RESUMO
Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving "Aortic teams" made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of "AORTIC TEAM"(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.
Assuntos
Anestesiologia , Anestésicos , Aorta Torácica/cirurgia , Consenso , Humanos , DorRESUMO
La patología de la aorta siempre supone un reto para la medicina. Tanto para sudiagnóstico como para su tratamiento, dicha patología requiere ser abordada de forma multidisciplinar debido a la complejidad técnica y tecnológica de los medios empleados. Gracias a los esfuerzos durante años se están obteniendo frutos en forma de mejora de resultados, mediante un abordaje sistemático y protocolizado llevado acabo en el seno de un grupo de expertos (Comités de aorta o Aortic team) en el quese implican cardiólogos, cirujanos cardíacos, cirujanos vasculares, anestesiólogos y radiólogos, entre otros. Con este documento, realizado entre los grupos de trabajo de Aorta de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del dolor (SEDAR) y la Sociedad Española de Cirugía Torácica y Cardiovascular (SECTCV) se busca difundir protocolos de trabajo consensuados por ambas sociedades. La EACTS y la ESVS en el último documento de consenso de expertos definen el concepto de AORTIC TEAM(1). El equipo debe estar estrechamente involucrado en todo el proceso de diagnóstico, tratamiento y seguimiento y debe estar compuesto por miembros de cirugía cardiovascular en colaboración con anestesiología, cardiología, radiología y genética. Se recomienda la centralización de la atención de las patologías del arco aórtico en grandes centros porque es la única forma de comprender de manera efectiva el curso natural de la enfermedad, proporcionar toda la gama de opciones de tratamiento bajo un mismo prisma y tratar las posibles complicaciones. Debe estar disponible una vía simplificada de atención de emergencias (con disponibilidad 24h al día y 7 días a la semana), una adecuada capacidad de transporte y transferencia de pacientes, así como la posibilidad de una activación rápida del equipo multidisciplinar.(AU)
Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving Aortic teams made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of AORTIC TEAM(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.(AU)
Assuntos
Humanos , Aorta/cirurgia , Aorta Torácica/cirurgia , Espanha , Aorta/patologia , Cirurgia Torácica , Aneurisma Aórtico , Manuseio das Vias Aéreas , Anestesia/efeitos adversos , Cirurgia Geral , Anestesiologia , Reanimação Cardiopulmonar , Conferências de Consenso como Assunto , EspecializaçãoRESUMO
Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving "Aortic teams" made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of "AORTIC TEAM"(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.
Assuntos
Humanos , Masculino , Feminino , Manejo da Dor , Anestesiologia , Anestesia , Cirurgia TorácicaRESUMO
Este artículo ha sido retirado por indicación del Editor Jefe de la revista, después de constatar que parte de su contenido había sido plagiado, sin mencionar la fuente original: European Heart Journal (2014) 35, 2873 926.: https://academic.oup.com/eurheartj/article/35/41/2873/407693#89325738 El autor de correspondencia ha sido informado de la decisión y está de acuerdo con la retirada del artículo. El Comité Editorial lamenta las molestias que esta decisión pueda ocasionar. Puede consultar la política de Elsevier sobre la retirada de artículos en https://www.elsevier.com/about/our-business/policies/article-withdrawal
Assuntos
Anestesia , Anestesiologia , Cirurgia Torácica , Aorta Abdominal , ConsensoRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico , Carcinoma in Situ/diagnóstico por imagem , Neoplasias Cutâneas/diagnósticoRESUMO
Objetivo. Conocer la práctica clínica habitual de los anestesiólogos españoles en el manejo del tratamiento endovascular del infarto isquémico cerebral agudo (IIA). Materiales y métodos. Encuesta diseñada desde la Sección de Neurociencias de la SEDAR, enviada a todos los servicios de anestesiología en hospitales españoles con unidad de referencia de ictus, entre julio y noviembre de 2016. Resultados. De los 47 hospitales donde se realiza tratamiento endovascular del IIA, en 37 participa el servicio de anestesiología. Obtuvimos 30 respuestas, eliminándose 3 por duplicidad (tasa de respuesta del 72,9%). El 63% de los hospitales tiene cobertura asistencial para el tratamiento endovascular del IIA las 24 h del día. El anestesiólogo encargado es el de presencia física en el hospital en un 55,3%. Existe gran variabilidad interhospitalaria en la monitorización no estándar y el tipo de anestesia. El criterio más empleado