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1.
Int J Chronic Dis ; 2019: 9418971, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31187034

RESUMO

Background: The quick sequential organ failure assessment (qSOFA) and the Eastern Cooperative Oncologic Group (ECOG) scale are simple and easy parameters to measure because they do not require laboratory tests. The objective of this study was to compare the discriminatory capacity of the qSOFA and ECOG to predict hospital mortality in postsurgical cancer patients without infection. Methods: During the period 2013-2017, we prospectively collected data of all patients without infection who were admitted to the ICU during the postoperative period, except those who stayed in the ICU for <24 hours or patients under 18 years. The ECOG score during the last month before hospitalization and the qSOFA performed during the first hour after admission to the intensive care unit (ICU) were collected. The primary outcome for this study was the in-hospital mortality rate. Results: A total of 315 patients were included. The ICU and hospital mortality rates were 6% and 9.2%, respectively. No difference was observed between the qSOFA [AUC=0.75 (95% CI = 0.69-0.79)] and the ECOG scores [AUC=0.68 (95%CI =0.62-0.73)] (p=0.221) for predicting in-hospital mortality. qSOFA greater than 1 predicted in-hospital mortality with a high sensitivity (100%) but low specificity (38.8%); positive predictive value of 26.3% and negative predictive value of 93.1% compared to 74.4% of specificity, 55.1% of sensitivity%; positive predictive value of 18% and negative predictive value of 94.2% for an ECOG score greater than 1. Multivariable Cox regression analysis identified two independent predicting factors of in-hospital mortality, which included ECOG score during the last month before hospitalization (HR: 1.46; 95 % CI: 1.06-2.00); qSOFA calculated in the first hours after ICU admission (OR: 3.17; 95 % CI: 1.79-5.63). Conclusion: No difference was observed between the qSOFA and ECOG for predicting in-hospital mortality. The qSOFA score performed during the first hour after admission to the ICU and ECOG scale during the last month before hospitalization were associated with in-hospital mortality in postsurgical cancer patients without infection. The qSOFA and ECOG score have a potential to be included as early warning tools for hospitalized postsurgical cancer patients without infection.

3.
Gac Med Mex ; 154(2): 172-179, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-29733072

RESUMO

Introduction: Hospitalized patients are susceptible to medication errors, which represent between the fourth and the sixth cause of death. The department of intra-hospital pharmacovigilance intervenes in the entire process of medication with the purpose to prevent, repair and assess damages. Objective: To analyze medication errors reported by Mexican Fundación Clínica Médica Sur pharmacovigilance system and their impact on patients. Method: Prospective study carried out from 2012 to 2015, where medication prescriptions given to patients were recorded. Owing to heterogeneity, data were described as absolute numbers in a logarithmic scale. Results: 292 932 prescriptions of 56 368 patients were analyzed, and 8.9% of medication errors were identified. The treating physician was responsible of 83.32% of medication errors, residents of 6.71% and interns of 0.09%. No error caused permanent damage or death. Conclusion: This is the pharmacovigilance study with the largest sample size reported.


Assuntos
Hospitais , Erros de Medicação/prevenção & controle , Farmacovigilância , Humanos , Estudos Prospectivos
4.
Arch Cardiol Mex ; 88(3): 219-224, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29606490

RESUMO

Takotsubo Cardiomyopathy mainly occurs in postmenopausal women, with or without cardiovascular disease, and is commonly associated with emotional or physical stress. After nearly 27 years of extensive efforts towards a better understanding of this disorder, current knowledge remains limited. Many people suffer post-traumatic stress, and this situation can be associated to stress cardiomyopathy. The case is presented of a female who suffers stress associated with the earthquake of 19 September 2017 in Mexico City, and arrived in the Emergency Department in cardiogenic shock.


Assuntos
Terremotos , Serviço Hospitalar de Emergência , Choque Cardiogênico/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Idoso , Feminino , Humanos , México , Choque Cardiogênico/etiologia , Cardiomiopatia de Takotsubo/etiologia
5.
Ultrasound Q ; 34(4): 219-225, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29683962

RESUMO

Pulmonary ultrasonography is a complementary study that is easy to perform at the patient bedside with no need to transfer the patient to special areas. The technique provides information with high sensitivity and specificity for different pathologies. Pulmonary ultrasonography is a very important diagnostic tool in the assessment of lung, pleural, and chest wall diseases. Pulmonary ultrasound provides low-cost analysis, easy real-time reproduction, and safety, all of which have made it a beneficial tool in the diagnostic arsenal available to medical personnel. The purpose of this review was to describe the usefulness of pulmonary ultrasound in critical areas.


