Traqueostomia: condutas e técnica / Tracheostomy: Conducts and Technique

A traqueostomia é um procedimento cirúrgico que objetiva permitir desobstrução das vias aéreas superiores do paciente com intuito de garantir a vida. O procedimento é realizado em situações de comprometimento do trato respiratório superior por tumores, cirurgias, traumas faciais graves ou infecções. A traqueostomia também é realizada para prevenir lesões laríngeas ou nas vias aéreas superiores causadas por intubação traqueal prolongada. O objetivo desse trabalho é apresentar técnicas e condutas corretas... (AU)

Tracheostomy is a surgical procedure that aims to allow unblocking of the patient's upper airways in order to ensure life. The procedure is performed in situations of involvement of the upper respiratory tract by tumors, surgery, severe facial trauma or infections. Tracheostomy is also performed to prevent laryngeal or upper airway injuries caused by prolonged tracheal intubation. The objective of this work is to present a techniques and correct conduct... (AU)

Surgical site infection in bariatric surgery: results of a care bundle. / Infecção de sítio cirúrgico após cirurgia bariátrica: resultados de uma abordagem com pacote de cuidados.

OBJECTIVE: to present a descriptive analysis of the results of a care bundle applied to obese patients submitted to bariatric surgery, regarding infection control. METHODS: a care bundle was designed to control surgical site infection (SSI) rates in patients undergoing bariatric surgery. The bundle included smoking cessation, bathing with 4% chlorhexidine two hours before surgery, cefazolin (2g bolus) in anesthetic induction associated with a continuous infusion of the same drug at a dose of 1g over a two-hour period, appropriate trichotomy, glycemic control, supplemental oxygen, normothermia, intraspinal morphine for the relief of pain, and sterile dressing removal 48 hours after surgery. All patients were followed up for 30 days. RESULTS: among the 1,596 included patients, 334 (20.9%) underwent open surgery and 1,262 (79.1%) underwent videolaparoscopic surgery. SSI rates were 0.5% in the group submitted to laparoscopic surgery and 3% in the one submitted to open surgery. The overall incidence of SSI was 1%. Intra-abdominal, respiratory tract, and urinary tract infections occurred in 0.9%, 1.1%, and 1.5% of the sample, respectively. Higher body mass index was associated with higher incidence of SSI (p=0.001). Among patients with diabetes, 2.2% developed SSI, while the rate of infection among non-diabetics was only 0.6%. CONCLUSION: the established care bundle, structured by core evidence-based strategies, associated with secondary measures, was able to maintain low SSI rates after bariatric surgery.

OBJETIVO: apresentar uma análise descritiva dos resultados de um pacote de cuidados aplicado em pacientes obesos submetidos à cirurgia bariátrica, no que diz respeito ao controle de infecção. MÉTODOS: um pacote de cuidados foi estruturado, visando a conter as taxas de infecção de sítio cirúrgico (ISC) em pacientes submetidos à cirurgia bariátrica. O pacote incluiu interrupção de tabagismo, banho com clorexidina 4% duas horas antes da cirurgia, cefazolina 2g em bolus na indução anestésica associada à administração da mesma droga com dose de 1g em infusão contínua, tricotomia apropriada, controle glicêmico, oxigênio suplementar, normotermia, controle da dor com morfina intrarraquidiana e remoção do curativo estéril 48 horas após a cirurgia. Todos os pacientes foram seguidos por 30 dias. RESULTADOS: entre os 1.596 pacientes incluídos, 334 (20,9%) foram submetidos à cirurgia aberta e 1.262 (79,1%) à cirurgia videolaparoscópica. As taxas de ISC foram de 0,5% no grupo submetido à cirurgia laparoscópica e de 3% nos submetidos à cirurgia aberta. A incidência geral de ISC foi de 1%. Infecções intra-abdominal, do trato respiratório e do trato urinário ocorreram em 0,9%, 1,1% e 1,5% da amostra, respectivamente. Faixas mais elevadas de índice de massa corporal foram associadas a maiores incidências de ISC (p=0,001). Entre os pacientes com diabetes, 2,2% desenvolveram ISC, enquanto a taxa de infecção entre os não diabéticos foi de apenas 0,6%. CONCLUSÃO: o pacote de cuidados instituído, estruturado por estratégias centrais baseadas em evidências, associadas à medidas secundárias, foi capaz de manter baixas taxas de ISC após cirurgia bariátrica.

