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1.
Acta Anaesthesiol Scand ; 64(4): 494-500, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31883373

RESUMO

BACKGROUND: Postoperative delirium (POD) is a severe brain dysfunction. Although data indicate a high relevance, no survey has investigated the routine practice to monitor delirium outside the ICU setting after surgery. Prior to publishing of the new European Society of Anaesthesiology (ESA) guidelines on POD, an international survey was conducted to assess current practice. METHODS: European Society of Anaesthesiology-endorsed online survey; Trial Registration: NCT-identifier: 02513537. RESULTS: In total, 566 respondents from 62 countries accessed, and 564 (99.6%) completed the survey (completion rate). Overall, 385 (68%) of the respondents reported that delirium is either "very relevant" or "relevant" for their daily clinical practice. In all, 38 (7%) of the respondents routinely monitor for delirium in >50% of all patients. Asked on the monitoring time point, more than half (n = 308, 55%) indicated to screen before or at recovery room discharge, 235 (42%) up to the first postoperative day, 143 (25%) up to 3 days, and 77 (14%) up to 5 postoperative days. Although there is a lack of long-term monitoring, nearly all respondents (n = 530, 94%) reported to treat delirium. Availability of EEG/EMG-based monitoring to assess the depth of anaesthesia was high in the study group (n = 547, 97%) and was used by more than one-third of the respondents to reduce risk of burst suppression (n = 189, 34%). CONCLUSION: Although delirium is perceived as a relevant condition among anaesthesiologists, there is a high demand for implementing monitoring strategies after publishing of the POD Guideline. The survey shows that tools necessary for POD Guideline implementation are available in the centres represented by the respondents.

2.
Eur J Anaesthesiol ; 35(6): 407-465, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29708905

RESUMO

: The purpose of this update of the European Society of Anaesthesiology (ESA) guidelines on the pre-operative evaluation of the adult undergoing noncardiac surgery is to present recommendations based on the available relevant clinical evidence. Well performed randomised studies on the topic are limited and therefore many recommendations rely to a large extent on expert opinion and may need to be adapted specifically to the healthcare systems of individual countries. This article aims to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthesiologists all over Europe to integrate - wherever possible - this knowledge into daily patient care. The Guidelines Committee of the ESA formed a task force comprising members of the previous task force, members of ESA scientific subcommittees and an open call for volunteers was made to all individual active members of the ESA and national societies. Electronic databases were searched from July 2010 (end of the literature search of the previous ESA guidelines on pre-operative evaluation) to May 2016 without language restrictions. A total of 34 066 abtracts were screened from which 2536 were included for further analysis. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final draft guideline was posted on the ESA website for 4 weeks and the link was sent to all ESA members, individual or national (thus including most European national anaesthesia societies). Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.


Assuntos
Anestesiologia/normas , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Medicina Baseada em Evidências/normas , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/normas , Adulto , Europa (Continente) , Humanos , Assistência ao Paciente/normas
3.
Aging Clin Exp Res ; 30(3): 225-227, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29512043
4.
Aging Clin Exp Res ; 30(3): 229-235, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29446038

RESUMO

Universally recognized goals of preoperative anesthesia assessment are the evaluation of patient's health status to define the entity of the surgical risk, and the anticipation of possible complications while optimizing and planning preventive strategies. Data obtained by Comprehensive Geriatric Assessment (CGA) and frailty evaluation are of extreme usefulness in surgical risk evaluation in older patients and in the decision about surgery. It is from the team-based discussion of such results that the most appropriate treatment can be individuated, surgery invasiveness and duration critically analyzed and if needed modified, and the best perioperative strategy carefully tailored. These data should thus be used as reference points not only in preoperative assessment but also in planning the perioperative course, from pre-habilitation to adequate intraoperative management to complications prevention and care continuity after discharge. It is from such a far-seeing approach that issues emerged from preoperative evaluation can really contribute to decision-making about surgery in the elderly.


