RÉSUMÉ
Los pacientes con lesión medular crónica tienenunas alteraciones fisiopatológicas que determinan unaimportante morbilidad y mortalidad en el periodo perioperatorio. El marcapasos diafragmático es un dispositivo que permite la ventilación pulmonar en pacientescon lesiones cervicales altas y mejora la calidad de vidafrente al uso de ventilación mecánica. Presentamos el caso de una paciente con lesiónmedular crónica y portadora de un marcapasos diafragmático que fue programada para realización de nefrolitotomía percutánea y colocación de catéter doble Jderecho. El anestesista debe conocer la situación fisiopatológica de estos pacientes para asegurar la seguridad en el proceso perioperatorio.(AU)
Patients with chronic spinal cord injury suffer froma number of pathophysiological alterations that canlead to important morbidity and mortality in the perioperative period. The diaphragmatic pacemaker is adevice that enables pulmonary ventilation in patientswith high cervical cord injuries and provides them witha better quality of life when compared to mechanicalventilation. We present here the clinical case of a patient withchronic spinal cord injury who used a diaphragmaticpacemaker, and who was scheduled for percutaneousnephrolithotomy and double-J stent implantation. Theanesthesiologist should know the pathophysiologicalsituation of these patients in order to provide a safeperioperatory care.(AU)
Sujet(s)
Humains , Femelle , Adulte , Période périopératoire , Traumatismes de la moelle épinière , Pacemaker , Patients hospitalisés , Examen physique , Nerf phrénique , Ventilation artificielle , Traumatismes du couRÉSUMÉ
Patients with chronic spinal cord injury suffer from a number of pathophysiological alterations that can lead to important morbidity and mortality in the perioperative period. The diaphragmatic pacemaker is a device that enables pulmonary ventilation in patients with high cervical cord injuries and provides them with a better quality of life when compared to mechanical ventilation. We present here the clinical case of a patient with chronic spinal cord injury who used a diaphragmatic pacemaker, and who was scheduled for percutaneous nephrolithotomy and double-J stent implantation. The anesthesiologist should know the pathophysiological situation of these patients in order to provide a safe perioperatory care.
Sujet(s)
Pacemaker , Traumatismes de la moelle épinière , Muscle diaphragme , Humains , Qualité de vie , Ventilation artificielle , Traumatismes de la moelle épinière/complications , Traumatismes de la moelle épinière/thérapieRÉSUMÉ
FUNDAMENTO: Los pacientes sometidos a cirugía bariátrica presentan mayor riesgo de complicaciones debido al uso de opioides. El objetivo es valorar la seguridad e idoneidad del protocolo Anestesia libre de opioides (OFA) implantado en el Hospital Universitario Virgen de la Victoria en 2018. MATERIAL Y MÉTODOS: Estudio prospectivo llevado a cabo en 38 pacientes sometidos a cirugía bariátrica laparoscópica bajo protocolo OFA durante el año 2018 en el H.U. Virgen de la Victoria (Málaga). Se recogieron variables para establecer el control hemodinámico y del dolor perioperatorio que se analizaron mediante Stata V.16. RESULTADOS: La edad media fue 43 años, el índice de masa corporal medio 48,14 y la estancia media en quirófano 178 minutos. El control de la respuesta hipertensiva tras la laringoscopia sucedió en el 88,1% de los casos. Al ingreso en la Unidad de Recuperación Post Anestésica (URPA), la SpO2 sin aporte suplementario en el traslado presentó una mediana de 97% con p75 ≥ 95%, mientras que el p75 de la evaluación del dolor mediante escala visual analógica (EVA) fue 3, con un 68% de pacientes sin dolor. Al alta de URPA, todos presentaron EVA menor de 4 y solo fue necesario administrar una dosis baja de petidina en siete pacientes. CONCLUSIÓN: La OFA ha resultado ser segura y conseguir un control del dolor óptimo. En los casos reconvertidos, el buen control de los parámetros abre la posibilidad de su utilización en cirugías más dolorosas
