisms of the UGT1A1 gene and enhancer c.211G > A are correlated with the occurrence of elevated total bilirubin in the early postoperative period of TIPS. Allele A carrier may have a higher risk of elevated total bilirubin in the early postoperative period.


Subject(s)
Female , Humans , Male , Adult , Middle Aged , Bilirubin , Esophageal and Gastric Varices , Gastrointestinal Hemorrhage/surgery , Portasystemic Shunt, Transjugular Intrahepatic , Postoperative Period , Retrospective Studies , Treatment Outcome , Glucuronosyltransferase/genetics
13.
Chinese Journal of Reparative and Reconstructive Surgery ; (12): 1081-1085, 2023.
Article in Chinese | WPRIM | ID: wpr-1009027

ABSTRACT

OBJECTIVE@#To investigate the effects of enhanced recovery after surgery (ERAS) on postoperative function and pain in total hip arthroplasty (THA) patients with high comorbidity.@*METHODS@#Patients with THA who were admitted between January 2020 and January 2022 were selected as the study objects, and a total of 223 patients with high comorbidity met the selection criteria. Patients were randomly divided into two groups using the random envelope method. During perioperative period, 112 cases in the ERAS group were treated according to the ERAS protocol and 111 cases in the control group with the traditional protocol. There was no significant difference in gender, age, body mass index, Charlson comorbidity index, preoperative diagnosis, the type and number of the comorbidities, preoperative visual analogue scale (VAS) score between the two groups ( P>0.05). However, the Harris score of ERAS group was significantly lower than that of control group before operation ( P<0.05). Preoperative and postoperative hospital stays were recorded. The VAS score was used to evaluate the pain before operation, at 1 day after operation, at the leaving bed time, at the day after discharge, and at 2 weeks after operation. Harris score was used to evaluate hip function before operation and at 2 weeks, 1 month, 3 months, 6 months, and 12 months after operation. The incidence of complications, 30-day readmission rate, mortality rate, and patient's satisfaction were recorded.@*RESULTS@#The length of preoperative hospital stay in ERAS group was significantly shorter than that in control group ( P<0.05). But there was no significant difference in the length of postoperative hospital stay between groups ( P>0.05). All patients in the two groups were followed up 12 months. The VAS score in the two groups after operation was lower than that before operation, and showed a gradually trend with the extension of time, with significant differences between different time points ( P<0.05). VAS scores of ERAS group were significantly lower than those of control group at different time points after operation ( P<0.05). The postoperative Harris scores in both groups were higher than those before operation, and showed a gradually increasing trend with the extension of time, with significant differences between different time points ( P<0.05). Harris scores of ERAS group at 2 weeks, 1 month, and 3 months after operation were significantly higher than those of control group ( P<0.05). Complications occurred in 2 cases (1.79%) of the ERAS group and 6 cases (5.41%) of the control group, with no significant difference in incidence ( P>0.05). In the control group, 1 case was readmitted within 30 days after operation, and 1 case died of severe pneumonia within 1 year of follow-up. There was no readmission or death in ERAS group, and there was no significant difference in the above indexes between the two groups ( P>0.05). At last follow-up, the satisfaction rate of patients in ERAS group was slightly higher than that in control group, but the difference was not significant ( P>0.05).@*CONCLUSION@#For THA patients with high comorbidity, ERAS protocol can shorten preoperative waiting time, better reduce pain, and improve hip function.


Subject(s)
Humans , Arthroplasty, Replacement, Hip , Enhanced Recovery After Surgery , Comorbidity , Pain , Postoperative Period
14.
Journal of Biomedical Engineering ; (6): 1117-1125, 2023.
Article in Chinese | WPRIM | ID: wpr-1008941

ABSTRACT

In recent years, wearable devices have seen a booming development, and the integration of wearable devices with clinical settings is an important direction in the development of wearable devices. The purpose of this study is to establish a prediction model for postoperative pulmonary complications (PPCs) by continuously monitoring respiratory physiological parameters of cardiac valve surgery patients during the preoperative 6-Minute Walk Test (6MWT) with a wearable device. By enrolling 53 patients with cardiac valve diseases in the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, the grouping was based on the presence or absence of PPCs in the postoperative period. The 6MWT continuous respiratory physiological parameters collected by the SensEcho wearable device were analyzed, and the group differences in respiratory parameters and oxygen saturation parameters were calculated, and a prediction model was constructed. The results showed that continuous monitoring of respiratory physiological parameters in 6MWT using a wearable device had a better predictive trend for PPCs in cardiac valve surgery patients, providing a novel reference model for integrating wearable devices with the clinic.