para su elección, es una decisión consensuada entre anestesiólogo, neurólogo y neurorradiólogo (59,3%). El tiempo transcurrido desde el inicio de la técnica anestésica hasta la punción arterial en un 59,3% es de 10-15 min. En un 44,4%, se mantiene una presión arterial sistólica entre 140-180mmHg y diastólica <105mmHg. El control de la glucemia se realiza en un 81,5% de los hospitales. El 66,7% (18) lleva a cabo una heparinización endovenosa durante el procedimiento pero con un régimen muy variado. El 85,2% coincide en la educción y extubación del paciente al final del procedimiento en caso de deterioro neurológico leve o moderado sin complicaciones añadidas. Conclusiones. La gran variabilidad observada en el manejo anestésico y organización del tratamiento endovascular del IIA, pone de manifiesto la necesidad de crear unas pautas de actuación comunes entre los anestesiólogos de España (AU)
Objective. To assess the anaesthetic management of treatment for endovascular acute ischaemic stroke (AIS) in Spain. Materials and method. A survey was designed by the SEDAR Neuroscience Section and sent to the Spanish anaesthesiology departments with a primary stroke centre between July and November 2016. Results. Of the 47 hospitals where endovascular treatment of AIS is performed, 37 anaesthesiology departments participated. Thirty responses were obtained; three of which were eliminated due to duplication (response rate of 72.9%). Health coverage for AIS endovascular treatment was available 24hours a day in 63% of the hospitals. The anaesthesiologist in charge of the procedure was physically present in the hospital in 55.3%. There was large inter-hospital variability in non-standard monitoring and type of anaesthesia. The most important criterion for selecting type of anaesthesia was multidisciplinary choice made by the anaesthesiologist, neurologist and neuroradiologist (59.3%). The duration of time from arrival to arterial puncture was 10-15minutes in 59.2%. In 44.4%, systolic blood pressure was maintained between 140-180mmHg, and diastolic blood pressure<105mmHg. Glycaemic levels were taken in 81.5% of hospitals. Intravenous heparinisation was performed during the procedure in 66.7% with different patterns of action. In cases of moderate neurological deterioration with no added complications, 85.2% of the included hospitals awakened and extubated the patients. Conclusions. The wide variability observed in the anaesthetic management and the organization of the endovascular treatment of AIS demonstrates the need to create common guidelines for anaesthesiologists in Spain (AU)
Assuntos
Humanos , Anestesia/métodos , Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/cirurgia , Infarto Cerebral/cirurgia , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Período Perioperatório/estatística & dados numéricos , Padrões de Prática Médica/tendências , Cuidados Pré-Operatórios/métodos , Inibidores da Agregação Plaquetária/uso terapêutico , Anticoagulantes/uso terapêuticoRESUMO
OBJECTIVE: To assess the anaesthetic management of treatment for endovascular acute ischaemic stroke (AIS) in Spain. MATERIALS AND METHOD: A survey was designed by the SEDAR Neuroscience Section and sent to the Spanish anaesthesiology departments with a primary stroke centre between July and November 2016. RESULTS: Of the 47 hospitals where endovascular treatment of AIS is performed, 37 anaesthesiology departments participated. Thirty responses were obtained; three of which were eliminated due to duplication (response rate of 72.9%). Health coverage for AIS endovascular treatment was available 24hours a day in 63% of the hospitals. The anaesthesiologist in charge of the procedure was physically present in the hospital in 55.3%. There was large inter-hospital variability in non-standard monitoring and type of anaesthesia. The most important criterion for selecting type of anaesthesia was multidisciplinary choice made by the anaesthesiologist, neurologist and neuroradiologist (59.3%). The duration of time from arrival to arterial puncture was 10-15minutes in 59.2%. In 44.4%, systolic blood pressure was maintained between 140-180mmHg, and diastolic blood pressure<105mmHg. Glycaemic levels were taken in 81.5% of hospitals. Intravenous heparinisation was performed during the procedure in 66.7% with different patterns of action. In cases of moderate neurological deterioration with no added complications, 85.2% of the included hospitals awakened and extubated the patients. CONCLUSIONS: The wide variability observed in the anaesthetic management and the organization of the endovascular treatment of AIS demonstrates the need to create common guidelines for anaesthesiologists in Spain.
