Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 16 de 16
Filtrar
Más filtros











Intervalo de año de publicación
1.
Rev. bras. anestesiol ; 67(1): 89-91, Jan.-Feb. 2017.
Artículo en Inglés | LILACS | ID: biblio-843348

RESUMEN

Abstract Inotropic drugs are part of the treatment of heart failure; however, inotropic treatment has been largely debated due to the increased incidence of adverse effects and increased mortality. Recently levosimendan, an inotropic positive agent, has been proved to be effective in acute heart failure, reducing the mortality and improving cardiac and renal performance. We report the case of a 75-year-old woman with history of heart and renal failure and hip fracture. Levosimendan was used in preoperative preparation as an adjuvant therapy, to improve cardiac and renal function and to allow surgery.


Resumo Fármacos inotrópicos fazem parte do tratamento de insuficiência cardíaca; no entanto, o tratamento com inotrópicos tem sido amplamente debatido devido ao aumento da incidência de efeitos adversos e da mortalidade. Recentemente, levosimendana, um agente inotrópico positivo, provou ser eficaz na insuficiência cardíaca aguda, reduz a mortalidade e melhora o desempenho cardíaco e renal. Relatamos o caso de uma paciente de 75 anos, com história de insuficiência cardíaca e renal e fratura de quadril. Levosimendana foi usada na preparação do pré-operatório como terapia adjuvante para melhorar a função cardíaca e renal e permitir a cirurgia.


Asunto(s)
Humanos , Femenino , Anciano , Piridazinas/uso terapéutico , Choque Cardiogénico/etiología , Vasodilatadores/uso terapéutico , Cardiotónicos/uso terapéutico , Lesión Renal Aguda/tratamiento farmacológico , Fracturas de Cadera/complicaciones , Hidrazonas/uso terapéutico , Resultado del Tratamiento , Atención Perioperativa , Lesión Renal Aguda/etiología , Simendán
2.
Rev Bras Anestesiol ; 67(1): 89-91, 2017.
Artículo en Portugués | MEDLINE | ID: mdl-25896643

RESUMEN

Inotropic drugs are part of the treatment of heart failure; however, inotropic treatment has been largely debated due to the increased incidence of adverse effects and increased mortality. Recently levosimendan, an inotropic positive agent, has been proved to be effective in acute heart failure, reducing the mortality and improving cardiac and renal performance. We report the case of a 75-year-old woman with history of heart and renal failure and hip fracture. Levosimendan was used in preoperative preparation as an adjuvant therapy, to improve cardiac and renal function and to allow surgery.

3.
Braz J Anesthesiol ; 67(1): 89-91, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28017176

RESUMEN

Inotropic drugs are part of the treatment of heart failure; however, inotropic treatment has been largely debated due to the increased incidence of adverse effects and increased mortality. Recently levosimendan, an inotropic positive agent, has been proved to be effective in acute heart failure, reducing the mortality and improving cardiac and renal performance. We report the case of a 75-year-old woman with history of heart and renal failure and hip fracture. Levosimendan was used in preoperative preparation as an adjuvant therapy, to improve cardiac and renal function and to allow surgery.


Asunto(s)
Lesión Renal Aguda/tratamiento farmacológico , Cardiotónicos/uso terapéutico , Fracturas de Cadera/complicaciones , Hidrazonas/uso terapéutico , Piridazinas/uso terapéutico , Choque Cardiogénico/etiología , Vasodilatadores/uso terapéutico , Lesión Renal Aguda/etiología , Anciano , Femenino , Humanos , Atención Perioperativa , Simendán , Resultado del Tratamiento
4.
Rev. bras. anestesiol ; 66(3): 329-332, May.-June 2016. tab
Artículo en Inglés | LILACS | ID: lil-782878