Subject(s)
Humans , Lung , Walking/physiology , Walk Test , Heart Valves/surgery , Postoperative Period , Postoperative Complications/etiology
15.
Article in Portuguese | LILACS, CONASS, ColecionaSUS, SES-GO | ID: biblio-1512052

ABSTRACT

No período de pós Transplante Renal (TxR) o uso de imunossupressores é indicado. Seu uso crônico se associa a alterações endocrinometabólicas e do estado nutricional. Objetivo: Avaliar o estado nutricional de pacientes com Doenças Renais Crônicas (DRC) submetidos ao transplante renal. Método: Trata-se de um estudo transversal, realizado com pessoas que vivem com a DRC, submetidas ao TxR, no período mínimo de 6 (seis) meses. Coletou-se dados socioeconômicos, demográficos, antecedentes clínicos e antropométricos. Feita análise estatística dos dados e determinada a média e desvio padrão das variáveis numéricas. Verificou-se a normalidade dos dados pelo teste de Shapiro Wilk. Para variáveis não-paramétricas, foi aplicado teste de U-Mann-Whitney. Para variáveis categóricas, foi realizada análise descritiva. A comparação foi feita por Qui-quadrado de Pearson ou teste Exato de Fisher. Foi adotado p<0,05. Resultados: Ao avaliar 52 pacientes observou-se interação significativa entre o sexo feminino e o ganho de peso (p=0,02). A eutrofia foi prevalente segundo o Índice de massa corporal IMC (48,08%), entretanto, a adequação da CB, CMB e AMBC apontou relevantes percentuais de desnutrição. Aumento da incidência de diabetes (5,77% vs 30,77%) e de dislipidemia (3,85% vs 17,31%) no período pós TxR. Conclusão: O ganho de peso se associou significativamente ao sexo feminino. Verificou-se que mesmo diante da prevalência de eutrofia ao avaliar o IMC, a desnutrição foi presente ao se classificar as adequações das circunferências corporais


In the period after Renal Transplantation (KTx) the use of immunosuppressants is indicated, their chronic use is associated with endocrine-metabolic alterations and nutritional status. Objective: Evaluate the nutritional status of patients with Chronic Kidney Diseases (CKD) after kidney transplantation. Method: This is a cross-sectional study, carried out with people living with CKD, submitted to KTx, for a minimum period of 6 (six) months. Data on socioeconomic, demographic, clinical and anthropometric background were collected. Statistical analysis of the data was performed and the mean and standard deviation of numerical variables were determined. Data normality was verified by the Shapiro Wilk test. For non-parametric variables, U-Mann-Whitney´s test was applied. For categorical variables, descriptive analysis was performed. Comparison was performed using Pearson's chi-square or Fisher's test. The results were discussed at the 5% level of significance. Results: When assessing 52 patients, a significant interaction was observed between female gender and weight gain. (p=0,02). Eutrophy was prevalent according to BMI(48,08%) However, the adequacy of the MAC, MAMC and AMA presented relevant percentages of malnutrition. Increased incidence of diabetes (5,77% vs 30,77%) and dyslipidemia (3,85% vs 17,31%) in the period after KTx. Conclusion: The weight gain was significantly associated with female gender. It was found that even in the face of the prevalence of eutrophy when assessing BMI, malnutrition was present when classifying the adequacy of body circumferences


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Kidney Transplantation , Postoperative Period , Weight Gain , Malnutrition/epidemiology , Immunosuppressive Agents/adverse effects
16.
Article in Portuguese | LILACS, CONASS, ColecionaSUS, SES-GO | ID: biblio-1511511