Assuntos
Anestesia , Anestesiologia , Isquemia Encefálica/cirurgia , Procedimentos Endovasculares , Padrões de Prática Médica , Acidente Vascular Cerebral/cirurgia , Anestesia/normas , Pesquisas sobre Atenção à Saúde , Humanos , Assistência Perioperatória/normas , EspanhaRESUMO
No disponible
Assuntos
Feminino , Humanos , Masculino , Ceratose/terapia , Fototerapia/instrumentação , Fototerapia/métodos , Fototerapia , Luz Solar , Helioterapia/métodos , Helioterapia , Dermatopatias/terapia , Fototerapia/normas , Fototerapia/tendênciasRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Plasmócitos/patologia , Exantema/patologia , Dermatopatias Papuloescamosas/diagnóstico , Diagnóstico DiferencialAssuntos
Ceratose Actínica/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Luz Solar , Carcinoma Basocelular/tratamento farmacológico , Humanos , Conceitos Meteorológicos , Fármacos Fotossensibilizantes/efeitos da radiação , Protoporfirinas/efeitos da radiação , Protoporfirinas/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológico , EspanhaRESUMO
OBJECTIVES: Mortality is high when cardiogenic shock develops after cardiotomy, making it impossible to discontinue extracorporeal circulation and/or leading to low postoperative cardiac output that is refractory to treatment with vasoactive drugs or implantation of an intra-aortic balloon pump. Extracorporeal membrane oxygenation (ECMO) provides temporary assisted circulation, lending hemodynamic and respiratory support to the patient with cardiogenic shock in order to prevent multiple organ failure and death. MATERIAL AND METHODS: For this retrospective study of cases in which ECMO was applied in our hospital's assisted circulation unit, we analyzed demographic data, indication, score on the European system for cardiac operative risk evaluation (Euroscore), duration of assistance, complications, and survival. RESULTS: In the first 3 years after the assisted circulation unit was established, during which 1375 cardiac interventions took place, ECMO was used postoperatively in 12 patients (0.87%). In 8 of the patients, assistance was provided during cardiac surgery following cardiotomy and in 4 transplant patients it was used following primary graft failure. The mean (SD) patient age was 56.8 (9.1) years. The Euroscore predicted 37.3% (16.7%) of the deaths. ECMO was used for a mean of 5.4 (2.5) days. The most frequent complications were bleeding in the surgical area, cardiac tamponade, and acute renal insufficiency. Overall in-hospital mortality was 50%, lower than rates reported in the literature. CONCLUSIONS: ECMO provided viable temporary support, maintaining adequate cardiac output while the patient's condition could be observed and heart function evaluated. Mortality was reduced.
Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Oxigenação por Membrana Extracorpórea , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Objetivos: La aparición de un shock cardiogénico postcardiotomía con imposibilidad de desconexión de la circulación extracorpórea y/o el desarrollo de bajo gasto postoperatorio refractario a los fármacos vasoactivos y balón de contrapulsación, conlleva alta mortalidad. El oxigenador de membrana extracorpóreo (ECMO) es un sistema de asistencia circulatoria temporal que proporciona un apoyo hemodinámico y respiratorio al paciente en situación de shock cardiogénico para evitar el desarrollo consecuente de fallo multiorgánico y muerte. Material y métodos: Se recogieron de manera retrospectiva todos los casos que fueron tratados con ECMO tras la puesta en marcha de la unidad de asistencia circulatoria en nuestro hospital. Se registraron datos demográficos, indicación, valoración Euroscore de los pacientes, duración de la asistencia, complicaciones y supervivencia. Resultados: En los primeros tres años de funcionamiento, de un total de 1.375 intervenciones de cirugía cardiaca se colocó el sistema ECMO en 12 pacientes (0,87%) postquirúrgicos, 8 postcardiotomía en cirugía cardiaca y 4 tras fallo primario del injerto postrasplante cardiaco. La media de edad fue de 56,8 ± 9,1 años, el porcentaje previsto de mortalidad calculado por Euroscore de 37,3% ± 16,7%, la duración media de la asistencia de 5,4 ± 2,5 días. Las complicaciones más frecuentes fueron la hemorragia en la zona quirúrgica, el taponamiento y la insuficiencia renal aguda. La mortalidad global intrahospitalaria fue del 50%, inferior a la publicada. Conclusiones: En nuestra serie, el ECMO fue una alternativa real de soporte temporal que proporcionó el tiempo necesario para observar y decidir sobre la viabilidad cardiaca, manteniendo un gasto cardiaco adecuado que redujo la mortalidad en estos pacientes(AU)