RESUMEN

ABSTRACT BACKGROUND: The delivery of cardiac patients is a challenge for the anaesthesiologist, to whom the welfare of both the mother and the foetus is a main issue. In case of caesarean section, advanced monitoring allows to optimize haemodynamic condition and to improve morbidity and mortality. OBJECTIVE: To describe the use of pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus® for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. CASE REPORT: We describe the case of a 28-year-old woman with a congenital heart disease who was submitted to a caesarean section under general anaesthesia for maternal pathology and foetal breech presentation. Intra- and post-operative management was optimized by advanced haemodynamic monitorization obtained by pulse contour wave analysis and thermodilution calibration (Picco Plus® monitor). The information about preload, myocardial contractility and postcharge was useful in guiding the fluid therapy and the use of vasoactive drugs. CONCLUSION: This case report illustrates the importance of advanced haemodynamic monitoring with an acceptably invasive device in obstetric patients with high cardiac risk. The increasing experience in advanced haemodynamic management will probably permit to decrease morbidity and mortality of obstetric patients in the future.


RESUMO JUSTIFICATIVA: O parto em pacientes cardíacas é um desafio para o anestesiologista, para o qual o bem-estar tanto da mãe quanto do feto é a questão principal. Em caso de cesariana, o monitoramento avançado permite melhorar a condição hemodinâmica e diminuir a morbidade e mortalidade. OBJETIVO: Descrever o uso da análise do contorno do pulso calibrado por termodiluição transpulmonar (Picco Plus®) para o manejo perioperatório de cesariana em paciente com miocardiopatia grave. RELATO DE CASO: Descrevemos o caso de uma paciente de 28 anos com uma doença cardíaca congênita, submetida a uma cesariana sob anestesia geral devido a afecção materna e apresentação fetal pélvica. O manejo nos períodos intraoperatório e pós-operatório foi aprimorado por monitoração hemodinâmica avançada obtida pela análise do contorno da onda de pulso e calibração por termodiluição (monitor Picco Plus®). As informações sobre pré-carga, pós-carga e contratilidade miocárdica foram úteis para orientar a reposição hídrica e o uso de medicamentos vasoativos. CONCLUSÃO: Este relato de caso ilustra a importância da monitoração hemodinâmica avançada com dispositivo aceitavelmente invasivo em pacientes obstétricas com alto risco cardíaco. O aumento do conhecimento no manejo hemodinâmico avançado provavelmente possibilitará a redução da morbidade e mortalidade de pacientes obstétricas no futuro.


Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Cesárea , Atención Perioperativa/métodos , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Cardiomiopatías/complicaciones , Termodilución/instrumentación , Termodilución/métodos , Hemodinámica
5.
Braz J Anesthesiol ; 66(3): 329-32, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27108834

RESUMEN

BACKGROUND: The delivery of cardiac patients is a challenge for the anaesthesiologist, to whom the welfare of both the mother and the foetus is a main issue. In case of caesarean section, advanced monitoring allows to optimize haemodynamic condition and to improve morbidity and mortality. OBJECTIVE: To describe the use of pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. CASE REPORT: We describe the case of a 28-year-old woman with a congenital heart disease who was submitted to a caesarean section under general anaesthesia for maternal pathology and foetal breech presentation. Intra- and post-operative management was optimized by advanced haemodynamic monitorization obtained by pulse contour wave analysis and thermodilution calibration (Picco Plus(®) monitor). The information about preload, myocardial contractility and postcharge was useful in guiding the fluid therapy and the use of vasoactive drugs. CONCLUSION: This case report illustrates the importance of advanced haemodynamic monitoring with an acceptably invasive device in obstetric patients with high cardiac risk. The increasing experience in advanced haemodynamic management will probably permit to decrease morbidity and mortality of obstetric patients in the future.


Asunto(s)
Cardiomiopatías/complicaciones , Cesárea , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Atención Perioperativa/métodos , Adulto , Femenino , Hemodinámica , Humanos , Embarazo , Termodilución/instrumentación , Termodilución/métodos
6.
Rev. bras. anestesiol ; 66(1): 82-85, Jan.-Feb. 2016. tab
Artículo en Portugués | LILACS | ID: lil-773478