BACKGROUND: Patients subjected to bariatric surgery present a greater risk of complications due to the use of opioids. The goal is to evaluate the security and suitability of the Opioid Free Anaesthesia (OFA) protocol implemented in the Hospital Universitario Virgen de la Victoria in 2018. METHOD: Prospective study carried out on 38 patients subjected to laparoscopic bariatric surgery under the OFA protocol in the year 2018 at the H.U. Virgen de la Victoria (Málaga, Spain). Variables were gathered to establish haemodynamic control and perioperative pain, which were analysed using Stata V.16. RESULTS: The average age was 43 years, the average body mass index was 48.14 and the average stay in the operating theatre was 178 minutes. Control of hypertensive response following laryngoscopy occurred in 88.1% of the cases. On entering the Post Anaesthesia Care Unit (PACU), SpO2 without a supplementary contribution in the transfer showed a median of 97% with p75 ≥ 95%, while the p75 of pain evaluation by means of Visual Analogue Scale (VAS) was 3, with 68% of patients without pain. On discharge from the PACU, all presented VAS below 4 and it was only necessary to administer a low dose of Pethidine in seven patients. CONCLUSION: The OFA has proved to be secure and achieves optimum pain control. In the reconverted cases, good control of the parameters opens up the possibility of its use in more painful surgeries
Sujet(s)
Humains , Femelle , Adulte , Adulte d'âge moyen , Analgésiques non narcotiques/administration et posologie , Chirurgie bariatrique/méthodes , Hôpitaux universitaires , Laparoscopie , Études prospectives , Période périopératoire , Indice de masse corporelle , Mesure de la douleur/effets des médicaments et des substances chimiques , Mesure de la douleur/méthodes , Douleur postopératoireRÉSUMÉ
BACKGROUND: Patients subjected to bariatric surgery present a greater risk of complications due to the use of opioids. The goal is to evaluate the security and suitability of the Opioid Free Anaesthesia (OFA) protocol implemented in the Hospital Universitario Virgen de la Victoria in 2018. METHOD: Prospective study carried out on 38 patients subjected to laparoscopic bariatric surgery under the OFA protocol in the year 2018 at the H.U. Virgen de la Victoria (Málaga, Spain). Variables were gathered to establish haemodynamic control and perioperative pain, which were analysed using Stata v.16. RESULTS: The average age was 43 years, the average body mass index was 48.14 and the average stay in the operating theatre was 178 minutes. Control of hypertensive response following laryngoscopy occurred in 88.1% of the cases. On entering the Post Anaesthesia Care Unit (PACU), SpO2 without a supplementary contribution in the transfer showed a median of 97% with p75 = 95%, while the p75 of pain evaluation by means of Visual Analogue Scale (VAS) was 3, with 68% of patients without pain. On discharge from the PACU, all presented VAS below 4 and it was only necessary to administer a low dose of Pethidine in seven patients. CONCLUSION: The OFA has proved to be secure and achieves optimum pain control. In the reconverted cases, good control of the parameters opens up the possibility of its use in more painful surgeries.
Sujet(s)
Anesthésie/méthodes , Anesthésiques/administration et posologie , Chirurgie bariatrique/méthodes , Laparoscopie , Adulte , Analgésiques morphiniques/administration et posologie , Réveil anesthésique , Indice de masse corporelle , Femelle , Humains , Hypertension artérielle/épidémiologie , Hypotension artérielle/épidémiologie , Mâle , Adulte d'âge moyen , Durée opératoire , Mesure de la douleur/méthodes , Douleur postopératoire/diagnostic , Douleur postopératoire/prévention et contrôle , Complications postopératoires/épidémiologie , Vomissements et nausées postopératoires/prévention et contrôle , Études prospectivesRÉSUMÉ
BACKGROUND: Some studies have been performed to assess the effects of levosimendan on cardiac function when administered to cardiac surgery patients with low cardiac output syndrome (LCOS) in the immediate postoperative period. Levosimendan is an inotropic agent for the treatment of low cardiac output syndrome that seems to have a protective effect on renal function. METHODS: It is a quasi-experimental study. A total of 100 patients with LCOS received either beta-agonists or levosimendan. We assessed the incidence of postoperative kidney failure in cardiac surgery patients. In patients who had kidney failure at diagnosis of LCOS, we examined whether differences existed in the evolution of kidney failure based on the treatment administered for LCOS. The parameters measured included haemodynamics, oxygen supply, and renal function as assessed by the AKI scale. ANOVA, Student's t-test and Wilcoxon or Friedman tests were used. RESULTS: Up to 30% of cardiac surgery patients had kidney failure at diagnosis of LCOS. Kidney failure at discharge from the ICU was more frequent in patients who received beta-agonist drugs as compared to those who received levosimendan (p < 0.05). CONCLUSION: The incidence of kidney failure decreased with the postoperative administration of levosimendan to cardiac surgery patients with LCOS, as compared to beta-agonists. TRIAL REGISTRATION: Current Controlled Trials ISRCTN 46058317. Date of registration: 7/10/2019. Retrospectively registered.
