RESUMO
Perioperative management of patients with adrenal gland diseases requires detailed information on the individual endocrine status and the potential complications. Typical signs of primary hyperaldosteronism (Conn's syndrome) comprise arterial hypertension, hypokalaemia and metabolic alkalosis. In such cases preoperative treatment with spironolactone is highly recommended. In patients with hypercortisolism (Cushing's syndrome) the following concomitant disorders must be considered particularly: arterial hypertension, osteoporosis, vulnerable skin, diabetes mellitus, and increased risk for infection and thromboembolism. In all patients with proven or suspected adrenocortical insufficiency (i.e. Addison's disease, after removal of a cortisol producing tumour or as the result of long-term therapy with glucocorticoids) consequent perioperative supplementation of hydrocortisone is mandatory. In patients with phaeochromcytoma hypertensive crisis and tachyarrhythmias may occur intraoperatively resulting from massive catecholamine release. Thus, preoperative treatment with the beta-antagonist phenoxybenzamine is obligatory. In contrast, nitroprusside is the substance of choice for intraoperative control of blood pressure. beta-blocking agents may be used in phaeochromocytoma but only under sufficient beta-blockade. Removal of a malignant tumour of the adrenal gland may induce massive haemorrhage, and thus anaesthetic management has to be modified.
Assuntos
Doenças das Glândulas Suprarrenais/complicações , Doenças das Glândulas Suprarrenais/cirurgia , Complicações Intraoperatórias/prevenção & controle , Androgênios/fisiologia , Síndrome de Cushing/fisiopatologia , Síndrome de Cushing/cirurgia , Estrogênios/fisiologia , Feminino , Glucocorticoides/fisiologia , Humanos , Hiperaldosteronismo/fisiopatologia , Hiperaldosteronismo/cirurgia , Masculino , Mineralocorticoides/fisiologia , Pré-Medicação/métodos , Pré-Medicação/normas , Cuidados Pré-Operatórios , Gestão de RiscosRESUMO
Se presenta un trabajo sobre medios de contraste iodados y sus efectos adversos, poniéndose énfasis en el concepto de premedicación, tratamiento de las reacciones y consentimiento informado
Assuntos
Humanos , Anafilaxia , Meios de Contraste/efeitos adversos , Consentimento Livre e Esclarecido , Anafilaxia/tratamento farmacológico , Anafilaxia/terapia , Meios de Contraste/classificação , Anamnese Homeopática , Compostos de Iodo , Compostos de Iodo/efeitos adversos , Iodo/efeitos adversos , Pré-Medicação/normas , Radiografia/normas , Prontuários Médicos/normasRESUMO
Se presenta un trabajo sobre medios de contraste iodados y sus efectos adversos, poniéndose énfasis en el concepto de premedicación, tratamiento de las reacciones y consentimiento informado (AU)
Assuntos
Humanos , Meios de Contraste/efeitos adversos , Anafilaxia/prevenção & controle , Consentimento Livre e Esclarecido , Iodo/efeitos adversos , Meios de Contraste/classificação , Pré-Medicação/normas , Radiografia/normas , Anamnese Homeopática , Prontuários Médicos/normas , Compostos de Iodo/efeitos adversos , Compostos de Iodo/diagnóstico , Anafilaxia/tratamento farmacológico , Anafilaxia/terapiaRESUMO
Cefoperazone, an antibiotic commonly used for prophylaxis of infection, has been associated with hypoprothrombinemia and bleeding. To reduce the risk of bleeding, co-administration of vitamin K has been advised. We reassessed the need for vitamin K use in a retrospective analysis of 50 patients undergoing urologic procedures and who had received cefoperazone for three days to prevent infection. Eleven of 50 patients were given vitamin K because of liver or renal disease. Prothrombin time was not elevated in any of the 50 patients analyzed. We conclude that routine use of vitamin K with cefoperazone for perioperative prophylaxis of infection may be unwarranted in patients without identified risk for bleeding.