RESUMEN

BACKGROUND AND OBJECTIVES: Aortic stenosis increases perioperative morbidity and mortality, perioperative invasive monitoring is advised for patients with an aortic valve area <1.0 cm2 or a mean aortic valve gradient >30 mm Hg and it is important to avoid hypotension and arrhythmias. We report the anaesthetic management with continuous spinal anaesthesia and minimally invasive haemodynamic monitoring of two patients with severe aortic stenosis undergoing surgical hip repair. CASE REPORT: Two women with severe aortic stenosis were scheduled for hip fracture repair. Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring was used for anaesthetic management of both. Surgery was performed successfully after two consecutive doses of 2 mg of isobaric bupivacaine 0.5% in one of them and four consecutive doses in the other. Haemodynamic conditions remained stable throughout the intervention. Vital signs and haemodynamic parameters remained stable throughout the two interventions. CONCLUSION: Our report illustrates the use of continuous spinal anaesthesia with minimally invasive haemodynamic monitoring as a valid alternative to general or epidural anaesthesia in two patients with severe aortic stenosis who are undergoing lower limb surgery. However, controlled clinical trials would be required to establish that this technique is safe and effective in these type or patients.


JUSTIFICATIVA E OBJETIVOS: A estenose aórtica aumenta a morbidade e mortalidade no período perioperatório. A monitoração invasiva no perioperatório é recomendada para pacientes com área valvar <1,0 cm2 ou gradiente médio >30 mm Hg, além de ser importante evitar a hipotensão e arritmias. Relatamos o manejo anestésico com o uso de raquianestesia contínua e monitoração hemodinâmica minimamente invasiva em duas pacientes com estenose aórtica grave, submetidas à cirurgia de reparação do quadril. RELATO DE CASO: Duas pacientes com estenose aórtica grave foram programadas para cirurgia de reparação de fratura de quadril. Raquianestesia contínua com monitoração hemodinâmica minimamente invasiva foi usada para o manejo anestésico de ambas as pacientes. A cirurgia foi realizada com sucesso após duas doses consecutivas de 2 mg de bupivacaína isobárica a 0,5% em uma das pacientes e quatro doses consecutivas na outra. As condições hemodinâmicas permaneceram estáveis durante a intervenção. Os sinais vitais e parâmetros hemodinâmicos permaneceram estáveis durante as duas intervenções. CONCLUSÃO: Nosso relato descreve o uso da raquianestesia contínua com monitoração hemodinâmica minimamente invasiva como uma alternativa válida para a anestesia geral ou peridural em duas pacientes com estenose aórtica grave, submetidas à cirurgia de membro inferior. Contudo, ensaios clínicos controlados são necessários para estabelecer que a técnica é segura e eficaz nesse tipo de pacientes.


Asunto(s)
Humanos , Femenino , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/complicaciones , Bupivacaína/administración & dosificación , Fracturas de Cadera/cirugía , Anestesia Raquidea/métodos , Estenosis de la Válvula Aórtica/patología , Índice de Severidad de la Enfermedad , Monitoreo Intraoperatorio/métodos , Hemodinámica
7.
Braz J Anesthesiol ; 66(1): 82-5, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26768936

RESUMEN

BACKGROUND AND OBJECTIVES: Aortic stenosis increases perioperative morbidity and mortality, perioperative invasive monitoring is advised for patients with an aortic valve area <1.0 cm(2) or a mean aortic valve gradient >30 mmHg and it is important to avoid hypotension and arrhythmias. We report the anaesthetic management with continuous spinal anaesthesia and minimally invasive haemodynamic monitoring of two patients with severe aortic stenosis undergoing surgical hip repair. CASE REPORT: Two women with severe aortic stenosis were scheduled for hip fracture repair. Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring was used for anaesthetic management of both. Surgery was performed successfully after two consecutive doses of 2mg of isobaric bupivacaine 0.5% in one of them and four consecutive doses in the other. Haemodynamic conditions remained stable throughout the intervention. Vital signs and haemodynamic parameters remained stable throughout the two interventions. CONCLUSION: Our report illustrates the use of continuous spinal anaesthesia with minimally invasive haemodynamic monitoring as a valid alternative to general or epidural anaesthesia in two patients with severe aortic stenosis who are undergoing lower limb surgery. However, controlled clinical trials would be required to establish that this technique is safe and effective in these type or patients.