ABSTRACT

A definição de amputação compreende a separação total ou parcial de um membro do resto do corpo, com finalidade de proporcionar alívio à dor ou evitar a morte. Apesar de ser algo ocorrido no corpo físico e de cunho reconstrutor, também pode gerar impactos psíquicos a quem vivencia. Objetivos: A presente pesquisa tem como objetivo realizar um estudo qualitativo sobre como as pessoas que sofreram amputação de membros inferiores (MMII) lidam com o processo de mudança corporal e a vivência do luto. O desenvolvimento deste estudo justifica-se pelo avanço no campo da investigação do processo associado à cirurgia de amputação e seus aspectos psicológicos. Isso possibilita uma possível contribuição para a compreensão de como esses sujeitos vivenciam o processo de luto e a reintegração de sua imagem corporal, uma vez que a amputação pode trazer consequências em diversas áreas da vida do paciente. Metodologia: O estudo foi realizado através de uma amostragem intencional, composta por seis participantes, submetidos à amputação de membros inferiores, internados em um hospital de urgências. Para isso foram realizadas duas entrevistas semiestruturadas, utilizadas em dois momentos: após a indicação clínica de amputação e no pós-operatório, após a retirada do membro. Posteriormente, as entrevistas foram analisadas por meio da técnica de análise de conteúdo. Resultados e Discussão: A partir das entrevistas realizadas, emergiram diversos conteúdos emocionais. Assim, compreendeu-se que a amputação, em grande medida, assumiu um caráter traumático para os sujeitos, sobretudo considerando-se as especificidades de cada situação em particular. Conclusões: Mediante o estudo realizado, concluiu-se que o acompanhamento psicológico nesse cenário visa a manejar o impacto psicológico que a perda do membro pode ocasionar na vida do paciente, auxiliando na construção de uma nova imagem corporal, permitindo, assim, que o sujeito possa lidar com as decorrentes repercussões emocionais


The definition of amputation comprises the complete or partial separation of a limb from the rest of the body, with the purpose of providing pain relief or preventing death. Although it is something that happens in the physical body and has a reconstructive nature, it can also generate psychological impacts on those who experience it. Objectives: The objective of this research is to conduct a qualitative study on how individuals who have undergone lower limb amputations cope with the process of bodily changes and the experience of mourning. The development of this study is justified by the advancements in the field of investigation regarding the amputation surgery process and its psychological aspects. This allows for a potential contribution to the understanding of how these individuals experience the mourning process and the reintegration of their body image, as amputation can have consequences in various areas of the patient's life. Methodology: The study was conducted through intentional sampling, consisting of six participants who had undergone lower limb amputations and were hospitalized in an emergency hospital. Two semi-structured interviews were conducted, used at two moments: after the clinical indication of amputation and post-operative limb removal, and later analyzed using content analysis technique. Results and Discussion: Several emotional contents emerged from the interviews conducted. Thus, it was understood that amputation, to a great extent, assumed a traumatic character for these individuals, especially considering the specificities of each particular situation. Conclusions: Based on the conducted study, it was concluded that psychological support in this scenario aims to manage the psychological impact that limb loss can cause in the patient's life, assisting in the construction of a new body image and enabling the individual to cope with the resulting emotional repercussions


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Amputees/psychology , Postoperative Period , Epidemiology, Descriptive , Emergency Service, Hospital
17.
ABCD (São Paulo, Online) ; 36: e1753, 2023. tab
Article in English | LILACS | ID: biblio-1447012

ABSTRACT

ABSTRACT BACKGROUND: Vitamin, mineral, and metabolic deficiencies occur in the postoperative period of bariatric surgery, in the short and long term, and are worrisome intercurrences. AIMS: To evaluate the association of serum vitamin D levels with the lipid profile in obese patients undergoing bariatric surgery. METHODS: Case series of patients assisted from 2010 to 2018, in a private hospital of medium and high complexity, who underwent bariatric surgery using sleeve gastrectomy or Roux-en-Y gastric bypass techniques, monitored by the same surgeon. Sociodemographic, clinical, laboratory, and anthropometric data were collected preoperatively and at 6, 12, and 24 months after surgery. RESULTS: A total of 156 individuals, mostly female (75.6%) were monitored. The most frequent comorbidities were hepatic steatosis (76.3%) and hypertension (48.27). Regarding preoperative vitamin D levels, only 18.9% of the population had a satisfactory level (≥30 ng/mL). There was a reduction in weight and an improvement in the lipid profile after surgery. Significant correlations were observed between the lipid profile and vitamin D concentration only in the sample submitted to the Roux-en-Y gastric bypass technique: negative correlation between total cholesterol and vitamin D two years after surgery; positive correlation between triglycerides and vitamin D one year after surgery; and negative correlation between high-density lipoprotein and vitamin D two years post-surgery. CONCLUSIONS: It is essential to routinely monitor vitamin D levels and lipid profile pre- and postoperatively in order to avoid damage associated with this vitamin deficiency.


