RESUMO
The incidence of liver failure continues to increase, and it is associated with increased perioperative morbidity and mortality. Liver failure is associated with multiorgan dysfunction, including central nervous, cardiac, respiratory, gastrointestinal, renal, and hematological systems. Preoperative identification, optimization, and tailored anesthetic management are essential for optimum outcomes in patients with liver disease undergoing surgery. The coagulopathy of liver failure is a balanced coagulopathy better assessed by thromboelastography than conventional testing, and it is not directly associated with bleeding risk.
Assuntos
Anestesia/métodos , Falência Hepática/complicações , Abdome/cirurgia , Coagulação Sanguínea , Procedimentos Cirúrgicos Cardíacos , Humanos , Monitorização Intraoperatória , Dor Pós-Operatória/prevenção & controle , Ferimentos e Lesões/cirurgiaRESUMO
The incidence of liver failure continues to increase, and it is associated with increased perioperative morbidity and mortality. Liver failure is associated with multiorgan dysfunction, including central nervous, cardiac, respiratory, gastrointestinal, renal, and hematological systems. Preoperative identification, optimization, and tailored anesthetic management are essential for optimum outcomes in patients with liver disease undergoing surgery. The coagulopathy of liver failure is a balanced coagulopathy better assessed by thromboelastography than conventional testing, and it is not directly associated with bleeding risk.
Assuntos
Anestesia/métodos , Hepatopatias/complicações , Hepatopatias/cirurgia , Falência Hepática/prevenção & controle , Cuidados Pré-Operatórios/métodos , HumanosAssuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Estenose da Valva Aórtica/cirurgia , Gerenciamento Clínico , Assistência Perioperatória/métodos , Feocromocitoma/cirurgia , Índice de Gravidade de Doença , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Feocromocitoma/complicações , Feocromocitoma/diagnóstico por imagemRESUMO
Bronchial thermoplasty (BT) is a novel, Food and Drug Administration-approved nondrug treatment for patients whose asthma remains uncontrolled despite traditional pharmacotherapy. BT involves application of controlled radiofrequency energy to reduce airway smooth muscle in large- and medium-sized airways. Although BT is often performed under general anesthesia, anesthetic management strategies for BT are poorly described. We describe the anesthetic management of 7 patients who underwent 19 BT treatments in a tertiary academic medical center.
Assuntos
Manuseio das Vias Aéreas/métodos , Anestesia Intravenosa/métodos , Anestésicos Intravenosos/administração & dosagem , Asma/terapia , Termoplastia Brônquica/métodos , Adulto , Idoso , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/normas , Anestesia Intravenosa/normas , Asma/diagnóstico , Termoplastia Brônquica/instrumentação , Termoplastia Brônquica/normas , Broncoscópios/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Liso/efeitos dos fármacos , Músculo Liso/fisiologia , Estudos RetrospectivosRESUMO
BACKGROUND: The role of thoracic paravertebral blockade (TPVB) in decreasing opioid requirements in breast cancer surgery is well documented, and there is mounting evidence that this may improve survival and reduce the rate of malignancy recurrence following cancer-related mastectomy. We compared the two techniques currently in use at our institution, the anatomic landmark-guided (ALG) multilevel versus an ultrasound-guided (USG) single injection, to determine an optimal technique. METHODS: We retrospectively reviewed records of patients who received TPVB from January 2013 to December 2014. Perioperative opioid use, post anesthesia care unit (PACU) pain scores and length of stay, block performance, and complications were compared between the two groups. RESULTS: We found no statistical difference between the two approaches in the studied outcomes. We did find that the number of times attending physicians in the ALG group took over the blocks from residents was significantly greater than that of the USG group (p=0.006) and more local anesthetic was used in the USG group (p=0.04). CONCLUSION: This study compared the ALG approach with the USG approach for patients undergoing mastectomy for breast cancer. Based on our observations, an attending physician is more likely to take over an ALG injection, and more local anesthetic is administered during USG single injection.