Asunto(s)
Anestesia Raquidea/métodos , Estenosis de la Válvula Aórtica/complicaciones , Bupivacaína/administración & dosificación , Fracturas de Cadera/cirugía , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/patología , Femenino , Hemodinámica , Humanos , Monitoreo Intraoperatorio/métodos , Índice de Severidad de la Enfermedad
8.
Rev Bras Anestesiol ; 66(3): 329-32, 2016.
Artículo en Portugués | MEDLINE | ID: mdl-25441226

RESUMEN

BACKGROUND: The delivery of cardiac patients is a challenge for the anaesthesiologist, to whom the welfare of both the mother and the foetus is a main issue. In case of caesarean section, advanced monitoring allows to optimize haemodynamic condition and to improve morbidity and mortality. OBJECTIVE: To describe the use of pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. CASE REPORT: We describe the case of a 28-year-old woman with a congenital heart disease who was submitted to a caesarean section under general anaesthesia for maternal pathology and foetal breech presentation. Intra- and post-operative management was optimized by advanced haemodynamic monitorization obtained by pulse contour wave analysis and thermodilution calibration (Picco Plus(®) monitor). The information about preload, myocardial contractility and postcharge was useful in guiding the fluid therapy and the use of vasoactive drugs. CONCLUSION: This case report illustrates the importance of advanced haemodynamic monitoring with an acceptably invasive device in obstetric patients with high cardiac risk. The increasing experience in advanced haemodynamic management will probably permit to decrease morbidity and mortality of obstetric patients in the future.

11.
J Crit Care ; 30(3): 537-42, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25600574

RESUMEN

PURPOSE: Because procalcitonin (PCT) might be surrogate for antimicrobial discontinuation in general intensive care units (ICUs), this study explored its use for secondary peritonitis in 4 surgical ICUs (SICUs). METHODS: A retrospective study including all consecutive patients with secondary peritonitis, controlled infection source, requiring surgery, and at least 48-hour SICU admission was performed (June 2012-June 2013). Patients were divided following notations in medical records into PCT-guided (notation of PCT-based antibiotic discontinuation) and non-PCT-guided (no notation) groups. RESULTS: A total of 121 patients (52 PCT-guided, 69 non-PCT-guided) were included. No differences in clinical scores, biomarkers, or septic shock (30 [57.7%] PCT-guided vs 40 [58.0%] non-PCT-guided) were found. Length of intra-SICU (median, 5.0 days; both groups) or in-hospital (median, 20.0 vs 17.5 days) stay, and mortality intra-SICU (9.6% vs 13.0%), 28-day (15.4% vs 20.3%), or in-hospital (19.2% vs 29.0%) were not significantly different (PCT-guided vs non-PCT-guided). In septic shock patients, no mortality differences were found (PCT-guided vs non-PCT-guided): 16.7% vs 22.5% (intra-SICU), 26.7% vs 32.5% (28-day), and 33.3% vs 42.5% (in-hospital). Treatment was shorter in the PCT-guided group (5.1 ±2.1 vs 10.2 ± 3.7 days, P < .001), without differences between patients with and without septic shock. CONCLUSION: Procalcitonin guidance produced 50% reduction in antibiotic duration (P < .001, log-rank test).


Asunto(s)
Algoritmos , Antibacterianos/administración & dosificación , Calcitonina/sangre , Peritonitis/tratamiento farmacológico , Precursores de Proteínas/sangre , Choque Séptico/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Biomarcadores , Péptido Relacionado con Gen de Calcitonina , Cuidados Críticos , Femenino , Hospitales , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Peritonitis/sangre , Estudios Retrospectivos , Choque Séptico/sangre , Choque Séptico/mortalidad
12.
Actual. anestesiol. reanim ; 23(4): 16-19[4], oct.-dic. 2013. ilus
Artículo en Español | IBECS | ID: ibc-118827

