RESUMO
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.
Assuntos
Cardiotônicos/administração & dosagem , Doença da Artéria Coronariana/cirurgia , Éteres Metílicos/administração & dosagem , Revascularização Miocárdica/métodos , Inibidores da Agregação Plaquetária/administração & dosagem , Propofol/administração & dosagem , Idoso , Anestésicos Intravenosos/administração & dosagem , Doença da Artéria Coronariana/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sevoflurano , Resultado do TratamentoRESUMO
El Ministerio de Sanidad (MSSSI) aprobó (abril de 2013) el proyecto denominado «Compromiso por la Calidad de las Sociedades Científicas en España», en respuesta a la demanda social y profesional por la sostenibilidad del sistema de salud. La iniciativa se enmarca en las actividades de la Red Española de Agencias de Evaluación de Tecnologías y Prestaciones, del Sistema Nacional de Salud, y está coordinado de forma conjunta por la Subdirección General de Calidad y Cohesión, por el Instituto Aragonés de Ciencias de la Salud (IACS), y por la Sociedad Española de Medicina Interna (SEMI). A este Proyecto se han incorporado todas las sociedades científicas de nuestro país, y su objetivo principal es disminuir la utilización de intervenciones sanitarias innecesarias, con el fin de acordar recomendaciones de «no hacer», basadas en la evidencia científica. Nuestro objetivo primario fue identificar intervenciones que no han demostrado eficacia, tienen efectividad escasa o dudosa, no son coste-efectivas o no son prioritarias. Los objetivos secundarios fueron: la reducción de la variabilidad en la práctica clínica, la difusión entre médicos y pacientes para orientar en la toma de decisiones, el uso adecuado de los recursos sanitarios y, por último, la promoción de la seguridad clínica y la reducción de la iatrogenia. El proceso de selección de las 5 recomendaciones de «no hacer» se realizó mediante la metodología Delphi. 25 panelistas (todo anestesiólogos) eligieron entre 15 propuestas basadas en: evidencia de calidad que la sustenta, relevancia o impacto clínico de la misma y población a la que afecta. Las 5 recomendaciones propuestas fueron: No mantener niveles profundos de sedación en pacientes críticos sin una indicación específica; No realizar radiografía preoperatoria de tórax en pacientes menores de 40 años con estado físico ASA I o II; No realizar, de manera sistemática, pruebas preoperatorias en cirugía de cataratas, salvo indicación basada en historia clínica y exploración física; No programar cirugía electiva con riesgo de hemorragia en pacientes con anemia hasta realizar estudio diagnóstico y tratamiento adecuados; y No realizar pruebas de laboratorio (hemograma, bioquímica y estudio de coagulación) en pacientes sanos o con enfermedad sistémica leve (ASA I y II) previo a cirugías de bajo riesgo, con pérdida estimada de sangre mínima (AU)
In April 2013 the Ministry of Health (MSSSI) adopted the project called «Commitment to Quality by Scientific Societies in Spain», in response to social and professional demands for sustainability of the health system. The initiative is part of the activities of the Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System, and is coordinated jointly by the Quality and Cohesion Department, the Aragon Institute of Health Sciences (IACS), and the Spanish Society of Internal Medicine (SEMI). All the scientific societies in Spain have been included in this project, and its main objective is to reduce the unnecessary use of health interventions in order to agree «do not do» recommendations, based on scientific evidence. The primary objective was to identify interventions that have not proven effective, have limited or doubtful effectiveness, are not cost-effective, or do not have priority. Secondary objectives were: reducing variability in clinical practice, to spread information between doctors and patients to guide decision-making, the appropriate use of health resources and, the promotion of clinical safety and reducing iatrogenesis. The selection process of the 5 «do not do» recommendations was made by Delphi methodology. A total of 25 panellists (all anaesthesiologists) chose between 15 proposals based on: evidence that supports quality, relevance, or clinical impact, and the people they affect. The 5 recommendations proposed were: Do not maintain deep levels of sedation in critically ill patients without a specific indication; Do not perform preoperative chest radiography in patients under 40 years-old with ASA physical status I or II; Do not systematically perform preoperative tests in cataract surgery unless otherwise indicated based on clinical history and physical examination; Do not perform elective surgery in patients with anaemia at risk of bleeding until a diagnostic workup is performed and treatment is given; and not perform laboratory tests (blood count, biochemistry and coagulation) prior to surgery in healthy or low risk patients (ASA I and II) with minimal estimated blood loss (AU)
Assuntos
Humanos , Masculino , Feminino , Conferências de Consenso como Assunto , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Anestesia/ética , Anestesia/métodos , Anestesia/normas , Sociedades Científicas/legislação & jurisprudência , Sociedades Científicas/organização & administração , Sociedades Científicas/normas , Constituição e EstatutosRESUMO
In April 2013 the Ministry of Health (MSSSI) adopted the project called "Commitment to Quality by Scientific Societies in Spain", in response to social and professional demands for sustainability of the health system. The initiative is part of the activities of the Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System, and is coordinated jointly by the Quality and Cohesion Department, the Aragon Institute of Health Sciences (IACS), and the Spanish Society of Internal Medicine (SEMI). All the scientific societies in Spain have been included in this project, and its main objective is to reduce the unnecessary use of health interventions in order to agree "do not do" recommendations, based on scientific evidence. The primary objective was to identify interventions that have not proven effective, have limited or doubtful effectiveness, are not cost-effective, or do not have priority. Secondary objectives were: reducing variability in clinical practice, to spread information between doctors and patients to guide decision-making, the appropriate use of health resources and, the promotion of clinical safety and reducing iatrogenesis. The selection process of the 5 "do not do" recommendations was made by Delphi methodology. A total of 25 panellists (all anaesthesiologists) chose between 15 proposals based on: evidence that supports quality, relevance, or clinical impact, and the people they affect. The 5 recommendations proposed were: Do not maintain deep levels of sedation in critically ill patients without a specific indication; Do not perform preoperative chest radiography in patients under 40 years-old with ASA physical status I or II; Do not systematically perform preoperative tests in cataract surgery unless otherwise indicated based on clinical history and physical examination; Do not perform elective surgery in patients with anaemia at risk of bleeding until a diagnostic workup is performed and treatment is given; and not perform laboratory tests (blood count, biochemistry and coagulation) prior to surgery in healthy or low risk patients (ASA I and II) with minimal estimated blood loss.
Assuntos
Anestesiologia , Cuidados Críticos , Sociedades Científicas , Humanos , Dor , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde , EspanhaRESUMO
El marco legal del anestesiólogo en Cirugía Mayor Ambulatoria está cobrando relativa importancia en los últimos años. Cada vez más los profesionales vamos tomando conciencia de las implicaciones legales en las que podemos incurrir al realizar nuestro trabajo diario. El análisis de sentencias judiciales en España demuestra que es una especialidad con altas cuantías indemnizatorias. Es muy importante que los anestesiólogos conozcamos todo lo relativo a las normas de los servicios y centros donde desarrollamos nuestra labor asistencial, de igual manera debemos conocer las normas de los colegios profesionales y de las sociedades científicas, y las leyes de ámbito regional y estatal que afectan a nuestro trabajo (AU)
The legal framework anesthesiologist at Ambulatory Surgery, is gaining on importance in recent years, more and more professionals will become aware of the legal implications you may incur while performing our daily work. Analysis of court decisions in Spain shows that anesthesiology is a specialty with high compensatory amounts. It is very important that anesthesiologists know everything about standards of services and facilities where we do care work, just as we must know the rules of professional associations and scientific societies, and the laws of regional and state level that affect our work (AU)