Assuntos
Cuidados Críticos/métodos , Pneumopatias/diagnóstico por imagem , Ultrassonografia/métodos , Humanos , Pulmão/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Sensibilidade e Especificidade
6.
Biomed Res Int ; 2017: 3702605, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29214164

RESUMO

Purpose: To evaluate the clinical characteristics and outcomes of critically ill patients with testicular cancer (TC) admitted to an oncological intensive care unit (ICU). Methods: This was a prospective observational study. There were no interventions. Results: During the study period, 1,402 patients with TC were admitted to the Department of Oncology, and 60 patients (4.3%) were admitted to the ICU. The most common histologic type was nonseminomatous germ cell tumors (55/91.7%). The ICU, hospital, and 6-month mortality rates were 38.3%, 45%, and 63.3%, respectively. The Cox multivariate analysis identified the white blood cells count (HR = 1.06, 95% CI = 1.01-1.11, and P = 0.005), ionized calcium (iCa) level (HR = 1.23, 95% CI = 1.01-1.50, and P = 0.037), and 2 or more organ failures during the first 24 hours after ICU admission (HR = 3.86, 95% CI = 1.96-7.59, and P < 0.001) as independent predictors of death for up to 6 months. Conclusion: The ICU, hospital, and 6-month mortality rates were 38.3%, 45%, and 63.3%, respectively. The factors associated with an increased 6-month mortality rate were white blood cells count, iCa level, and 2 or more organ failures during the first 24 hours after ICU admission.


Assuntos
Estado Terminal/mortalidade , Neoplasias Testiculares/mortalidade , Neoplasias Testiculares/patologia , Adulto , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Análise Multivariada , Neoplasias Embrionárias de Células Germinativas/mortalidade , Neoplasias Embrionárias de Células Germinativas/patologia , Estudos Prospectivos
7.
Mol Clin Oncol ; 7(5): 747-750, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29142747

RESUMO

The aim of the present study was to investigate the incidence of organ dysfunction, and to describe the clinical characteristics and intensive care unit (ICU) outcomes of critically ill cancer patients who were admitted to an oncological ICU during the isolated limb perfusion post-operative period. The present study was an observational investigation of 42 critically ill cancer patients who were admitted to the ICU of the Instituto Nacional de Cancerología, during the isolated limb perfusion post-operative period, between July 2010 and February 2016. The mean age of the patients was 45.7±16.9 years, and 45.2% (19 cases) were female. Soft tissue sarcoma was the most common pre-operative diagnosis (38.1%), and the mean duration of surgery was 267.6±50.1 min. Furthermore, a mean blood loss volume of 732.3±526.1 ml during the procedure was recorded, and the patients received a mean volume of 3.88±1.28 l crystalloid fluid during the surgical procedure, subsequently requiring an additional 2.95±6.28 l on the first post-operative day. The incidence of organ dysfunction was 90.5% and was most frequently noted in the respiratory (81%), hepatic (33%), hematologic (31%) and renal (11.9%) systems. No patients succumbed to the disease during the ICU and hospital stay. Nevertheless, <10% of the patients required vasopressors. Additionally, <5% of the patients required invasive mechanical ventilation. Therefore, ICU admission directly following isolated limb perfusion should not be standardized.

8.
Ther Clin Risk Manag ; 10: 139-45, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24600229

RESUMO

INTRODUCTION: Hypoxic hepatitis (HH) is observed frequently in intensive care units. Information in the cardiac intensive care unit (CICU) is limited. The aim of this study was to analyze the clinical course and outcomes of HH in the specific setting of the CICU. METHODS: We analyzed records of patients with HH admitted to the CICU (Group 1). Data were collected and compared with those of an intermediate group of patients with altered liver test results that did not meet the HH criteria who had a serum aminotransferase level of five to ≤20 times the upper-normal limit (Group 2), and with a control group who had an aminotransferase level less than five times the upper-normal limit (Group 3). RESULTS: PATIENTS WITH HH EXHIBITED A WORSE HEMODYNAMIC PROFILE AND MORE OF THESE PATIENTS WERE IN SHOCK: 17 (94.4%) in Group 1, 14 (77.8%) in Group 2, and seven (38.9%) in Group 3 (P=0.001). Cardiogenic shock was the most frequent event: 12 (66.7%) in Group 1, 13 (72.2%) in Group 2, and six (33.3%) in Group 3 (P=0.006). The mortality rate was 55.6%. Mechanical ventilation was an independent factor associated with death (odds ratio 12.25, 95% confidence interval 1.26-118.36). CONCLUSION: The mortality rate of patients with HH in CICU is high and is associated with ventilatory disturbances.

9.
Case Rep Emerg Med ; 2013: 634174, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24027645

RESUMO

Background and Aim. Levetiracetam is a second-generation antiepileptic drug. It is approved as an adjunctive treatment of partial onset seizures with or without secondary generalization. It is considered safe with less than 1% of patients with transient elevations of liver enzymes. Methods. We report a case of acute liver failure secondary to Levetiracetam in combination with Lacosamide documented with a liver biopsy. Results. Liver biopsy demonstrated acute liver injury with a predominant submassive necrosis pattern and features of a drug-induced hepatitis. Conclusions. This is the first published case of acute liver failure due to antiepileptic therapy with Levetiracetam in combination with Lacosamide.