Infecção de sítio cirúrgico após cirurgia bariátrica: resultados de uma abordagem com pacote de cuidados / Surgical site infection in bariatric surgery: results of a care bundle

RESUMO Objetivo: apresentar uma análise descritiva dos resultados de um pacote de cuidados aplicado em pacientes obesos submetidos à cirurgia bariátrica, no que diz respeito ao controle de infecção. Métodos: um pacote de cuidados foi estruturado, visando a conter as taxas de infecção de sítio cirúrgico (ISC) em pacientes submetidos à cirurgia bariátrica. O pacote incluiu interrupção de tabagismo, banho com clorexidina 4% duas horas antes da cirurgia, cefazolina 2g em bolus na indução anestésica associada à administração da mesma droga com dose de 1g em infusão contínua, tricotomia apropriada, controle glicêmico, oxigênio suplementar, normotermia, controle da dor com morfina intrarraquidiana e remoção do curativo estéril 48 horas após a cirurgia. Todos os pacientes foram seguidos por 30 dias. Resultados: entre os 1.596 pacientes incluídos, 334 (20,9%) foram submetidos à cirurgia aberta e 1.262 (79,1%) à cirurgia videolaparoscópica. As taxas de ISC foram de 0,5% no grupo submetido à cirurgia laparoscópica e de 3% nos submetidos à cirurgia aberta. A incidência geral de ISC foi de 1%. Infecções intra-abdominal, do trato respiratório e do trato urinário ocorreram em 0,9%, 1,1% e 1,5% da amostra, respectivamente. Faixas mais elevadas de índice de massa corporal foram associadas a maiores incidências de ISC (p=0,001). Entre os pacientes com diabetes, 2,2% desenvolveram ISC, enquanto a taxa de infecção entre os não diabéticos foi de apenas 0,6%. Conclusão: o pacote de cuidados instituído, estruturado por estratégias centrais baseadas em evidências, associadas à medidas secundárias, foi capaz de manter baixas taxas de ISC após cirurgia bariátrica.

ABSTRACT Objective: to present a descriptive analysis of the results of a care bundle applied to obese patients submitted to bariatric surgery, regarding infection control. Methods: a care bundle was designed to control surgical site infection (SSI) rates in patients undergoing bariatric surgery. The bundle included smoking cessation, bathing with 4% chlorhexidine two hours before surgery, cefazolin (2g bolus) in anesthetic induction associated with a continuous infusion of the same drug at a dose of 1g over a two-hour period, appropriate trichotomy, glycemic control, supplemental oxygen, normothermia, intraspinal morphine for the relief of pain, and sterile dressing removal 48 hours after surgery. All patients were followed up for 30 days. Results: among the 1,596 included patients, 334 (20.9%) underwent open surgery and 1,262 (79.1%) underwent videolaparoscopic surgery. SSI rates were 0.5% in the group submitted to laparoscopic surgery and 3% in the one submitted to open surgery. The overall incidence of SSI was 1%. Intra-abdominal, respiratory tract, and urinary tract infections occurred in 0.9%, 1.1%, and 1.5% of the sample, respectively. Higher body mass index was associated with higher incidence of SSI (p=0.001). Among patients with diabetes, 2.2% developed SSI, while the rate of infection among non-diabetics was only 0.6%. Conclusion: the established care bundle, structured by core evidence-based strategies, associated with secondary measures, was able to maintain low SSI rates after bariatric surgery.

Evaluation of nicotine patch in pain control of patients undergoing laparoscopic cholecystectomy.

OBJECTIVE: to analyze the effects of nicotine patch on pain control, occurrence of nausea and its hemodynamic repercussions in laparoscopic cholecystectomy procedures. METHODS: we conducted an analytical, prospective, randomized, triple-blinded, clinical study between January and July 2017. The sample consisted of 17 patients who underwent laparoscopic cholecystectomy for the treatment of cholelithiasis. Nine patients used nicotine patch, and eight, placebo patch. The studied variables were pain, nausea, patient satisfaction, blood pressure, heart rate, oximetry and morphine rescue. RESULTS: taking into account the pain and nausea parameters, there was no statistically significant difference between the groups (p>0.05). Also, the evaluation of rescue medication, both opioids and prokinetics, did not show any significant statistical difference between the groups. Among the hemodynamic parameters, there was only one statistically significant difference in the analysis of oxygen saturation and systolic blood pressure (SBP) six hours after surgery: the mean oxygen saturation was higher in the Test group (97.89 x 95.88) and the mean SBP was higher in the Control group (123.89 x 110.0). CONCLUSION: although pain levels were lower for nicotine within 24 hours, the action of nicotine and the need for rescue opioids in pain control were not statistically significant between the groups and at the time intervals studied. There was no clinical repercussion in the hemodynamic parameters.