RESUMO RACIONAL: Deficiências vitamínicas, minerais e metabólicas ocorrem no pós-operatório de cirurgia bariátrica, a curto e longo prazo, sendo intercorrências preocupantes. OBJETIVOS: Avaliar a associação dos níveis séricos de vitamina D com o perfil lipídico, em pacientes obesos submetidos à cirurgia bariátrica. MÉTODOS: Série de casos de pacientes atendidos de 2010 até 2018, em hospital privado de média e alta complexidade, submetidos à cirurgia bariátrica pelas técnicas da gastrectomia vertical e derivação gástrica em Y de Roux, acompanhados pelo mesmo cirurgião. Foram coletados dados sociodemográficos, clínicos, dados laboratoriais e antropométricos no pré-operatório, 6 meses, 12 meses e 24 meses após cirurgia. RESULTADOS: Foram acompanhados 156 indivíduos, maioria sexo feminino (75,6%), comorbidades mais frequentes foram esteatose hepática (76,3%) e hipertensão (48,27). Em relação aos níveis de vitamina D pré-operatórios, apenas 18,9% da população apresentaram níveis satisfatórios (=30 ng/mL). Observou-se redução do peso e melhora do perfil lipídico pós-cirúrgico. Sobre as correlações entre o perfil lipídico e concentração de vitamina D foram observadas correlações significativas apenas na amostra que passou pela técnica cirúrgica derivação gástrica em Y de Roux: correlação negativa entre o colesterol total e vitamina D após 2 anos de cirurgia; correlação positiva entre triglicerídeo e vitamina D 1 ano pós-operatório; e correlação negativa entre HDL e vitamina D 2 anos pós-operatório. CONCLUSÕES: é essencial acompanhar os níveis de vitamina D e perfil lipídico no pré e pós-operatório de forma rotineira a fim de evitar danos relacionados a deficiência dessa vitamina.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Vitamin D Deficiency/etiology , Vitamin D Deficiency/blood , Bariatric Surgery/adverse effects , Postoperative Period , Vitamin D , Body Mass Index , Bariatric Surgery/methods , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Obesity/surgery
18.
Braz. J. Anesth. (Impr.) ; 73(4): 418-425, 2023. tab, graf
Article in English | LILACS | ID: biblio-1447610

ABSTRACT

Abstract Background Robotic-Assisted Hysterectomies (RAH) require Trendelenburg positioning and pneumoperitoneum, which further accentuate alteration in respiratory mechanics induced by general anesthesia. The role of Recruitment Maneuver (RM) as a lung-protective strategy during intraoperative surgical settings has not been much studied. We planned this study to evaluate the effect of RM on perioperative oxygenation and postoperative spirometry using PaO2/FiO2 and FEV1/FVC, respectively in patients undergoing RAH. Methods Sixty-six ASA I‒II female patients scheduled for elective RAH were randomized into group R (recruitment maneuver, n = 33) or group C (control, n = 33). Portable spirometry was done one day before surgery. Patients were induced with general anesthesia, and mechanical ventilation started with volume control mode, with Tidal Volume (TV) of 6-8 mL.kg−1, Respiratory Rate (RR) of 12 min, inspiratory-expiratory ratio (I: E ratio) of 1:2, FiO2 of 0.4, and Positive End-Expiratory Pressure (PEEP) of 5 cmH2O. Patients in group R received recruitment maneuvers of 30 cmH2O every 30 minutes following tracheal intubation. The primary objectives were comparison of oxygenation and ventilation between two groups intraoperatively and portable spirometry postoperatively. Postoperative pulmonary complications, like desaturation, pulmonary edema, pneumonia, were monitored. Results Patients who received RM had significantly higher PaO2 (mmHg) (203.2+-24.3 vs. 167.8+-27.3, p < 0.001) at T2 (30 min after the pneumoperitoneum). However, there was no significant difference in portable spirometry between the groups in the postoperative period (FVC, 1.40 ± 0.5 L vs. 1.32 ± 0.46 L, p= 0.55). Conclusion This study concluded that intraoperative recruitment did not prevent deterioration of postoperative spirometry values; however, it led to improved oxygenation intraoperatively.


