RESUMO
Los pacientes con lesión medular crónica tienenunas alteraciones fisiopatológicas que determinan unaimportante morbilidad y mortalidad en el periodo perioperatorio. El marcapasos diafragmático es un dispositivo que permite la ventilación pulmonar en pacientescon lesiones cervicales altas y mejora la calidad de vidafrente al uso de ventilación mecánica. Presentamos el caso de una paciente con lesiónmedular crónica y portadora de un marcapasos diafragmático que fue programada para realización de nefrolitotomía percutánea y colocación de catéter doble Jderecho. El anestesista debe conocer la situación fisiopatológica de estos pacientes para asegurar la seguridad en el proceso perioperatorio.(AU)
Patients with chronic spinal cord injury suffer froma number of pathophysiological alterations that canlead to important morbidity and mortality in the perioperative period. The diaphragmatic pacemaker is adevice that enables pulmonary ventilation in patientswith high cervical cord injuries and provides them witha better quality of life when compared to mechanicalventilation. We present here the clinical case of a patient withchronic spinal cord injury who used a diaphragmaticpacemaker, and who was scheduled for percutaneousnephrolithotomy and double-J stent implantation. Theanesthesiologist should know the pathophysiologicalsituation of these patients in order to provide a safeperioperatory care.(AU)
Assuntos
Humanos , Feminino , Adulto , Período Perioperatório , Traumatismos da Medula Espinal , Marca-Passo Artificial , Pacientes Internados , Exame Físico , Nervo Frênico , Respiração Artificial , Lesões do PescoçoRESUMO
Patients with chronic spinal cord injury suffer from a number of pathophysiological alterations that can lead to important morbidity and mortality in the perioperative period. The diaphragmatic pacemaker is a device that enables pulmonary ventilation in patients with high cervical cord injuries and provides them with a better quality of life when compared to mechanical ventilation. We present here the clinical case of a patient with chronic spinal cord injury who used a diaphragmatic pacemaker, and who was scheduled for percutaneous nephrolithotomy and double-J stent implantation. The anesthesiologist should know the pathophysiological situation of these patients in order to provide a safe perioperatory care.
Assuntos
Marca-Passo Artificial , Traumatismos da Medula Espinal , Diafragma , Humanos , Qualidade de Vida , Respiração Artificial , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/terapiaRESUMO
Introducción: La narcolepsia es el segundo trastorno del sueño en frecuencia y se caracteriza por somnolencia excesiva durante el día junto con otros síntomas como cataplejía, parálisis del sueño y alucinaciones. Su fisiopatología y tratamiento, así como los síndromes que asocia, pueden interferir de forma severa con el acto anestésico. Metodología: Debido al déficit de evidencia de calidad que aporte un grado de recomendación alto en la anestesia de estos pacientes, se realizó una revisión narrativa de la literatura no sistemática en Pubmed. Como descriptores se usaron narcolepsy, anesthesia, surgery, perioperative, opioid, obstructive, apnea y sleep y se emplearon de forma individual y cruzándolos con conectores AND y OR. Conclusión: La recomendación de evitar opioides y la estabilidad de la anestesia libre de opioides (OFA), hace de esta última una opción para estos pacientes. Se describe un caso en el que se empleó de forma segura.(AU)
Introduction: Narcolepsy is the second most common sleep disorder. It is characterised by excessive daytime sleepiness together with other symptoms such as cataplexy, sleep paralysis, and hallucinations. The pathophysiology and treatment of this disease, together with its associated syndromes, can severely interfere with anaesthesia. Methodology: Due to the lack of quality evidence on which to base a high grade of recommendation for anaesthesia in these patients, we performed a non-systematic, narrative review of the literature in Pubmed. We used the descriptors narcolepsy, anesthesia, surgery, perioperative, opioid, obstructive, apnea and sleep both individually and with AND and OR connectors. Conclusion: The recommendation to avoid opioids and the stability of opioid-free anaesthesia (OFA) make this approach an option to consider in these patients. We describe a case in which it was used safely.(AU)
Assuntos
Humanos , Masculino , Feminino , Anestesia , Narcolepsia/diagnóstico , Analgésicos Opioides/efeitos adversos , Paralisia do Sono , Cataplexia/diagnósticoRESUMO
INTRODUCTION: Narcolepsy is the second most common sleep disorder. It is characterised by excessive daytime sleepiness together with other symptoms such as cataplexy, sleep paralysis, and hallucinations. The pathophysiology and treatment of this disease, together with its associated syndromes, can severely interfere with anaesthesia. METHODOLOGY: Due to the lack of quality evidence on which to base a high grade of recommendation for anaesthesia in these patients, we performed a non-systematic, narrative review of the literature in Pubmed. We used the descriptors narcolepsy, anesthesia, surgery, perioperative, opioid, obstructive, apnea and sleep both individually and with AND and OR connectors. CONCLUSION: The recommendation to avoid opioids and the stability of opioid-free anaesthesia (OFA) make this approach an option to consider in these patients. We describe a case in which it was used safely.