Evaluation of nicotine patch in pain control of patients undergoing laparoscopic cholecystectomy / Avaliação do adesivo de nicotina no controle da dor em pacientes submetidos à colecistectomia videolaparoscópica

ABSTRACT Objective: to analyze the effects of nicotine patch on pain control, occurrence of nausea and its hemodynamic repercussions in laparoscopic cholecystectomy procedures. Methods: we conducted an analytical, prospective, randomized, triple-blinded, clinical study between January and July 2017. The sample consisted of 17 patients who underwent laparoscopic cholecystectomy for the treatment of cholelithiasis. Nine patients used nicotine patch, and eight, placebo patch. The studied variables were pain, nausea, patient satisfaction, blood pressure, heart rate, oximetry and morphine rescue. Results: taking into account the pain and nausea parameters, there was no statistically significant difference between the groups (p>0.05). Also, the evaluation of rescue medication, both opioids and prokinetics, did not show any significant statistical difference between the groups. Among the hemodynamic parameters, there was only one statistically significant difference in the analysis of oxygen saturation and systolic blood pressure (SBP) six hours after surgery: the mean oxygen saturation was higher in the Test group (97.89 x 95.88) and the mean SBP was higher in the Control group (123.89 x 110.0). Conclusion: although pain levels were lower for nicotine within 24 hours, the action of nicotine and the need for rescue opioids in pain control were not statistically significant between the groups and at the time intervals studied. There was no clinical repercussion in the hemodynamic parameters.

RESUMO Objetivo: analisar os efeitos do adesivo de nicotina sobre o controle da dor, ocorrência de náuseas e suas repercussões hemodinâmicas em cirurgias de colecistectomia videolaparoscópica. Métodos: estudo analítico, do tipo ensaio clínico, prospectivo, randomizado e triplo-cego realizado entre janeiro e julho de 2017. A amostra foi composta de 17 pacientes em pós-operatório de colecistectomia videolaparoscópica para tratamento de colelitíase. Nove pacientes fizeram uso do adesivo com nicotina e oito de adesivo placebo. As variáveis estudadas foram: dor, náusea, satisfação do paciente, pressão arterial, frequência cardíaca, oximetria e resgate de morfina. Resultados: levando em consideração os parâmetros dor e náuseas, não houve diferença estatisticamente significativa entre os grupos (p>0,05). Ainda, a avaliação da medicação de resgate, tanto opioide como procinéticos, também não evidenciou diferença estatística relevante entre os grupos. Dentre os parâmetros hemodinâmicos, só houve diferença estatística nas análises da saturação de oxigênio e da pressão arterial sistólica (PAS) seis horas após a cirurgia: a média da saturação de oxigênio foi maior no grupo Teste (97,89 x 95,88) e a média da PAS foi maior no grupo Controle (123,89 x 110,0). Conclusão: apesar dos níveis de dor terem sido menores para nicotina no intervalo de 24 horas, a ação da nicotina e a necessidade de opioide de resgate no controle da dor não foram estatisticamente significantes entre os grupos e intervalos de tempo estudados. Não houve repercussão clínica nos parâmetros hemodinâmicos.

Hemimandibulectomia como tratamiento de ameloblastoma multiquístico / Hemimandibulectomy as multicystic ameloblastoma treatment

Ameloblastoma es un tumor de origen odontogénica que presenta crecimiento lento como una de las características principales, localmente invasivo y raramente causa metástasis. Pueden alcanzar grandes dimensiones si no tratado precozmente, convirtiéndose en un desafío su exéresis y reconstrucción en fases más avanzadas. El actual artículo tiene como objetivo relatar un caso clínico de un ameloblastoma multiquístico que afecta toda la región de la mandíbula derecha, en la cual fue realizado hemimandibulectomia, seguido de una reconstrucción con placa de 2.4mm y prótesis de cóndilo mandibular confeccionada en resina acrílica termopolimerizada, cubierta por el colgajo del músculo esternocleidomastoideo

The ameloblastoma is a tumor of odontogenic origin that present as main characteristics slow growth, locally invasive and they rarely cause metastasis. They can reach great dimensions if relegated the precocious treatment, turning his it complete removal and reconstruction in more advanced phases. The present article has as objective tells the clinical case of an ameloblastoma multicístico involving every area right mandibular, in which hemimandibulectomy was accomplished, following by reconstruction with plate 2.4mm and prosthesis of mandibular condylar made in resin acrylic thermopolimerizate, associated to shred of the muscle externocleidomastoideo

Treatment of chronic mandibular dislocations by eminectomy: Follow-up of10 cases and literature review

