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1.
Neurogastroenterol Motil ; 36(4): e14768, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38487993

RESUMO

INTRODUCTION: Gastric inlet patches are often incidental, but can also be a treatable cause of laryngo-esophageal symptoms. METHODS: We retrospectively reviewed all patients whose gastric inlet patches were diagnosed following assessment for laryngopharyngeal and swallowing symptoms. Improvement following Argon Plasma Coagulation (APC) was assessed using Minimum Clinically-Important Difference methodology combining voice, throat, and swallowing domains. Correlations between APC response and measures of reflux and mucosal barrier integrity, measured during 24-h pH-impedance manometry, were obtained. Proximal and Distal Mean Nocturnal Baseline Impedance (MNBI) values were separately calculated and the novel variable of Mucosal Impedance Gradient was derived as [((Distal MNBI-Proximal MNBI)/((Distal MNBI + Proximal MMBI)/2)) x 100]. KEY RESULTS: Inlet patches were detected in 57 of 651 patients who had Transnasal Panendoscopy (8.7 ± 2.2%). There were 34 males. Mean age was 58 years. Mean duration of symptoms was 2 years. The commonest symptoms were hoarseness (n = 33), throat symptoms (n = 24), and dysphagia (n = 21), respectively. APC was used to ablate patches in 34 patients. Treatment response was 71% at a mean followup of 5.5 months. MIG > - 25% predicted response to APC, with area under the receiver operating characteristic curve of 0.875 (Sensitivity = 81%; Specificity = 100%; p < 0.0001). CONCLUSIONS: Gastric inlet patches are common and under-recognized. They can cause protracted pharyngo-esophageal symptoms. Patch ablation is an effective treatment for carefully selected patients. Optimal patient selection requires multidisciplinary teamwork. Mucosal Impedance Gradient could further refine patient selection.


Assuntos
Baías , Refluxo Gastroesofágico , Masculino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Mucosa Gástrica/cirurgia , Refluxo Gastroesofágico/diagnóstico , Estômago , Impedância Elétrica , Monitoramento do pH Esofágico/métodos
3.
Science ; 383(6687): 1096-1103, 2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38452063

RESUMO

Monitoring homeostasis is an essential aspect of obtaining pathophysiological insights for treating patients. Accurate, timely assessments of homeostatic dysregulation in deep tissues typically require expensive imaging techniques or invasive biopsies. We introduce a bioresorbable shape-adaptive materials structure that enables real-time monitoring of deep-tissue homeostasis using conventional ultrasound instruments. Collections of small bioresorbable metal disks distributed within thin, pH-responsive hydrogels, deployed by surgical implantation or syringe injection, allow ultrasound-based measurements of spatiotemporal changes in pH for early assessments of anastomotic leaks after gastrointestinal surgeries, and their bioresorption after a recovery period eliminates the need for surgical extraction. Demonstrations in small and large animal models illustrate capabilities in monitoring leakage from the small intestine, the stomach, and the pancreas.


Assuntos
Implantes Absorvíveis , Fístula Anastomótica , Trato Gastrointestinal , Ultrassom , Animais , Humanos , Homeostase , Estômago , Trato Gastrointestinal/cirurgia , Fístula Anastomótica/diagnóstico por imagem , Modelos Animais
5.
Food Funct ; 15(6): 3130-3140, 2024 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-38436057

RESUMO

Nitrite widely exists in meat products, and has the functions of bacteriostasis, antisepsis, and color development. However, in an acidic environment, nitrite will react with amines, and further generate nitrosamines with carcinogenic and teratogenic effects. Polyphenols have good antioxidant and nitrite-scavenging effects. This study aimed to evaluate the inhibitory effects of gallic acid, catechin, and procyanidin B2 on the nitrosation reaction under stomach simulating conditions and discuss the potential inhibitory mechanism. The nitrite scavenging rate and nitrosamine synthesis blocking rate of gallic acid, catechin, and procyanidin B2 under different reaction times and contents was determined by UV-vis spectrophotometry. The possible products of the reaction of the three polyphenols with nitrite were analyzed by high-performance liquid chromatography-mass spectrometry (HPLC-MS) to reveal the mechanism of inhibiting nitrification. The results showed that the scavenging rate of the three polyphenols on nitrite and the blocking rate of nitrosamine synthesis increased with the increase of the content and reaction time. The ability of the three polyphenols to inhibit nitrosation was catechin > procyanidin B2 > gallic acid. HPLC-MS analysis showed that under simulated gastric juice conditions, the three phenolics were oxidized by nitrous acid to form their semiquinone radicals as the intermediates and nitrosated derivatives, while nitrite might be converted to ˙NO. These results suggested that gallic acid, catechin, and procyanidin B2 could inhibit nitrosation reactions in an acidic environment and may be used as food additives to reduce nitrite residues and nitrosamines in food.