Assuntos
Anestesia , Cataplexia , Narcolepsia , Paralisia do Sono , Analgésicos Opioides/efeitos adversos , Cataplexia/diagnóstico , Humanos , Narcolepsia/diagnósticoRESUMO
FUNDAMENTO: Los pacientes sometidos a cirugía bariátrica presentan mayor riesgo de complicaciones debido al uso de opioides. El objetivo es valorar la seguridad e idoneidad del protocolo Anestesia libre de opioides (OFA) implantado en el Hospital Universitario Virgen de la Victoria en 2018. MATERIAL Y MÉTODOS: Estudio prospectivo llevado a cabo en 38 pacientes sometidos a cirugía bariátrica laparoscópica bajo protocolo OFA durante el año 2018 en el H.U. Virgen de la Victoria (Málaga). Se recogieron variables para establecer el control hemodinámico y del dolor perioperatorio que se analizaron mediante Stata V.16. RESULTADOS: La edad media fue 43 años, el índice de masa corporal medio 48,14 y la estancia media en quirófano 178 minutos. El control de la respuesta hipertensiva tras la laringoscopia sucedió en el 88,1% de los casos. Al ingreso en la Unidad de Recuperación Post Anestésica (URPA), la SpO2 sin aporte suplementario en el traslado presentó una mediana de 97% con p75 ≥ 95%, mientras que el p75 de la evaluación del dolor mediante escala visual analógica (EVA) fue 3, con un 68% de pacientes sin dolor. Al alta de URPA, todos presentaron EVA menor de 4 y solo fue necesario administrar una dosis baja de petidina en siete pacientes. CONCLUSIÓN: La OFA ha resultado ser segura y conseguir un control del dolor óptimo. En los casos reconvertidos, el buen control de los parámetros abre la posibilidad de su utilización en cirugías más dolorosas
BACKGROUND: Patients subjected to bariatric surgery present a greater risk of complications due to the use of opioids. The goal is to evaluate the security and suitability of the Opioid Free Anaesthesia (OFA) protocol implemented in the Hospital Universitario Virgen de la Victoria in 2018. METHOD: Prospective study carried out on 38 patients subjected to laparoscopic bariatric surgery under the OFA protocol in the year 2018 at the H.U. Virgen de la Victoria (Málaga, Spain). Variables were gathered to establish haemodynamic control and perioperative pain, which were analysed using Stata V.16. RESULTS: The average age was 43 years, the average body mass index was 48.14 and the average stay in the operating theatre was 178 minutes. Control of hypertensive response following laryngoscopy occurred in 88.1% of the cases. On entering the Post Anaesthesia Care Unit (PACU), SpO2 without a supplementary contribution in the transfer showed a median of 97% with p75 ≥ 95%, while the p75 of pain evaluation by means of Visual Analogue Scale (VAS) was 3, with 68% of patients without pain. On discharge from the PACU, all presented VAS below 4 and it was only necessary to administer a low dose of Pethidine in seven patients. CONCLUSION: The OFA has proved to be secure and achieves optimum pain control. In the reconverted cases, good control of the parameters opens up the possibility of its use in more painful surgeries
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Analgésicos não Narcóticos/administração & dosagem , Cirurgia Bariátrica/métodos , Hospitais Universitários , Laparoscopia , Estudos Prospectivos , Período Perioperatório , Índice de Massa Corporal , Medição da Dor/efeitos dos fármacos , Medição da Dor/métodos , Dor Pós-OperatóriaRESUMO
BACKGROUND: Patients subjected to bariatric surgery present a greater risk of complications due to the use of opioids. The goal is to evaluate the security and suitability of the Opioid Free Anaesthesia (OFA) protocol implemented in the Hospital Universitario Virgen de la Victoria in 2018. METHOD: Prospective study carried out on 38 patients subjected to laparoscopic bariatric surgery under the OFA protocol in the year 2018 at the H.U. Virgen de la Victoria (Málaga, Spain). Variables were gathered to establish haemodynamic control and perioperative pain, which were analysed using Stata v.16. RESULTS: The average age was 43 years, the average body mass index was 48.14 and the average stay in the operating theatre was 178 minutes. Control of hypertensive response following laryngoscopy occurred in 88.1% of the cases. On entering the Post Anaesthesia Care Unit (PACU), SpO2 without a supplementary contribution in the transfer showed a median of 97% with p75 = 95%, while the p75 of pain evaluation by means of Visual Analogue Scale (VAS) was 3, with 68% of patients without pain. On discharge from the PACU, all presented VAS below 4 and it was only necessary to administer a low dose of Pethidine in seven patients. CONCLUSION: The OFA has proved to be secure and achieves optimum pain control. In the reconverted cases, good control of the parameters opens up the possibility of its use in more painful surgeries.