Introduction: Temporomandibular joint (TMJ) dislocation is defined as an excessive forward movement of thecondyle beyond the articular eminence, with complete separation of the articular surfaces and fixation in thatposition.Objectives: To report ten cases treated by eminectomy for chronic mandibular dislocations, to evaluate the resultsof these surgeries and make a critical review of the literature.Methods: The sample was obtained from the records of the Department of Oral and Maxillofacial Surgery, Universityof Pernambuco and comprises cases submitted to chronic mandibular dislocation treatment by eminectomybetween 2002 and 2007. Pre- and postoperative assessment included a thorough history and physical examinationto determine the maximal mouth opening, presence of pain and sounds, frequency of luxations, recurrence rateand presence of facial nerve paralysis.Results: The mean maximal mouth opening in the preoperative period was 48.4 ± 8.5 mm and in the postoperativeperiod it was 41.3 ± 5.0 mm. No facial nerve paralysis or recurrence was observed.Conclusion: The treatment of chronic mandibular dislocations by eminectomy was shown to be efficient in relationshipto the postoperative maximal mouth opening, recurrence and articular function (AU)

Treatment of chronic mandibular dislocations by eminectomy: follow-up of 10 cases and literature review.

INTRODUCTION: Temporomandibular joint (TMJ) dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence, with complete separation of the articular surfaces and fixation in that position. OBJECTIVES: To report ten cases treated by eminectomy for chronic mandibular dislocations, to evaluate the results of these surgeries and make a critical review of the literature. METHODS: The sample was obtained from the records of the Department of Oral and Maxillofacial Surgery, University of Pernambuco and comprises cases submitted to chronic mandibular dislocation treatment by eminectomy between 2002 and 2007. Pre- and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of luxations, recurrence rate and presence of facial nerve paralysis. RESULTS: The mean maximal mouth opening in the preoperative period was 48.4 +/- 8.5 mm and in the postoperative period it was 41.3 +/- 5.0 mm. No facial nerve paralysis or recurrence was observed. CONCLUSION: The treatment of chronic mandibular dislocations by eminectomy was shown to be efficient in relationship to the postoperative maximal mouth opening, recurrence and articular function.

Princípios bioéticos na cirurgia de terceiro molar incluso em adolescentes e adultos jovens / Bioetics principles in the impacted molar third surgery in adolescents and young Adults

OBJETIVO: Há pouca controvérsia sobre o valor de remover os terceiros molares inclusos que causam alterações patológicas ou sintomas severos. No entanto,a remoção profilática tem sido discutida e estudada por muitos anos. O manuscrito objetivou discutir, através de uma revisão bibliográfica ampla,se a remoção profilática de terceiros molares inclusos,diante da evidência científica,é benéfica ou não ao paciente. MATERIAL E MÉTODOS: As bases de dados Cochrane, LILACS e BBO foram consultadas através do portal da BIREME e a base de dados MEDLINE (1966-2005) foi consultada através da PUBMED. Os artigos foram classificados de acordo com níveis de evidência. RESULTADO: Treze artigos que estavam de acordo os níveis de evidência preestabelecidos foram selecionados. CONCLUSÃO: Não há estudos de qualidade suficiente que afirmem que a remoção profilática dos terceiros molares é maléfica ou benéfica ao paciente.

PURPOSE: There is no controversy about removal of symptomatic impacted third molars. Therefore the prophylactic removal has been discussed and studied for many years. The manuscript evaluated if prophylactic removal of asymptomatic impacted wisdom teeth is beneficial or not to the patient making a literature review. MATERIAL AND METHODS: The Cochrane, LILACS and BBO databases were searched through the bireme portal and the MEDLINE database (1966-2005) searched by PUBMED portal. RESULTS: Thirteen articles were selected according to the preestablished evidence levels. CONCLUSION: No evidenced based studies were found to support that prophylactic removal of asymptomatic impacted wisdom teeth is beneficial or not to the patient.

Aspirações positivas em anestesias por bloqueio do nervo alveolar inferior / Positive Aspiration in Anesthesia for Inferior Alveolar Nerve Block

O objetivo deste presente trabalho é, através de uma revisão bibliográfica, estabelecer os riscos de aspirações positivas decorrentes do bloqueio do nervo alveolar inferior bem como alertar os que fazem uso da anestesia local sobre a fundamental importância da aspiração da solução anestésica antes e durante sua administração. Como decorrência da revisão de literatura e da discussão empreendida, concluiu-se que a utilização da seringa de refluxo passivo é a forma mais segura de prevenção da injeção intravascular e das reações adversas atribuídas à overdose