Assuntos
Biflavonoides , Catequina , Nitrosaminas , Proantocianidinas , Ácido Gálico/farmacologia , Nitritos , Nitrosação , Polifenóis , Estômago
6.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 46(1): 143-146, 2024 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-38433645

RESUMO

Hepatoid adenocarcinoma is a rare and unique type of adenocarcinoma,resembling hepatocellular carcinoma in histopathology.Most cases occur in the stomach,lacking specific clinical and imaging manifestations,which leads to high rates of missed diagnosis and misdiagnosis.Hepatoid adenocarcinoma in the peritoneal cavity is even rarer.This article reports a case of hepatoid adenocarcinoma with the manifestation of diffuse peritoneal thickening,aiming to provide reference for clinical diagnosis and treatment.


Assuntos
Adenocarcinoma , Cavidade Peritoneal , Humanos , Peritônio , Adenocarcinoma/diagnóstico , Estômago
8.
Nan Fang Yi Ke Da Xue Xue Bao ; 44(2): 217-225, 2024 Feb 20.
Artigo em Chinês | MEDLINE | ID: mdl-38501406

RESUMO

OBJECTIVE: To investigate the efficacy of Jianpiwenyang Gel (SSWYG) for treating chronic diarrhea and explore its therapeutic mechanism. METHODS: Eighty patients with chronic diarrhea of spleen and stomach weakness type were randomized into two groups for interventions with lifestyle adjustment and treatment with bifid triple viable capsules (control group, n=40) or naval application with SSWYG (treatment group, n=40) for one week, after which symptoms of chronic diarrhea were evaluated. The Chinese medicine system pharmacology analysis platform (TCMSP), GeneCards, NCBI, OMIM database and GEO database (GSE14841) were used to obtain the active ingredients and target proteins of SSWYG and chronic diarrhea-related targets. The key targets were obtained by topological analysis for Gene Ontology (GO) and KEGG analyses. The affinity and binding characteristics of SSWYG for specific targets were verified by molecular docking using AutoDock software. RESULTS: In both groups, gastrointestinal symptom rating scale (GSRS), Bristol Scale and TCM syndrome scores significantly improved after the treatments (P < 0.05), and better effects were observed in the treatment group (P < 0.05). Sixtyeight targets of SSWYG in treating chronic diarrhea were obtained, and 33 most probable ones were screened out by topological analysis. GO and KEGG analyses identified several chronic diarrhea-related pathways including the TNF and IL-17 pathways. Molecular docking study showed good affinity of the core components of SSWYG for the key targets CASP3, JNK, IL1B, IL6, and AKT1. JUN and CASP3 had the lowest binding energy and the highest stable binding energy with multiple major active ingredients of SSWYG. CONCLUSION: SSWYG can significantly improve clinical symptoms of chronic diarrhea possibly by regulating the TNF and IL-17 as well as other pathways via CASP3 and JUN, suggesting a complex therapeutic mechanism of SSWYG involving multiple ingredients and targets and coordinated regulation of multiple pathways.


Assuntos
Medicamentos de Ervas Chinesas , Baço , Humanos , Caspase 3 , Interleucina-17 , Simulação de Acoplamento Molecular , Estômago , Diarreia/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico
9.
Acta Cir Bras ; 39: e391124, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38477785