Assuntos
Anestesia , Avaliação Geriátrica , Cuidados Pré-Operatórios , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Fragilidade , Avaliação Geriátrica/métodos , Humanos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos
5.
Aging Clin Exp Res ; 30(3): 245-248, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29353441

RESUMO

Postoperative delirium (POD) is an adverse clinical outcome characterized by cognitive, affective and behavioral symptoms with typically an acute onset and a fluctuating course. POD is attributed to certain patients' predisposing factors as well as to treatment-related precipitating factors. While there are several single-component interventions for the prevention of POD, evolving evidence suggests the importance of a system approach in the prevention of POD. This involves strategies by multidisciplinary teams with additional geriatric consultation services to identify risk factors for POD and to modify their impact on the perioperative course. Some patients may profit from postponing an elective surgery and undergoing a prehabilitation program to optimize his/her resilience for the surgical and anesthesiologic stressors.


Assuntos
Delírio/etiologia , Complicações Pós-Operatórias/etiologia , Idoso , Humanos , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Fatores de Risco , Estresse Fisiológico
6.
Monaldi Arch Chest Dis ; 87(2): 842, 2017 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-28967724

RESUMO

Postoperative delirium (POD) is an acute organic cerebral disturbance of consciousness and attention in combination with additional cognitive symptoms. It usually develops shortly after surgery and lasts for some hours up to some days. It worsens clinical outcomes, prolongs the hospital stay and leads to negative trajectories of cognitive, emotional and functional outcomes up to month if not years after surgery. There are several known predisposing and precipitating factors. Several of them are influenceable. Offering optimal and safe care for an elderly surgery patient requires a team based approach. Strategies for reducing POD incidence include early detection of risk factors, adaptation of surgical and anaesthesiologic techniques, avoiding certain drugs, optimisation of haemostasis, continuously monitoring of the patients' cognitive status as well as early mobilization and careful management of eventual early signs of POD. If POD is prevented, it's negative trajectories may be likewise anticipated.


Assuntos
Cognição/fisiologia , Delírio/prevenção & controle , Complicações Pós-Operatórias/psicologia , Cuidados Pré-Operatórios/normas , Idoso , Idoso de 80 Anos ou mais , Delírio/diagnóstico , Delírio/epidemiologia , Deambulação Precoce/efeitos adversos , Deambulação Precoce/métodos , Diagnóstico Precoce , Humanos , Incidência , Cuidados Intraoperatórios/normas , Tempo de Internação , Cuidados Pós-Operatórios/normas , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco
8.
Eur J Anaesthesiol ; 34(4): 192-214, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28187050

RESUMO

The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care, postoperative detection of delirium and management of delirious patients. The scope of this guideline is not to cover ICU delirium. Considering that many medical disciplines are involved in the treatment of surgical patients, a team-based approach should be implemented into daily practice. This guideline is aimed to promote knowledge and education in the preoperative, intraoperative and postoperative setting not only among anaesthesiologists but also among all other healthcare professionals involved in the care of surgical patients.


Assuntos
Anestesiologia/normas , Delírio/prevenção & controle , Medicina Baseada em Evidências/normas , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Sociedades Médicas/normas , Anestesiologia/métodos , Consenso , Delírio/diagnóstico , Delírio/epidemiologia , Europa (Continente)/epidemiologia , Medicina Baseada em Evidências/métodos , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco
9.
Anesth Analg ; 114(6): 1190-215, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22467899

RESUMO

As the number of ambulatory surgery procedures continues to grow in an aging global society, the implementation of evidence-based perioperative care programs for the elderly will assume increased importance. Given the recent advances in anesthesia, surgery, and monitoring technology, the ambulatory setting offers potential advantages for elderly patients undergoing elective surgery. In this review article we summarize the physiologic and pharmacologic effects of aging and their influence on anesthetic drugs, the important considerations in the preoperative evaluation of elderly outpatients with coexisting diseases, the advantages and disadvantages of different anesthetic techniques on a procedural-specific basis, and offer recommendations regarding the management of common postoperative side effects (including delirium and cognitive dysfunction, fatigue, dizziness, pain, and gastrointestinal dysfunction) after ambulatory surgery. We conclude with a discussion of future challenges related to the growth of ambulatory surgery practice in this segment of our surgical population. When information specifically for the elderly population was not available in the peer-reviewed literature, we drew from relevant information in other ambulatory surgery populations.