Subject(s)
Humans , Female , Pneumoperitoneum/complications , Robotic Surgical Procedures , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Postoperative Period , Single-Blind Method , Tidal Volume , Hysterectomy/adverse effects , Lung
19.
São Paulo; s.n; 2023. 70 p. ilus, tab.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1510450

ABSTRACT

Introdução: O câncer colorretal (CCR) é um problema de saúde pública mundial cujo controle depende do estabelecimento de políticas públicas e programas de prevenção e rastreamento eficazes. No Brasil estudos relacionados à adesão e preferências a diferentes métodos de rastreamento são pouco conhecidos. Objetivo: Avaliar a associação de características demográficas, condição socioeconômica e variáveis clínicas na adesão para realização de testes de sangue oculto nas fezes (PSOF) dos tipos Imunoquimico Mecanizado (FIT) e Guaiaco (G-FOBT) em população de médio risco para o desenvolvimento de câncer colorretal. Método: Estudo observacional transversal, com coleta prospectiva de dados. Entre março de 2015 e abril de 2016 1.254 indivíduos assintomáticos, com idade entre 50 e 75 anos, foram consecutivamente selecionados a partir de campanhas hospitalares de rastreamento para neoplasias conduzidas pelo AC Camargo Cancer Center. Todos os participantes foram convidados ao rastreamento do CCR mediante realização dos testes (G-FOBT) e (FIT) e responderam a um questionário com características demográficas, condição socioeconômica e variáveis clínicas. Análise estatística: Para avaliar a independência entre variáveis qualitativas foi aplicado o teste de Qui-quadrado. As médias das variáveis quantitativas foram comparadas através do Teste t. Os resultados das análises univariadas foram utilizados para selecionar variáveis para os modelos de regressão logística múltipla, considerando-se valores de p≤0.20. As associações estão descritas por Odds Ratio (OR) e o intervalo de confiança adotado foi de 95% (95% CI). A significância considerada foi de 0.05. A partir dos resultados encontrados foi proposto um nomograma para a predição da probabilidade de adesão com base nas características dos indivíduos. Resultados: As taxas de adesão foram 55,6% e 48,8%, respectivamente para os testes FIT e G-FOBT (p<0.001). As médias de anos de estudos foram diferentes entre os grupos aderentes e não aderentes nos métodos FIT e G-FOBT (8.4vs 9.0; p = 0.001). Nas análises univariadas, as variáveis idade, tipo de atividade ocupacional, crença religiosa e realização prévia de PSOF influenciaram as taxas de adesão aos dois tipos de testes. Nos modelos multivariados, respectivamente para os exames FIT e G-FOBT as variáveis idade 60-75 anos (OR = 1.39; 95%IC 1.06­1.81) e (OR = 1.49; 95%IC 1.16­1.49), presença de crença religiosa (OR = 1.99; 95%IC 1.27­3.11) e (OR = 1.70; 95% IC 1.11­2.60), PSOF (OR = 2.22; 95% IC 1.61­ 3.05) e (OR = 1.26; 95% IC 1.26­2.20) e trabalho em tempo integral ou parcial (OR = 0.69; 95% IC 0.05­0.96) e (OR= 0.68; 95%IC 0.50­0.91) estiveram associadas de forma independente à adesão aos métodos de rastreamento do CCR. As variáveis, sexo, raça, estado civil, renda, presença de seguro saúde e distância da residência até o hospital não influenciaram na adesão aos exames FIT e G-FOBT. Conclusão: Maior idade, presença de crença religiosa, ausência de atividade de trabalho formal e realização prévia de PSOF estão relacionados à maior adesão aos testes (FIT) e o (G-FOBT), na população estudada.