RESUMO

PURPOSE: This study evaluated the protective effect of hesperidin on injury induced by gastric ischemia-reperfusion. METHODS: Fifty male Sprague Dawley rats (250-300 g) were divided into five groups: control (C), sham (S), ischemia (I), ischemia-reperfusion (I/R) and hesperidin + ischemia-reperfusion (Hes + I/R). Hesperidin was injected intraperitoneally at the dose of 100 mg/kg one hour before the experimental stomach ischemia-reperfusion. Celiac artery was ligated. After 45 minutes ischemia and 60 minutes reperfusion period, blood samples were obtained under anesthesia. Then, animals were sacrificed, stomach tissues were excised for biochemical, and histopathological analyses were performed. Malondialdehyde levels and superoxide dismutase, glutathione peroxidase activities and total antioxidant status (TAS), total oxidant status (TOS), protein, total thiol parameters were measured in plasma, and tissue homogenate samples. H + E, periodic acid-Schiff, hypoxia inducible factor, terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate nick end-labeling (TUNEL), and proliferating cell nuclear antigen (PCNA) for cell proliferation as immunohistochemical parameters were determined. RESULTS: Upon biochemical and histopathological assessment, hesperidin decreased stomach tissue changes in comparison with IR group. Ischemia-reperfusion injury led to a considerably increase in malondialdehyde, protein, and TOS levels (p < 0.001) in stomach tissue. Hesperidin treatment significantly decreased malondialdehyde, protein, and TOS levels (p < 0.001). Hesperidin increased superoxide dismutase, TAS, total thiol and glutathione peroxidase activities in comparison with IR group. Hesperidin reduced damage and also increased TUNEL and PCNA immunoreactivity in stomach tissue. CONCLUSIONS: Hesperidin was able to decrease I/R injury of the stomach tissue due to inhibition of lipid peroxidation and protein oxidation, duration of antioxidant, and free radical scavenger properties. Consequently, hesperidin can provide a beneficial therapeutic choice for preventing stomach tissue ischemia-reperfusion injury in clinical application.


Assuntos
Hesperidina , Traumatismo por Reperfusão , Masculino , Ratos , Animais , Antígeno Nuclear de Célula em Proliferação , Antioxidantes , Ratos Sprague-Dawley , Estômago , Superóxido Dismutase , Isquemia , Malondialdeído , Compostos de Sulfidrila , Glutationa Peroxidase
10.
J Med Case Rep ; 18(1): 86, 2024 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-38438911

RESUMO

BACKGROUND: Peutz-Jeghers syndrome is a rare hereditary condition characterized by gastrointestinal polyps and pigmented oral lesions. The case contributes to a deeper understanding of Peutz-Jeghers syndrome and underscores the significance of interdisciplinary collaboration for accurate diagnosis and tailored therapeutic strategies. CASE DESCRIPTION: We present a case of a 15-year-old Afghan female patient with multiple polyps throughout the gastrointestinal tract and mucocutaneous pigmentation. Despite previous medical visits and colonoscopies, her symptoms persisted. A multidisciplinary team discussed the case and recommended further investigations and interventions. A polypectomy was performed, confirming the presence of hamartomatous polyps. The patient was diagnosed with Peutz-Jeghers syndrome, but during the course of treatment she went through complications and was managed surgically as well. CONCLUSION: Timely polyp removal and lifelong surveillance are crucial in managing Peutz-Jeghers syndrome. Further research and genetic analysis are needed to improve understanding and management of this rare disorder.


Assuntos
Síndrome de Peutz-Jeghers , Pólipos , Feminino , Humanos , Adolescente , Síndrome de Peutz-Jeghers/complicações , Síndrome de Peutz-Jeghers/diagnóstico , Síndrome de Peutz-Jeghers/cirurgia , Estômago , Duodeno , Intestino Grosso
11.
Carbohydr Polym ; 333: 121926, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38494203

RESUMO

The interaction between mucoadhesive materials and mucin layers is of significant interest in the development of drug delivery systems and biomedical applications for effective targeting and prolonged stay in the gastrointestinal tract. In this article, the current advancement and mucoadhesive properties of chitosan concerning the stomach mucin layer and its interactions have been briefly addressed. Chitosan a biocompatible polysaccharide exhibited promising mucoadhesive properties attributed to its cationic nature and ability to establish bonds with mucin glycoproteins. The mucoadhesion mechanism is ascribed to the electrostatic interactions between the positively charged amino (NH2) groups of chitosan and the sialic acid residues in mucin glycoprotein which carry a negative charge. The article provides a succinct overview of prior uses, current trends, and recent advancements in chitosan-based gastric-targeted delivery systems. We look forward to further innovations and emerging research related to chitosan-based methods of delivery that may increase the chitosan suitability for use in novel therapeutic approaches.