Assuntos
Envelhecimento , Assistência Ambulatorial , Procedimentos Cirúrgicos Ambulatórios , Anestesia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/métodos , Anestesia/efeitos adversos , Anestesia/métodos , Comorbidade , Humanos , Pessoa de Meia-Idade , Seleção de Pacientes , Assistência Perioperatória , Complicações Pós-Operatórias/etiologia , Medição de Risco , Fatores de Risco , Resultado do Tratamento
10.
Curr Opin Anaesthesiol ; 23(6): 726-31, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20930621

RESUMO

PURPOSE OF REVIEW: Epidemiological data show a continuous expansion of elderly population, associated with an increased demand for surgical treatments by older patients. Geriatric anaesthesia is emerging as a new subspecialty. Outpatient anaesthesia for elderly patients requires greater specific knowledge and skills. Given the high economic and social pressure, anaesthetists will be requested to treat an increasing number of elderly as outpatients. RECENT FINDINGS: Functional status as a criterion for preoperative assessment of older patients has been introduced in the last years. In comparison to inpatient, outpatient setting seems to reduce the risk of postoperative cognitive disorders after surgery. Heart failure has shown to be an important risk factor of perioperative complication and death in the elderly; when more than mild, it contraindicates day surgery. Drug-eluting stents, which require a double antiaggregative therapy for 12 months after positioning, formally exclude patients from day surgery for that period. Sedation as a part of Monitored Anaesthesia Care (MAC) has shown to be potentially dangerous, due to increased risk of hypoxic complications and increased likelihood of cognitive disturbances. Effective postoperative pain treatment after geriatric day surgery requires careful pain assessment and drug titration. In the future, the development of telematic communication systems will extend indications. SUMMARY: Recent findings contribute to a better comprehension of the most important specificities of elderly patients undergoing day surgery and provide basic elements for a safe perioperative management in the outpatient setting.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Anestesia/métodos , Anestésicos/administração & dosagem , Avaliação Geriátrica/métodos , Dor Pós-Operatória/prevenção & controle , Cuidados Pré-Operatórios/métodos , Idoso , Idoso de 80 Anos ou mais , Humanos , Pacientes Ambulatoriais , Medição de Risco
11.
Curr Opin Anaesthesiol ; 19(6): 600-5, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17093362

RESUMO

PURPOSE OF REVIEW: After myorelaxants, myalgia and residual curarization may complicate recovery. Local anaesthesia and minimally invasive airway management make myorelaxants disputable in many outpatient procedures; nevertheless, neuromuscular blockade may be necessary to facilitate intubation or maintain muscle relaxation. Agent selection criteria are discussed. RECENT FINDINGS: Reduced hospital time is not associated with central neuraxial or peripheral nerve block. To reduce the risk for residual block, neuromuscular monitoring is mandatory. Use of reversal agents should not be restricted, although studies have shown higher incidence of postoperative nausea and vomiting following their use. Higher succinylcholine dosage is followed by lower incidence of myalgia. The relationship between fasciculation and myalgia is unclear. Sodium channel blockers or nonsteroidal antiinflammatory drugs may prevent myalgia. Sugammadex functions as a chelating agent. SUMMARY: Ear-nose-throat, open eye surgery and laparoscopy may demand myoresolution. Regional and minimally invasive anaesthesia are alternative solutions. Central and peripheral nerve blocks are associated with increased induction time, reduced pain scores, and decreased need for analgesics. Central neuraxial block, however, is associated with prolonged outpatient unit stay. Bad intubating conditions may cause pharyngo-laryngeal complications: the decision to avoid myorelaxants for tracheal intubation appears illogical. Incidence of postoperative residual curarization remains very high. Sugammadex offers new perspectives.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Anestesia por Condução , Anestesia Geral , Fármacos Neuromusculares Despolarizantes , Fármacos Neuromusculares não Despolarizantes , Anestesia por Condução/efeitos adversos , Anestesia Geral/efeitos adversos , Benzilisoquinolinas , Inibidores da Colinesterase/efeitos adversos , Humanos , Intubação Intratraqueal , Isoquinolinas , Mivacúrio , Relaxantes Musculares Centrais , Fármacos Neuromusculares Despolarizantes/efeitos adversos , Fármacos Neuromusculares não Despolarizantes/efeitos adversos , Dor Pós-Operatória/induzido quimicamente , Paralisia/induzido quimicamente , Paralisia/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Guias de Prática Clínica como Assunto , Medição de Risco , Esteroides , Succinilcolina , Sugammadex , gama-Ciclodextrinas/uso terapêutico
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