RESUMEN

El síndrome de distrés respiratorio, una forma muy grave de insuficiencia respiratoria aguda, constituye uno de los problemas más frecuentes en las Unidades de Reanimación, siendo por ello fundamental el conocimiento de posibles causas y manejo por parte del anestesiólogo reanimador. La combinación de taxanos y trastuzumab es un tratamiento de primera línea del cáncer de mama con sobreexpresión HER2 y que ha demostrado ser efectivo con tasas de respuesta de 50-67 %. La toxicidad pulmonar por ambos agentes en forma de síndrome de distrés respiratorio del adulto fue apenas descrita y la sospecha obliga a la suspensión del fármaco. Presentamos dos casos de pacientes que desarrollaron síndrome de distrés respiratorio agudo tratados en nuestra unidad de reanimación tras una semana de haber concluido el ciclo de quimioterapia con estos fármacos, habiéndose descartado diagnósticos alternativos (AU)


Acute respiratory distress syndrome, a very serious form of acute respiratory failure, is one of the most common problems in intensive care units thus being fundamental the knowledge of the possible causes and the management.The association of taxanes and trastuzumab is now a days considered one of the first line treatment for HER2 positive breast cancer due to the high rate of response (50-67 %). Lung injury, presented as acute respiratory distress syndrome, has been recently associated to these two agents. Immediate suspension of treatment is advised if organ toxicity is suspected. We report two cases of patients presenting with lung injury related to taxanes and trastuzumab treated in our Intensive Care Unit. Other causes of lung injury were excluded (AU)


Asunto(s)
Humanos , Femenino , /diagnóstico , Antineoplásicos/efectos adversos , Síndrome de Dificultad Respiratoria/inducido químicamente , Insuficiencia Multiorgánica/inducido químicamente , Neoplasias de la Mama/tratamiento farmacológico , Factores de Riesgo
13.
Rev. colomb. anestesiol ; 41(3): 223-225, jul.-set. 2013. tab
Artículo en Español | LILACS, COLNAL | ID: lil-686448

RESUMEN

La fibrosis quística (FQ) es un trastorno con herencia autosómica recesiva que aparece en aproximadamente 1:2.000 nacidos vivos en la población caucásica, responsable de una mortalidad precoz de los pacientes afectados, frecuentemente antes de alcanzar la edad reproductiva. La primera descripción de FQ en la literatura data de 1930, asociada a un pronóstico sombrío. La mejora en el manejo de estos pacientes ha llevado a una mejor calidad de vida asociada a una elevación en la esperanza de vida, permitiendo llegar con más frecuencia a la edad reproductiva. Se han descrito varios casos a partir del primer reporte de un caso de una parturienta portadora de FQ, en 1960. La morbilidad que origina la FQ a nivel pulmonar hace que el manejo del dolor durante el trabajo de parto y el parto sea prioritario, con el objetivo de reducir la sobrecarga que el dolor produce sobre el sistema cardiorrespiratorio. La administración de analgesia a través del catéter epidural reduce y elimina el dolor, permitiendo un parto más cómodo para la paciente y dejando disponible una vía para administrar anestesia regional, en caso de ser necesaria, evitando así la intubación orotraqueal y el efecto deletéreo que tendría sobre un sistema respiratorio debilitado.


Cystic fibrosis (CF) is an inherited autosomal recessive disorder appearing in approximately 1:2000 live births in the Caucasian population, responsible for early mortality in affected patients, often before they reach reproductive age. It was first described in the 1930s, and it was associated with a dismal prognosis. Improvements in the treatment of these patients have resulted in improved quality of life and longer life expectancy beyond sexual maturity. Since the first report of pregnancy in a patient with cystic fibrosis in 1960, the rates of conception have increased dramatically. Lung morbidity requires priority pain management during labor in order to reduce the burden imposed by pain on the cardiorespiratory system. Analgesia delivered over the epidural catheter reduces and eliminates pain, enhancing comfort and making a line available for regional anesthesia if required. This eliminates the need for orotracheal intubation and the deleterious effect on the weakened respiratory system.


Asunto(s)
Humanos
14.
Saudi J Anaesth ; 7(2): 205-9, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23956727

RESUMEN

Posterior reversible encephalopathy syndrome presents with a variety of neurologic features, which, although devastating at some point, are potentially reversible on prompt recognition and institution of appropriated treatment. We report the management of three cases occurring in the last 4 years in our tertiary university hospital.

SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA