Assuntos
Neoplasias Intestinais/terapia , Linfoma não Hodgkin/terapia , Dor Abdominal/etiologia , Antineoplásicos/uso terapêutico , Colonoscopia , Humanos , Neoplasias Intestinais/diagnóstico , Neoplasias Intestinais/patologia , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/patologia , Masculino , Pessoa de Meia-Idade , NecroseRESUMO
No disponible
Assuntos
Humanos , Anestesia/normas , Anestesiologia , Sedação Consciente/normas , Endoscopia do Sistema Digestório , Gastroenterologia , Hipnóticos e Sedativos/administração & dosagem , Sedação Consciente/métodos , Guias de Prática Clínica como Assunto , Espanha , Estados UnidosRESUMO
AIM: To evaluate the human and material resources available for sedation, and the usual manner of handling them at endoscopic units in Galicia. METHODS: A prospective and descriptive study based on the performance, distribution, and analysis of a clinical practice inquiry. We requested information about endoscopies performed, available means for sedation, sedation monitoring, and level of sedation used in each procedure. RESULTS: Our inquiry was answered by twenty endoscopic units (thirteen were in public hospitals, and eleven performed complex procedures). Of these units, 80% had a pulse oximeter, 42% had continuous electrocardiography, 40% had a defibrillator, and 45% had a recovery area. The drug most commonly used in gastroscopies was midazolam (76%), and the combination midazolam-meperidine was most frequent in both colonoscopies (72%) and ERCPs (60%). An anesthesiologist was usually available for certain procedures in 15% of units, and as an exception in 65%. Of those inquired, 35% wished to have a full-time anesthesiologist in the unit, 25% wished to have an anesthetist only for certain procedures, and 35% on an exceptional basis. Finally, endoscopists considered that 83% of therapeutical gastroscopies, 87% of therapeutical colonoscopies, 98% of ERCPs, 95% of enteroscopies, and 98% of echoendoscopies deserved sedation. CONCLUSIONS: Although endoscopists consider that endoscopic procedures should benefit from sedation in a high proportion, the available resources to safely monitor patients are inadequate in some units.
Assuntos
Anestesiologia , Sedação Consciente , Endoscopia do Sistema Digestório , Recursos em Saúde , Sedação Consciente/estatística & dados numéricos , Endoscopia do Sistema Digestório/estatística & dados numéricos , Humanos , Espanha , Recursos HumanosRESUMO
Objetivo: evaluar los medios materiales y humanos disponiblespara la sedación y el modo habitual de manejarla en las unidadesde endoscopia de Galicia.Métodos: estudio prospectivo, descriptivo, basado en la realización,distribución y análisis de una encuesta sobre práctica clínica.Se solicitó información sobre las exploraciones realizadas, losmedios disponibles para la sedación, el modo de controlarla y elnivel de sedación usado y deseable en cada exploración.Resultados: la encuesta fue respondida por veinte unidades deendoscopia (trece de titularidad pública y once realizaban exploracionesde alta complejidad). El 80% de las unidades estaban dotadasde pulsioximetría, el 42% de monitorización electrocardiográfica, el40% de defibrilador y finalmente, el 45% de sala de recuperación.El fármaco más utilizado en las gastroscopias fue el midazolam(76%) siendo la asociación midazolam-meperidina la sedación másutilizada en las colonoscopias (72%) y la CPRE (60%). El anestesistaestaba disponible para determinadas exploraciones de forma habitualen el 15%, y de forma excepcional en el 65% de las unidades.El 35% de los encuestados desearía tener un anestesista en la unidada tiempo completo, el 25% sólo para exploraciones determinadasy el 35% sólo para casos excepcionales. Finalmente, los encuestadosconsideran que es necesario algún grado de sedación en el83% de las gastroscopias terapéuticas, en el 87% de las colonoscopiasterapéuticas, en el 98% de las CPRE, en el 95% de las enteroscopiasy en el 98% de las ecoendoscopias.Conclusiones: aunque los endoscopistas consideran que losprocedimientos endoscópicos deben ser sedados en una proporciónelevada, en algunas unidades los medios disponibles paramonitorizar con seguridad a los pacientes son insuficientes
Aim: to evaluate the human and material resources availablefor sedation, and the usual manner of handling them at endoscopicunits in Galicia.Methods: a prospective and descriptive study based on theperformance, distribution, and analysis of a clinical practice inquiry.We requested information about endoscopies performed,available means for sedation, sedation monitoring, and level of sedationused in each procedure.Results: our inquiry was answered by twenty endoscopic units(thirteen were in public hospitals, and eleven performed complexprocedures). Of these units, 80% had a pulse oximeter, 42% hadcontinuous electrocardiography, 40% had a defibrillator, and 45%had a recovery area. The drug most commonly used in gastroscopieswas midazolam (76%), and the combination midazolammeperidinewas most frequent in both colonoscopies (72%) andERCPs (60%). An anesthesiologist was usually available for certainprocedures in 15% of units, and as an exception in 65%. Of thoseinquired, 35% wished to have a full-time anesthesiologist in theunit, 25% wished to have an anesthetist only for certain procedures,and 35% on an exceptional basis. Finally, endoscopistsconsidered that 83% of therapeutical gastroscopies, 87% of therapeuticalcolonoscopies, 98% of ERCPs, 95% of enteroscopies,and 98% of echoendoscopies deserved sedation.Conclusions: although endoscopists consider that endoscopicprocedures should benefit from sedation in a high proportion,the available resources to safely monitor patients are inadequatein some units
Assuntos
Humanos , Anestesiologia , Sedação Consciente/estatística & dados numéricos , Endoscopia do Sistema Digestório/estatística & dados numéricos , Recursos em Saúde , EspanhaAssuntos
Endoscopia do Sistema Digestório , Estenose Esofágica/cirurgia , Obstrução Intestinal/cirurgia , Esfinterotomia Endoscópica/instrumentação , Stents , Adenocarcinoma/complicações , Neoplasias do Colo/complicações , Neoplasias Esofágicas/complicações , Estenose Esofágica/etiologia , Humanos , Obstrução Intestinal/etiologia , Fístula Traqueoesofágica/complicaçõesRESUMO
Colonoscopy is presently always performed before surgical management of a volvulus in the sigmoid colon. It leads to know the viability of the mucosa and, when possible, to resolve the volvulus conservatively. Besides, with endoscopic control, we can place a decompression tube proximal to the volvulated sigmoid colon, favouring a non-surgical resolution. With this conservative approach it is possible to overcome the acute period, and to restore the viability of the sigmoid wall, waiting for a definitive surgical management with less morbidity and mortality. Only with endoscopy, revolvulation does occur in 35-50% of cases. We present the clinical case of a sigmoid volvulus with compromised sigmoid wall in an 82-year-old man with several clinical problems contraindicating surgery. Endoscopic devolvulation with tube placement was adequate to resolve this sigmoid volvulus.
Assuntos
Colonoscopia , Obstrução Intestinal/terapia , Doenças do Colo Sigmoide/terapia , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Mucosa Intestinal , Obstrução Intestinal/complicações , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/diagnóstico por imagem , Masculino , Radiografia Abdominal , Doenças do Colo Sigmoide/complicações , Doenças do Colo Sigmoide/diagnóstico , Doenças do Colo Sigmoide/diagnóstico por imagem , Fatores de TempoRESUMO
Actualmente la colonoscopia se realiza previamente al manejo quirúrgico de los vólvulos de sigma. Ello permite conocer el estado de la mucosa del colon volvulado, su viabilidad y, en ocasiones, resolver la volvulación de forma conservadora. Asimismo, mediante control endoscópico se puede dejar en posición un tubo de descompresión, colocado proximalmente al área volvulada, favoreciendo la resolución sin cirugía. Mediante este manejo conservador es posible superar el periodo agudo y recuperar la viabilidad de la pared del colon, evitando la cirugía urgente donde la morbimortalidad es mayor. El tratamiento endoscópico solamente no suele ser suficiente como solución definitiva apareciendo recidiva de la volvulación en el 3050 por ciento de los casos. Presentamos el caso de un vólvulo de sigma estrangulado, con compromiso de la pared colónica, en un paciente de 82 años de edad, con múltiples patologías de base que contraindicaban la cirugía. La devolvulación endoscópica, dejando en posición un tubo de descompresión, permitió la resolución del cuadro, sin recidiva posterior (AU)