Sujet(s)
Agonistes bêta-adrénergiques/administration et posologie , Bas débit cardiaque/traitement médicamenteux , Procédures de chirurgie cardiaque/méthodes , Cardiotoniques/administration et posologie , Simendan/administration et posologie , Sujet âgé , Sujet âgé de 80 ans ou plus , Bas débit cardiaque/physiopathologie , Femelle , Humains , Incidence , Mâle , Adulte d'âge moyen , Complications postopératoires/épidémiologie , Complications postopératoires/prévention et contrôle , Insuffisance rénale/épidémiologie , Insuffisance rénale/prévention et contrôleRÉSUMÉ
Los pacientes obesos sometidos a cirugía bariátrica tienen una alta probabilidad de presentar complicaciones que empeoran con el uso de opiáceos y que pueden ser disminuidas gracias a técnicas anestésicas como la anestesia libre de opiáceos (OFA). El riesgo de tener que reconvertir la técnica quirúrgica laparoscópica a cirugía abierta es una de las críticas a esta modalidad anestésica, ante la posibilidad de que no exista un correcto control simpático o nociceptivo. Presentamos el caso de una paciente programada para una cirugía bariátrica laparoscópica que, manteniendo la OFA, se reconvirtió a cirugía abierta (laparotomía exploradora), logrando un correcto control tanto hemodinámico como del dolor perioperatorio
Obese patients subjected to bariatric surgery have a high probability of presenting complications that worsen with the use of opioids and can be reduced thanks to anaesthetic techniques like opioid-free anaesthetics (OFA). The risk of having to convert the laparoscopic surgical technique into open surgery is one of the criticisms aimed at this anaesthetic modality, facing the possibility of there not being a correct sympathetic or nociceptive control. We present the case of a patient scheduled for laparoscopic bariatric surgery who, while maintaining OFA, was converted to open surgery (exploratory laparoscopy), with correct control achieved of both haemodynamics and perioperative pain
Sujet(s)
Humains , Femelle , Adulte , Laparotomie/méthodes , Obésité/chirurgie , Chirurgie bariatrique/méthodes , Laparoscopie/méthodes , Anesthésie/méthodes , Conversion en chirurgie ouverte , Analgésiques non narcotiques/usage thérapeutique , Adjuvants des anesthésiques/usage thérapeutique , Analgésie/méthodesRÉSUMÉ
Obese patients subjected to bariatric surgery have a high probability of presenting complications that worsen with the use of opioids and can be reduced thanks to anaesthetic techniques like opioid-free anaesthetics (OFA). The risk of having to convert the laparoscopic surgical technique into open surgery is one of the criticisms aimed at this anaesthetic modality, facing the possibility of there not being a correct sympathetic or nociceptive control. We present the case of a patient scheduled for laparoscopic bariatric surgery who, while maintaining OFA, was converted to open surgery (exploratory laparoscopy), with correct control achieved of both haemodynamics and perioperative pain.
Sujet(s)
Anesthésie , Chirurgie bariatrique/méthodes , Conversion en chirurgie ouverte , Laparotomie , Adulte , Anesthésie/méthodes , Femelle , HumainsRÉSUMÉ
Inodilators are a heterogeneous group of drugs with vasodilatory and inotropic effects. The cardioprotective effect of levosimendan is multifactorial, but now research on levosimendan is focused on the organ-protective properties of this drug in different settings, the regimen that seems to provide the greatest cardiologic and systemic benefits is early administration of levosimendan. We try to answer four questions in this review, which type of patients need this drug? what is the best time to start with it? and the best way that we could give it and finally the reasons for use it.
Sujet(s)
Procédures de chirurgie cardiaque , Cardiotoniques/administration et posologie , Soins périopératoires/méthodes , Complications postopératoires/prévention et contrôle , Simendan/administration et posologie , Vasodilatateurs/administration et posologie , Animaux , Procédures de chirurgie cardiaque/effets indésirables , Procédures de chirurgie cardiaque/mortalité , Cardiotoniques/effets indésirables , Prise de décision clinique , Calendrier d'administration des médicaments , Humains , Sélection de patients , Soins périopératoires/effets indésirables , Soins périopératoires/mortalité , Complications postopératoires/mortalité , Complications postopératoires/physiopathologie , Facteurs de risque , Simendan/effets indésirables , Résultat thérapeutique , Vasodilatateurs/effets indésirablesRÉSUMÉ
The implementation of cardioprotective strategies involving pre-, intra-, and postoperative interventions is key during cardiac surgery requiring extracorporeal circulation (ECC). The primary goal of this study was to review the physiopathology and protection strategies against myocardial damage secondary to ECC during cardiac surgery. The administration halogenated anesthetics for cardiac anesthesia is common place due to their well-known cardioprotective effects and their capacity to ensure hypnosis. An optimal myocardial protection strategy requires that a comprehensive approach should be adopted to cover pre-, intra-, and post-operative interventions. Pre-conditioning and post-conditioning share numerous pathways, mainly based on mitochondrial signaling, antiapoptotic pathways, and reduced inflammatory mediators. However, volatile anesthetic can also be administered during ECC, in which mechanism of action has been scantly investigated, during this period and its biology is still unknown.
Sujet(s)
Anesthésie par inhalation , Anesthésiques par inhalation/administration et posologie , Procédures de chirurgie cardiaque , Oxygénation extracorporelle sur oxygénateur à membrane , Hydrocarbures halogénés/administration et posologie , Complications postopératoires/prévention et contrôle , Anesthésie par inhalation/effets indésirables , Anesthésie par inhalation/mortalité , Anesthésiques par inhalation/effets indésirables , Animaux , Procédures de chirurgie cardiaque/effets indésirables , Procédures de chirurgie cardiaque/mortalité , Oxygénation extracorporelle sur oxygénateur à membrane/effets indésirables , Oxygénation extracorporelle sur oxygénateur à membrane/mortalité , Humains , Hydrocarbures halogénés/effets indésirables , Complications postopératoires/mortalité , Complications postopératoires/physiopathologie , Facteurs de risque , Résultat thérapeutiqueRÉSUMÉ
PURPOSE: Pre and post-operative administration of sevoflurane in myocardial revascularization surgery provides enhanced cardioprotective effects exerted by pharmacologic pre- and post-conditioning, as compared to propofol. The identification of the enzymes involved in conditioning mechanisms is crucial to the understanding of the effects of sevoflurane in cardiac surgery patients. The impact of sevoflurane on another crucial target organ-the kidney-was also assessed. METHODS: Ninety patients undergoing off-pump myocardial revascularization surgery were allocated to receive either intra- and postoperative sevoflurane (SS), intraoperative sevoflurane and postoperative propofol (SP), or intra- and postoperative propofol (PP)). Troponin I and hemodynamic parameters were monitored during the first 48 postoperative hours; blood and urine samples were collected at baseline and at 24h to determine Akt, ERK1/2, PKG, iNO, bradykinin receptor, caspase 3, NT proBNP and urinary NGAL. RESULTS: The enzymes were overexpressed in the SS group, remained unchanged in the SP group, and decreased in the PP group. Renal function was best preserved in the SS group. CONCLUSIONS: The overexpression of enzymes induced by intraoperative anesthesia and postoperative sedation with sevoflurane reduces myocardial damage and improves renal function in patients undergoing off-pump myocardial revascularization surgery.
Sujet(s)
Cardiotoniques/administration et posologie , Maladie des artères coronaires/chirurgie , Éthers méthyliques/administration et posologie , Revascularisation myocardique/méthodes , Antiagrégants plaquettaires/administration et posologie , Propofol/administration et posologie , Sujet âgé , Anesthésiques intraveineux/administration et posologie , Maladie des artères coronaires/traitement médicamenteux , Femelle , Humains , Mâle , Adulte d'âge moyen , Sévoflurane , Résultat thérapeutiqueRÉSUMÉ
The Acute Kidney Injury Network (AKIN) classification considers SCr values, urea and urine output in order to improve timely diagnose ARF and improve patient prognosis by early treatment. Preoperative levosimendan is a new way for cardiac and kidney protection, we try to evaluate this drug in fifteen patients comparing values of AKIN scale parameters pre and post cardiac surgery in patients with right ventricle dysfunction.
