RESUMEN
The Diaphragm Pacing Stimulator (DPS) has been used to treat ventilatory insufficiency in quadriplegic patients. The FDA approved a trial using the DPS in patients with amyotrophic lateral sclerosis (ALS). Three patients with advanced ALS, who underwent laparoscopic diaphragmatic pacer placement, and their general anesthetic management, are presented.
Asunto(s)
Esclerosis Amiotrófica Lateral/terapia , Terapia por Estimulación Eléctrica/métodos , Parálisis Respiratoria/terapia , Adulto , Esclerosis Amiotrófica Lateral/fisiopatología , Anestesia General/métodos , Diafragma/fisiopatología , Diseño de Equipo , Femenino , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Parálisis Respiratoria/etiologíaRESUMEN
Prescription amphetamines are being used more often for several medical conditions. Anesthesia concerns focus on the cardiovascular stability of patients who may be catecholamine-depleted and thus have a blunted response to intraoperative hypotension. Previously we reported one case of a patient receiving chronic amphetamine therapy who had a stable intraoperative course. We now report eight additional patients taking chronic prescription amphetamines who underwent a safe general anesthesia and outcome. Predominantly prescribed for narcolepsy and attention deficit hyperactivity disorder, amphetamine drugs had been given to these 8 patients for 2 to 10 yr. Ages ranged from 22 to 77 yr and genders were equally divided. All required general anesthesia for their surgical procedures and 6 of the 8 patients were tracheally intubated. Anesthesia operating room times ranged from 30 min to 4.25 h. The authors conclude that amphetamine use need not be stopped before surgery and anesthesia.
Asunto(s)
Anfetaminas/uso terapéutico , Anestesia General , Estimulantes del Sistema Nervioso Central/uso terapéutico , Cuidados Preoperatorios , Adulto , Anciano , Anfetaminas/efectos adversos , Estimulantes del Sistema Nervioso Central/efectos adversos , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Thorough and timely anesthesia preoperative evaluation is essential for good patient outcomes. Perioperative care is becoming more complex and comprehensive, while older and sicker patients are being considered for major thoracic surgery. In addition to pulmonary and wound care, prevention of cardiac complications with beta-blocker therapy, multimodal pain control, tighter glycemic control, nutritional support, and prevention of thromboembolism are important perioperative goals. Early identification of significant medical and nonmedical issues allows for complete evaluation and planning and decreases the likelihood of delays, cancellations, and complications. Good communication and preparation benefit everyone. The implementation of an anesthesia preoperative assessment program or clinic can help achieve these important goals.