INTRODUCTION: Colorectal surgeries are complex procedures, associated with higher rates of complications and readmissions than procedures at other surgical sites. Currently, standardized procedures aim the early recovery of patients treated for colorectal surgeries in order to reduce the length of hospital stay. The reduction in hospitalization time, however, despite being considered a positive result, may lead to a risk , since complications generally occur outside the hospital environment, making it difficult to assess and monitor these patients. OBJECTIVE: The aim of the present study was to develop a mobile health app , accessible on smartphones, to remotely monitor the signs and symptoms of patients in the postoperative period of colorectal surgeries, evaluating the outcomes of admission rate in the emergency department and rate of severe complications. (Clavien-Dindo 3 to 5) within a fifteen-day postoperative period. METHODS: The project was developed in two steps, the first being the structuring of the Digital Journey, with the creation of a platform with a decision algorithm for identifying symptoms and directing conducts, and the second the validation of the program in a pilot study. Patients aged between 18 and 80 years old, who were to undergo oncological colorectal surgeries, were included in the study. The study was conducted on the premises of the A.C.Camargo Cancer Center. Monitoring of patients and reporting of signs and symptoms by patients were performed via a remote monitoring platform, using a smartphone or computer. RESULTS: In the pilot study, in each of the three evaluation phases of the data obtained, the decision algorithm and the instrument for data collection were restructured, aiming to achieve greater sensitivity and specificity in the detection of complications by the platform, as well as greater patient satisfaction. The ability to detect complications increased at each analysis and adjustment phase, and after the third and final phase of adjustments, 45 (71.4%) adverse events were reported, of which 12 (19%) were symptoms classified as high grade. In this sample, the digital solution was able to identify 3 (4.8%) real complications with a sensitivity of 75%, specificity of 84%, accuracy of 83%, positive predictive value of 25% and negative predictive value of 98%. We also had, 5(7.9%) errors in filling out detected and 1(1.6%) complications not detected by the platform, due to error in filling out the daily assessment questionnaire. Our rehospitalization rate by indication of the platform, in this sample was 2 (3.2%) and admission to the emergency room, considering referral or not from the platform, was 8 (12.7%). Complete adherence to the monitoring program was 83%, with an NPS score ranging from 69 to 95, the highest score obtained in the last evaluation phase. CONCLUSION: The a mobile health app created was proved to be safe, with high adherence rates and good acceptance by patients, but it still needs to be adjusted with the intention of reducing costs of referral and admission to the emergency department.


Subject(s)
Humans , Male , Female , Colorectal Neoplasms/surgery , Telemedicine , Postoperative Period , Artificial Intelligence
20.
Belo Horizonte; s.n; 2023. 47 p.
Thesis in Portuguese | LILACS | ID: biblio-1518923

ABSTRACT

A incidência dos casos de neoplasia de rim tem aumentado consideravelmente e o emprego da cirurgia minimamente invasiva poupadora de néfrons é, atualmente, considerado o padrão ouro para tumores T1a e T1b. Essa cirurgia pode ser realizada de forma minimamente invasiva, por meio da técnica laparoscópica e laparoscópica assistida por robô. No entanto, faz-se necessário um estudo para avaliar os resultados dessas duas técnicas, tendo em vista uma crescente difusão da técnica robô assistida e um maior número de cirurgiões em treinamento. Soma-se a isso a importância de preservação renal e de segurança oncológica, possibilitada pela nefrectomia parcial, que ainda é subutilizada devido à maior dificuldade técnica de realizá-la pela via laparoscópica. OBJETIVO: comparar a cirurgia aparoscópica com a cirurgia laparoscópica assistida por robô na realização da nefrectomia parcial, no período per e pós-operatório, quanto aos resultados de cada uma delas. MÉTODO: trata-se de uma coorte retrospectiva de 209 pacientes com neoplasia de rim localizado, submetidos à nefrectomia parcial laparoscópica no Hospital Madre Teresa, no período de outubro de 2014 a junho de 2019, e à nefrectomia parcial assistida por robô, no Hospital Felício Rocho, entre os anos de 2018 a 2021. Os dados do estudo foram coletados e gerenciados, usando-se as ferramentas eletrônicas de captura de dados REDCap, além da pesquisa de prontuário. A análise dos dados foi realizada utilizandose o software SPSS versão 25. Em todos os testes estatísticos, foi considerado um nível de significância de 5%. RESULTADOS: em relação a fatores clínicos e cirúrgicos, observou-se que o tempo cirúrgico em horas, a permanência no hospital e a permanência no CTI foram maiores no grupo de nefrectomia parcial laparoscópica, quando comparados à nefrectomia parcial laparoscópica assistida por robô. Variáveis como complicações operatórias, hemotransfusão no per operatório, tipo de tumor, tamanho da lesão na peça cirúrgica e margens acometidas não mostraram diferença significativa entre os grupos (p>0,05). As complicações pós-operatórias foram mais frequentes no grupo de nefrectomia parcial laparoscópica (16,7%) quando comparadas ao grupo nefrectomia parcial laparoscópica assistida por robô (7,0%). O estadiamento pós-operatório também apresentou diferença significativa entre os grupos, sendo que os estádios iniciais (T0 e T1) foram proporcionalmente maiores no grupo de nefrectomia parcial laparoscópica, quando comparados ao grupo nefrectomia parcial laparoscópica assistida por robô. Já os estádios (T2 e T3) foram mais incidentes no grupo de nefrectomia parcial laparoscópica assistida por robô em relação ao outro grupo. CONCLUSÃO: com base nos resultados, pode-se afirmar que a técnica robô-assistida apresenta ganhos técnicos significativos e possibilita a ressecção de tumores tecnicamente mais difíceis, com menor taxa de complicações no pós-operatório. Apresenta tempo cirúrgico e tempo de internação hospitalar reduzidos em comparação com a cirurgia realizada por laparoscopia, além de alta precoce para aqueles que necessitam de unidade de terapia intensiva no pósoperatório.


Kidney cancer cases have increased considerably, and minimally invasive nephronsparing surgery is currently considered the gold standard for T1a and T1b tumors. This surgery can be performed minimally invasively, using the laparoscopic and robotassisted laparoscopic techniques. However, a study to evaluate the results of these two techniques is necessary, considering the increasing diffusion of the robot-assisted technique and the larger number of surgeons in training. Added to this is the importance of renal preservation and oncologic safety, made possible by partial nephrectomy, which is still underutilized due to the incredible technical difficulty of performing it laparoscopically. OBJECTIVE: To compare laparoscopic surgery with robot-assisted laparoscopic surgery in performing partial nephrectomy, in the per- and postoperative periods, regarding the results of each. METHODS: This is a retrospective cohort of 209 patients with localized kidney cancer who underwent laparoscopic partial nephrectomy at Hospital Madre Teresa from October 2014 to June 2019 and robot-assisted partial nephrectomy at Hospital Felício Rocho between the years 2018 and 2021. Study data were collected and managed using REDCap electronic data capture tools and chart search. Data analysis was performed using SPSS version 25 software. A 5% significance level was considered in all statistical tests. RESULTS: Regarding clinical and surgical factors, surgical time in hours, hospital stay, and intensive care unit stay were higher in the laparoscopic partial nephrectomy group when compared to the robot-assisted laparoscopic partial nephrectomy. Variables such as operative complications, intraoperative blood transfusion, tumor type, size of the lesion on the surgical specimen, and affected margins showed no significant difference between groups (p>0.05). The variable postoperative complications showed higher frequency in the laparoscopic partial nephrectomy group (16.7%) compared to the robot-assisted partial nephrectomy group (7.0%). Postoperative staging also showed significant differences between groups, with early stages (T0 and T1) proportionally higher in the laparoscopic partial nephrectomy group when compared to the robot-assisted laparoscopic partial nephrectomy group. Stages (T2 and T3) were higher in the laparoscopic robot-assisted partial nephrectomy group compared to the other group. CONCLUSION: Based on the results, it can be stated that the robot-assisted technique presents significant technical gains and allowed the resection of tumors that are technically more difficult and with a lower rate of complications in the postoperative period. It presented reduced surgical time and hospital stay compared to the surgery performed by laparoscopy. In patients who need to be referred to the intensive care unit postoperatively, the robot-assisted technique demonstrates a reduction in the length of stay in the intensive care unit.


Subject(s)
Humans , Male , Female , Postoperative Period , Wound Healing , Comparative Study , Carcinoma, Renal Cell , Laparoscopy , Preoperative Period , Robotic Surgical Procedures , Nephrectomy
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