RESUMO
BACKGROUND AND OBJECTIVE: A good acute pain control is necessary to achieve the main objective of Enhanced recovery After Surgery (ERAS) programs and accelerate recovery. The study objective is to evaluate postoperative (PO) acute pain, PO opioid consumption, and its association with functional recovery, after implementing a colorectal surgery ERAS program. An analysis was made as regards drugs adverse effects. METHODS: Observational cohort study on scheduled colorectal Surgery: one prospective cohort subjected to the ERAS care program, and one retrospective cohort that received traditional non-standardised care. A record was made of mean pain intensity (measured by a visual analogue scale, which classifies pain intensity from 0 to 10, from lower to higher intensity), as well as the amount of opioid consumption on the day of surgery and on the first three postoperative days, and drugs adverse effects. An analysis was made of the association between PO opioid consumption and ERAS program, and between PO opioid consumption and functional recovery. RESULTS: The study included a total of 410 patients (313 in the ERAS group and 97 in the control group). In the ERAS group, it was observed that the mean visual analogue scale was less than 2, with a smaller amount of PO opioid consumption, on each single day and the accumulated amount of the four days (4 [0-24] vs. 0 [0-4], P<.001). PO opioid consumption was associated with functional recovery (OR 0.97 [95% CI; 0.96-0.99], P=.011). No drugs adverse effects were observed. CONCLUSIONS: After implementing a colorectal Surgery ERAS program, good pain control was achieved, as well as a reduction in PO opioid consumption, which is associated with functional recovery. No drugs adverse effects were observed.
Assuntos
Analgésicos Opioides/uso terapêutico , Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Recuperação Pós-Cirúrgica Melhorada , Dor Pós-Operatória/prevenção & controle , Reto/cirurgia , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
La tromboendarterectomía pulmonar es un procedimiento infrecuente que precisa parada circulatoria para su realización, por lo que uno de sus principales riesgos son las lesiones neurológicas postoperatorias. La monitorización cerebral intra- y postoperatoria sería, por tanto, conveniente en estos procedimientos para detectar precozmente episodios de hipoperfusión, su intensidad, así como otros episodios postoperatorios de desaturación cerebral que puedan empeorar el pronóstico neurológico (AU)
Pulmonary thromboendarterectomy is an uncommon procedure and should be performed with circulatory arrest. One of the major concerns is the postoperative central neurological injuries. Perioperative brain oxygen monitoring is advisable in this surgical procedure for the early detection of brain hypoperfusion episodes and their intensity as well as any other postoperative episodes that can deteriorate the neurological outcome (AU)
Assuntos
Humanos , Masculino , Feminino , Oximetria/instrumentação , Oximetria/métodos , Oximetria , Endarterectomia/métodos , Choque/complicações , Parada Circulatória Induzida por Hipotermia Profunda/métodos , Oximetria/normas , Oximetria/tendências , Endarterectomia/instrumentação , Endarterectomia/normas , Período Pós-Operatório , Perfusão/métodosRESUMO
Pulmonary thromboendarterectomy is an uncommon procedure and should be performed with circulatory arrest. One of the major concerns is the postoperative central neurological injuries. Perioperative brain oxygen monitoring is advisable in this surgical procedure for the early detection of brain hypoperfusion episodes and their intensity as well as any other postoperative episodes that can deteriorate the neurological outcome.
Assuntos
Circulação Cerebrovascular , Endarterectomia/métodos , Hipóxia Encefálica/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Monitorização Intraoperatória/métodos , Oximetria/métodos , Artéria Pulmonar/cirurgia , Embolia Pulmonar/cirurgia , Idoso , Dano Encefálico Crônico/prevenção & controle , Parada Circulatória Induzida por Hipotermia Profunda , Humanos , Hipertensão Pulmonar/etiologia , Hipóxia Encefálica/sangue , Complicações Intraoperatórias/sangue , Masculino , Complicações Pós-Operatórias/prevenção & controle , Espectroscopia de Luz Próxima ao InfravermelhoRESUMO
BACKGROUND: Irradiation of the pituitary is widely considered the most appropriate treatment for patients with Cushing's disease in whom transsphenoidal microsurgery has been unsuccessful. However, there is little information about the long-term efficacy of this treatment. METHODS: We used external pituitary radiation to treat 30 adult patients with persistent or recurrent Cushing's disease after unsuccessful transsphenoidal surgery. The mean (+/-SD) dose of radiation was 50+/-1 Gy. Pituitary and adrenal function was assessed every six months after radiation therapy. Remission was defined as the regression of symptoms and signs of Cushing's syndrome, normal urinary cortisol excretion, and a low plasma cortisol concentration in the morning after the administration of 1 mg of dexamethasone at midnight. RESULTS: Twenty-five patients (83 percent) had remissions during a median follow-up of 42 months (range, 18 to 114). The remissions began 6 to 60 months after radiation therapy, but in most cases (22 patients) remission occurred during the first 2 years. None of the 25 patients had a relapse of Cushing's disease after remission was achieved. There was no relation between the response to radiotherapy and sex, age, urinary cortisol excretion before radiotherapy, the interval between surgery and radiotherapy, whether a pituitary adenoma was found by pathological examination, or tumor size. Seventeen patients had a deficiency of growth hormone after radiation therapy, 10 had a deficiency of gonadotropins, 4 had a deficiency of thyrotropin, and 1 had a deficiency of corticotropin. CONCLUSIONS: Pituitary irradiation is an effective and well-tolerated treatment for patients with Cushing's disease in whom transsphenoidal surgery is unsuccessful.