Assuntos
Quitosana , Mucinas Gástricas , Quitosana/química , Sistemas de Liberação de Medicamentos , Estômago
12.
Carbohydr Polym ; 333: 121953, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38494204

RESUMO

The importance of gastric digestion in starch-based emulsion is often overshadowed compared to intestinal digestion, despite acknowledging the activity of salivary α-amylase in the stomach. This study aimed to address this gap by investigating the digestion of starch-based emulsions through orogastrointestinal digestion experiments. Our observations revealed the crucial role of salivary α-amylase, which hydrolyzed ∼8 %, ∼56 %, and âˆ¼ 28 % of starch in emulsions stabilized by octenylsuccinylated maize starch (OMS-E), gelatinized OMS (GOMS-E), and retrograded OMS (ROMS-E), respectively, during the gastric phase. Consequently, ∼23 % of the oil in GOMS-E underwent lipolysis during this phase, whereas ∼13 and âˆ¼ 6 % of the oil was lipolyzed in OMS-E and ROMS-E, respectively. These phenomena significantly influenced their small intestinal digestion and the bioaccessibility of encapsulated curcumin. Notably, GOMS-E exhibited ∼28 % lower curcumin bioaccessibility than that of curcumin encapsulated in OMS-E or ROMS-E. This difference was attributed to premature gastric digestion and subsequent encapsulant release in the case of GOMS-E. This understanding can be utilized to manipulate the delivery and digestion of starch-based emulsions. Importantly, our findings highlight the necessity of considering gastric amylolysis and lipolysis when investigating the gastrointestinal fate of starch-based emulsions.


Assuntos
Curcumina , alfa-Amilases Salivares , Emulsões , Amido , Estômago , Digestão , Tamanho da Partícula
14.
Clin Nutr ESPEN ; 60: 356-361, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38479935

RESUMO

BACKGROUND & AIMS: Most of the 11.5 million feeding tubes placed annually in Europe and the USA are placed 'blind'. This carries a 1.6% risk that these tubes will enter the lung and 0.5% cause pneumothorax or pneumonia regardless of whether misplacement is identified prior to feeding. Tube placement by direct vision may reduce the risk of respiratory or oesophageal misplacement. This study externally validated whether an 'operator guide' would enable novice operators to differentiate the respiratory and alimentary tracts. METHODS: One IRIS tube was placed in each of 40 patients. Novice operators interpreted anatomical position using the built-in tube camera. Interpretation was checked from recorded images by consultant gastroenterologists and end-of-procedure checks using pH or X-ray checked by Radiologists and a consultant intensivist. RESULTS: The 40 patients were a median of 68y (IQR: 56-75), 70% male, mostly medical (65%), conscious (67.5%) and 70% had no artificial airway. Three tubes were removed due to failed placement. In the remaining 37 placements, novice operators identified the airway in 17 (45.9%) and airway + respiratory tract in 19 (51.4%), but redirected all these tubes into the oesophagus. By using direct vision to reduce the proportion of tubes near the airway or in respiratory tract from 0.514 to 0, operator discrimination between the respiratory and alimentary tracts was highly significant (0.514 vs 0: p < 0.0001, power >99.9% when significance = 0.05). In addition, organ boundaries (respiratory tract vs oesophagus, oesophagus vs stomach, stomach vs intestine) were identified in 100%. CONCLUSIONS: Novice operators, trained using the guide, identified all respiratory misplacements and accurately interpreted IRIS tube position. Guide-based training could enable widespread use of direct vision as a means to prevent tube-related complications.


Assuntos
Pneumonia , Pneumotórax , Humanos , Masculino , Feminino , Nutrição Enteral/métodos , Intubação Gastrointestinal/métodos , Estômago , Pneumotórax/etiologia
15.
Langenbecks Arch Surg ; 409(1): 90, 2024 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-38466450

RESUMO

PURPOSE: Near-infrared fluorescence imaging using indocyanine green (ICG-NIFI) can visualize a blood flow in reconstructed gastric tube; however, it depends on surgeon's visual assessment. The aim of this study was to re-analyze the ICG-NIFI data by an evaluator independent from the surgeon and feasibility of creating the time-intensity curve (TIC). METHODS: We retrospectively reviewed 97 patients who underwent esophageal surgery with gastric tube reconstruction between January 2017 and November 2022. From the stored ICG videos, fluorescence intensity was examined in the four regions of interest (ROIs), which was set around the planned anastomosis site on the elevated gastric tube. After creation the TICs using the OpenCV library, we measured the intensity starting point and time constant and assessed the correlation between the anastomotic leakage. RESULTS: Postoperative leakage occurred for 12 patients. The leakage group had significantly lack of blood flow continuity between the right and left gastroepiploic arteries (75.0% vs. 22.4%; P < 0.001) and tended to have slower ICG visualization time assessed by the surgeon's eyes (40 vs. 32 s; P = 0.066). TIC could create in 65 cases. Intensity starting point at all ROIs was faster than the surgeon's assessment. The leakage group tended to have slower intensity starting point at ROI 3 compared to those in the non-leakage group (22.5 vs. 19.0 s; P = 0.087). CONCLUSION: A TIC analysis of ICG-NIFI by an independent evaluator was able to quantify the fluorescence intensity changes that the surgeon had visually determined.