Sujet(s)
Hydrazones/usage thérapeutique , Rein/effets des médicaments et des substances chimiques , Pyridazines/usage thérapeutique , Dysfonction ventriculaire droite/physiopathologie , Atteinte rénale aigüe , Sujet âgé , Antiarythmiques/usage thérapeutique , Procédures de chirurgie cardiaque , Femelle , Humains , Tests de la fonction rénale , Mâle , Adulte d'âge moyen , Blocage neuromusculaire , Complications postopératoires/prévention et contrôle , Période préopératoire , SimendanRÉSUMÉ
PURPOSE: The benefits of intraoperative administration of halogenated agents in patients undergoing cardiac surgery have been shown by numerous studies. The mechanisms of preconditioning and postconditioning appear to be the cause of these benefits. The possibility of maintaining the early postoperative sedation with halogenated agents, after its intraoperative administration, can increase their benefits. PATIENTS AND METHODS: This is a prospective trial with 60 patients undergoing coronary artery bypass graft surgery divided into 3 groups according to the administration of hypnotic drugs in the intraoperative and postoperative periods (sevoflurane, sevoflurane: SS, sevoflurane-propofol: SP, propofol-propofol: PP). For the first 48 hours, hemodynamic parameters, the need for inotropic drugs, N-terminal pro-brain natriuretic peptide, and troponin I plasmatic concentrations were obtained. RESULTS: There were significant differences between group SS and the other 2 groups in the levels of N-terminal pro-brain natriuretic peptide (SS [501±280 pg/mL] compared with SP [1270±498 pg/mL] and PP [1775±527 pg/mL] [P<.05]) and troponin I (SS [0.5±0.4 ng/mL] compared with SP [1.61±1.30 ng/mL] and PP [2.27±1.5 ng/mL] [P<.05]) and a lower number of inotropic drugs. CONCLUSION: Sevoflurane administration in patients undergoing off-pump coronary artery bypass graft, in the operating room and the intensive care unit, decreases myocardial injury markers compared with patients who only received sevoflurane in the intraoperative period, but both were a better option to decrease levels of myocardial markers when compared with the propofol group.
Sujet(s)
Anesthésiques par inhalation/administration et posologie , Pontage coronarien à coeur battant , Éthers méthyliques/administration et posologie , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Études prospectives , Sévoflurane , Résultat thérapeutiqueSujet(s)
Tronc brachiocéphalique/traumatismes , Veines brachiocéphaliques/traumatismes , Cathétérisme veineux central/effets indésirables , Veines jugulaires , Complications postopératoires/étiologie , Plaies pénétrantes/étiologie , Sujet âgé , Fibrillation auriculaire/étiologie , Cystectomie , Humains , Hydrothorax/étiologie , Mâle , Épanchement pleural/diagnostic , Épanchement pleural/étiologie , Complications postopératoires/diagnostic , Prostatectomie , Tumeurs de la vessie urinaire/chirurgie , Dérivation urinaire , Plaies pénétrantes/diagnosticRÉSUMÉ
No disponible
Sujet(s)
Humains , Mâle , Adulte d'âge moyen , Veines jugulaires , Veines jugulaires/chirurgie , Cathétérisme/instrumentation , Intubation/instrumentation , Fibrillation auriculaire/complications , Fibrillation auriculaire/diagnostic , Thrombose/complications , Thrombose/diagnostic , Hématurie/complications , Cécité/complications , Électrocardiographie/instrumentation , Hémodynamique , Ventilation artificielle/méthodesRÉSUMÉ
OBJECTIVE: To analyze cardiac morbidity and mortality after major noncardiac surgery in high-risk elderly patients. PATIENTS AND METHOD: Retrospective study of patients 65 years old or older in the postoperative intensive care unit between January 1990 and September 1996, after major noncardiac surgery, with histories of known ischemic heart disease (IHD group) or with two or more coronary risk factors (CRF group). We analyzed age, number of risk factors, type of ischemic heart disease, type and nature of surgery and cardiac morbidity or mortality. RESULTS: Five hundred twenty-nine patients were studied. Mean age was 72.1 +/- 5.1 years. The CRF group contained 366 patients (69.1%); the IHD group contained 163 (30.2%) patients with angina or histories of myocardial infarction. Rates of morbidity in the two groups were 10.1% and 25.8%, respectively (p < 0.001); the cardiac death rates were 2.18% and 5.5%, respectively (p = 0.08). No effect of number of coronary risk factors, type of ischemic heart disease, or type of surgery was found. Emergency surgery was associated with greater morbidity (p < or = 0.0011 and p < 0.001, respectively) and mortality (p < 0.001 in both groups). Age over 75 years was related to increased rates of morbidity (p = 0.003) and mortality (p = 0.031). CONCLUSIONS: In our practice elderly patients with known ischemic heart disease undergoing major noncardiac surgery suffer more postoperative cardiac complications than do those who only have coronary risk factors. Mortality, however, is similar. The only factors associated with increased morbidity and mortality are emergency surgery and age over 75 years.