Objectives: Mortality is high when cardiogenic shock develops after cardiotomy, making it impossible to discontinue extracorporeal circulation and/or leading to low postoperative cardiac output that is refractory to treatment with vasoactive drugs or implantation of an intra-aortic balloon pump. Extracorporeal membrane oxygenation (ECMO) provides temporary assisted circulation, lending hemodynamic and respiratory support to the patient with cardiogenic shock in order to prevent multiple organ failure and death. Material and methods: For this retrospective study of cases in which ECMO was applied in our hospitals assisted circulation unit, we analyzed demographic data, indication, score on the European system for cardiac operative risk evaluation (Euroscore), duration of assistance, complications, and survival. Results: In the first 3 years after the assisted circulation unit was established, during which 1375 cardiac interventions took place, ECMO was used postoperatively in 12 patients (0.87%). In 8 of the patients, assistance was provided during cardiac surgery following cardiotomy and in 4 transplant patients it was used following primary graft failure. The mean (SD) patient age was 56.8 (9.1) years. The Euroscore predicted 37.3% (16.7%) of the deaths. ECMO was used for a mean of 5.4 (2.5) days. The most frequent complications were bleeding in the surgical area, cardiac tamponade, and acute renal insufficiency. Overall in-hospital mortality was 50%, lower than rates reported in the literature. Conclusions: ECMO provided viable temporary support, maintaining adequate cardiac output while the patients condition could be observed and heart function evaluated. Mortality was reduced(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Oxigenadores de Membrana/tendências , Oxigenadores de Membrana , Choque Cardiogênico/tratamento farmacológico , Cirurgia Torácica/métodos , Transplante de Coração/métodos , Transplante de Coração , Fatores de Risco , Sepse/mortalidade , Débito Cardíaco , Débito Cardíaco/fisiologia , Vasodilatadores/uso terapêutico , Doenças Cardiovasculares/prevenção & controleRESUMO
La sífilis gestacional (SG) y la sífilis congénita (SC) han cobrado especial atención en la última década en Uruguay y en la región. Configuran un problema de salud pública por la afectación directa a las mujeres y los recién nacidos, siendo una enfermedad para la cual se dispone de tratamientos asequibles, eficaces y de bajo costo. El imaginario social predominante en el sector sanitario y en la población, la visualiza como una enfermedad erradicada, lo cual refuerza las barreras para su prevención, diagnóstico y tratamiento oportuno. En tal sentido, las recomendaciones que surgen del estudio están dirigidas a incluir la Estrategia Nacional en un plan nacional e intersectorial sobre salud sexual y reproductiva, desde una visión de APS, intersectorial, de género y de derechos, con acciones dirigidas a los servicios de salud, al sistema de información en salud, a los y las profesionales y funcionarios de los servicios, a las mujeres en edad reproductiva, a los hombres en general, a las instituciones formadoras de profesionales, a los y las investigadores y a los medios de co- municación y periodistas.
Assuntos
Sífilis Congênita , Transmissão Vertical de Doenças Infecciosas , Serviços de Saúde Materno-Infantil , Cuidado Pré-NatalAssuntos
Oxigenação por Membrana Extracorpórea , Transplante de Coração , Infarto do Miocárdio/terapia , Complicações Pós-Operatórias/terapia , Choque Cardiogênico/terapia , Reanimação Cardiopulmonar , Fármacos Cardiovasculares/uso terapêutico , Terapia Combinada , Feminino , Humanos , Anastomose de Artéria Torácica Interna-Coronária , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/cirurgia , Complicações Pós-Operatórias/cirurgia , Cuidados Pré-Operatórios , Recidiva , Choque Cardiogênico/etiologia , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Oxigenadores de Membrana , Infarto do Miocárdio/complicações , Infarto do Miocárdio/reabilitação , Transplante de Coração/instrumentação , Revascularização Miocárdica/métodos , Revascularização Miocárdica/reabilitação , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/tendências , Norepinefrina/uso terapêutico , Dobutamina/uso terapêuticoRESUMO
OBJECTIVE: This study selected and field tested indicators to track changes in HIV prevention effectiveness in the USA. METHODS: During 1996-1999, the Centers for Disease Control and Prevention held two 2 day expert consultations with more than 80 national, state and local experts. A consensus-driven, evidence-based approach was used to select 70 indicators, which had to be derived from existing data, available in more than 25 states, and meaningful to state health officials in monitoring HIV. A literature review was performed for each indicator to determine general relevance, validity, and reliability. Two field tests in five US sites determined accessibility, feasibility, and usefulness. RESULTS: The final 37 core indicators represent four categories: biological, behavioral, services, and socio-political. Specific indicators reflect the epidemic and associated risk factors for men who have sex with men, injection drug users, heterosexuals at high risk, and childbearing women. CONCLUSIONS: Despite limitations, the indicators sparked the regular, proactive integration and review of monitoring data, facilitating a more effective use of data in HIV prevention community planning.