Assuntos
Esofagectomia , Estômago , Humanos , Estudos Retrospectivos , Estômago/diagnóstico por imagem , Estômago/cirurgia , Estômago/irrigação sanguínea , Esofagectomia/métodos , Verde de Indocianina , Fístula Anastomótica/diagnóstico por imagem , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Anastomose Cirúrgica/métodos
17.
PeerJ ; 12: e17082, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38529307

RESUMO

Background: Peroxisome proliferator-activated receptors (PPARs) exert multiple functions in the initiation and progression of stomach adenocarcinomas (STAD). This study analyzed the relationship between PPARs and the immune status, molecular mutations, and drug therapy in STAD. Methods: The expression profiles of three PPAR genes (PPARA, PPARD and PPARG) were downloaded from The Cancer Genome Atlas (TCGA) dataset to analyze their expression patterns across pan-cancer. The associations between PPARs and clinicopathologic features, prognosis, tumor microenvironment, genome mutation and drug sensitivity were also explored. Co-expression between two PPAR genes was calculated using Pearson analysis. Regulatory pathways of PPARs were scored using gene set variation analysis (GSVA) package. Quantitative real-time polymerase chain reaction (qRT-PCR), Western blot, Cell Counting Kit-8 (CCK-8) assay and transwell assay were conducted to analyze the expression and function of the PPAR genes in STAD cell lines (AGS and SGC7901 cells). Results: PPARA, PPARD and PPARG were more abnormally expressed in STAD samples and cell lines when compared to most of 32 type cancers in TCGA. In STAD, the expression of PPARD was higher in Grade 3+4 and male patients, while that of PPARG was higher in patient with Grade 3+4 and age > 60. Patients in high-PPARA expression group tended to have longer survival time. Co-expression analysis revealed 6 genes significantly correlated with the three PPAR genes in STAD. Single-sample GSEA (ssGSEA) showed that the three PPAR genes were enriched in 23 pathways, including MITOTIC_SPINDLE, MYC_TARGETS_V1, E2F_TARGETS and were closely correlated with immune cells, including NK_cells_resting, T_cells_CD4_memory_resting, and macrophages_M0. Immune checkpoint genes (CD274, SIGLEC15) were abnormally expressed between high-PPAR expression and low-PPAR expression groups. TTN, MUC16, FAT2 and ANK3 genes had a high mutation frequency in both high-PPARA/PPARG and low-PPARA/PPARG expression group. Fourteen and two PPARA/PPARD drugs were identified to be able to effectively treat patients in high-PPARA/PPARG and low-PPARA/PPARG expression groups, respectively. We also found that the chemotherapy drug Vinorelbine was positively correlated with the three PPAR genes, showing the potential of Vinorelbine to serve as a treatment drug for STAD. Furthermore, cell experiments demonstrated that PPARG had higher expression in AGS and SGC7901 cells, and that inhibiting PPARG suppressed the viability, migration and invasion of AGS and SGC7901 cells. Conclusions: The current results confirmed that the three PPAR genes (PPARA, PPARD and PPARG) affected STAD development through mediating immune microenvironment and genome mutation.


Assuntos
Adenocarcinoma , PPAR delta , Humanos , Masculino , PPAR gama/genética , Vinorelbina , PPAR alfa/genética , PPAR delta/genética , Adenocarcinoma/tratamento farmacológico , Resistência a Medicamentos , Estômago , Microambiente Tumoral/genética
18.
Lakartidningen ; 1212024 Mar 26.
Artigo em Sueco | MEDLINE | ID: mdl-38529925

RESUMO

A case of massive overdose of sustained release bupropion tablets is described. The patient presented with GCS 3, tachycardic and in vasoplegic shock. ECHO and EKG were initially normal. The hemodynamic situation was stabilised with vasopressors, but 18 h after presentation the patient deteriorated with wide complex arrhythmias rapidly progressing to cardiac arrest. The patient was put on VA-ECMO after 35 minutes of CPR. Circulation could be stabilized and ECMO was discontinued after 36 h. The patient was extubated on day 6 and made a complete recovery on discharge two weeks after presentation. At 34h, with ongoing ECMO, 236 tablets (with visible print identifying them as bupropion) were evacuated from the patient's stomach by gastroscopy. The tablets were analysed by NMR (nuclear magnetic resonance) but no longer contained any active substance. Blood levels of bupropion and hydroxybupropion at 36h were 790 and 1300 µg/l. The case illustrates a worrying surge in serious bupropion poisonings as noted by the Swedish Poisons Information Centre during the last 5 years.


Assuntos
Antidepressivos de Segunda Geração , Overdose de Drogas , Choque , Humanos , Bupropiona , Overdose de Drogas/terapia , Estômago
19.
Neurogastroenterol Motil ; 36(3): e14749, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38316631

RESUMO

BACKGROUND: Gastric myoelectric signals have been the focus of extensive research; although it is unclear how general anesthesia affects these signals, and studies have often been conducted under general anesthesia. Here, we explore this issue directly by recording gastric myoelectric signals during awake and anesthetized states in the ferret and explore the contribution of behavioral movement to observed changes in signal power. METHODS: Ferrets were surgically implanted with electrodes to record gastric myoelectric activity from the serosal surface of the stomach, and, following recovery, were tested in awake and isoflurane-anesthetized conditions. Video recordings were also analyzed during awake experiments to compare myoelectric activity during behavioral movement and rest. KEY RESULTS: A significant decrease in gastric myoelectric signal power was detected under isoflurane anesthesia compared to the awake condition. Moreover, a detailed analysis of the awake recordings indicates that behavioral movement is associated with increased signal power compared to rest. CONCLUSIONS & INFERENCES: These results suggest that both general anesthesia and behavioral movement can affect the signal power of gastric myoelectric recordings. In summary, caution should be taken in studying myoelectric data collected under anesthesia. Further, behavioral movement could have an important modulatory role on these signals, affecting their interpretation in clinical settings.


Assuntos
Anestesia , Isoflurano , Animais , Isoflurano/farmacologia , Furões , Estômago , Eletrodos , Complexo Mioelétrico Migratório
20.
Isr Med Assoc J ; 26(1): 24-29, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38420638

RESUMO

BACKGROUND: Pulmonary aspiration is a potentially lethal perioperative complication that can be precipitated by gastric insufflation. Face mask ventilation (FMV), a ubiquitous anesthetic procedure, can cause gastric insufflation. FMV with an inspiratory pressure of 15 cm H2O provides the best balance between adequate pulmonary ventilation and a low probability of gastric insufflation. There is no data about the effects of FMV > 120 seconds. OBJECTIVES: To investigate the effect of prolonged FMV on gastric insufflation. METHODS: We conducted a prospective observational study at a tertiary medical center with female patients who underwent oocyte retrieval surgery under general anesthesia FMV. Pre- and postoperative gastric ultrasound examinations measured the gastric antral cross-sectional area to detect gastric insufflation. Pressure-controlled FMV with an inspiratory pressure of 15 cm H2O was continued from the anesthesia induction until the end of the surgery. RESULTS: The study comprised 49 patients. Baseline preoperative gastric ultrasound demonstrated optimal and good image quality. All supine measurements were feasible. The median duration of FMV was 13 minutes (interquartile range 9-18). In the postoperative period, gastric insufflation was detected in only 2 of 49 patients (4.1%). There was no association between the duration of FMV and delta gastric antral cross-sectional area (ß -0.01; 95% confidence interval -0.04 to 0.01, P = 0.31). CONCLUSIONS: Pressure-controlled FMV with an inspiratory pressure of 15 cm H2O carries a low incidence of gastric insufflations, not only as a bridge to a definitive airway but as an alternative ventilation method for relatively short procedures in selective populations.


Assuntos
Insuflação , Máscaras Laríngeas , Feminino , Humanos , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Insuflação/efeitos adversos , Máscaras Laríngeas/efeitos adversos , Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , Estômago/diagnóstico por imagem , Estudos Prospectivos
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