10.
PLoS One ; 6(7): e22581, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21818342

RESUMO

BACKGROUND AND AIM: Intraoperative blood loss is a frequent complication of hepatic resection and orthotopic liver transplantation. Recombinant activated coagulation factor VII (rFVIIa) is a coagulation protein that induces hemostasis by directly activating factor X. There is no clear information about the prophylactic value of rFVIIa in hepatobiliary surgery, specifically in liver resection and orthotopic liver transplantation. The aim of this study was to assess the effect of rFVIIa prophylaxis to prevent mortality and bleeding resulting from hepatobiliary surgery. METHODS: Relevant randomized trials were identified by searching The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index. Randomized clinical trials comparing different rFVIIa prophylactic schemas against placebo or no intervention to prevent bleeding in hepatobiliary surgery were included. Adults undergoing liver resection, partial hepatectomy, or orthotopic liver transplantation were included. Dichotomous data were analyzed calculating odds ratios (ORs) and 95% confidence intervals (CIs). Continuous data were analyzed calculating mean differences (MD) and 95% CIs. RESULTS: Four randomized controlled trials were included. There were no significant differences between rFVIIa and placebo for mortality (OR 0.96; 95% CI 0.35-2.62), red blood cell units (MD 0.32; 95% CI -0.08-0.72) or adverse events (OR 1.55; 95% CI 0.97-2.49). CONCLUSIONS: The available information is limited, precluding the ability to draw conclusions regarding bleeding prophylaxis in hepatobiliary surgery using rFVIIa. Although an apparent lack of effect was observed in all outcomes studied, further research is needed.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Fator VIIa/uso terapêutico , Transplante de Fígado/efeitos adversos , Fígado/cirurgia , Perda Sanguínea Cirúrgica/mortalidade , Ensaios Clínicos como Assunto , Humanos , Fígado/patologia , Transplante de Fígado/mortalidade , Viés de Publicação , Proteínas Recombinantes/uso terapêutico , Resultado do Tratamento
12.
Crit Care Med ; 35(1): 280-5, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17133184

RESUMO

OBJECTIVE: To report the development of myocardial stunning and severe heart failure after lightning strike with total recovery of function. DESIGN: Case report. SETTING: Coronary care unit at Medica Sur Clinic, Mexico. PATIENT: A 42-yr-old woman who was hit by lightning developed rapid and progressive hemodynamic deterioration manifested by cardiogenic shock that required invasive monitoring. Twenty-four hours after the strike, intravenous levosimendan and intra-aortic balloon pump were initiated because the patient demonstrated no significant response to management with conventional inotropic agents. Two days later, echocardiographic signs of systolic and diastolic dysfunction improved markedly. Dual-isotope-imaging myocardial perfusion testing with technetium-99m-sestamibi and thallium-201, performed 9 days after admission, showed normal perfusion and normal left ventricular systolic function. The patient exhibited complete recovery of function. The exact mechanism of abnormal contractility in the absence of direct electrofulguration is unknown but may be explained by release of oxygen free radicals, proteolysis of the contractile apparatus, and cytosolic overload of intracellular calcium, followed by reduced myofilament sensitivity to calcium. These abnormalities are consistent with stunned myocardium. CONCLUSIONS: Lightning strike may cause serious contractile dysfunction in the absence of irreversible myocardial injury, but the exact mechanism of this phenomenon remains unknown. We propose that lighting strike can cause myocardial stunning resulting in severe but reversible left ventricular dysfunction. The patient's recovery was facilitated by support treatment including administration of levosimendan, which increases the intracellular sensitivity to calcium, a mechanism disturbed in patients with myocardial stunning.


Assuntos
Lesões por Ação do Raio/complicações , Miocárdio Atordoado/diagnóstico , Miocárdio Atordoado/etiologia , Adulto , Cardiotônicos/uso terapêutico , Causalidade , Cuidados Críticos/métodos , Progressão da Doença , Ecocardiografia , Eletrocardiografia , Epilepsia Tônico-Clônica/etiologia , Teste de Esforço , Feminino , Humanos , Hidrazonas/uso terapêutico , Balão Intra-Aórtico , Monitorização Fisiológica , Miocárdio Atordoado/fisiopatologia , Miocárdio Atordoado/terapia , Piridazinas/uso terapêutico , Compostos Radiofarmacêuticos , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Choque Cardiogênico/etiologia , Simendana , Tecnécio Tc 99m Sestamibi , Tálio , Disfunção Ventricular Esquerda/etiologia
13.
Arch Cardiol Mex ; 75 Suppl 3: S3-130-9, 2005.
Artigo em Espanhol | MEDLINE | ID: mdl-16366178

RESUMO

Congestive heart failure is a long standing health issue. Traditionally, heart failure has been treated with a wide array of drugs such as diuretics, digitalis, catecholamine and non catecholamine inotropics, although treatment with these drugs bears adverse effects, such as the generation of arrhythmia and even death. A new class of drugs has recently exerted a positive impact on the treatment of patients with heart failure; these are the calcium sensitizers that enhance myocardial contractility without increasing cytosolic calcium. Levosimendan is a calcium sensitizer that, besides increasing contractility, has a vasodilating effect due to the activation of K(ATP) channels, being both mechanisms responsible for an advantageous therapeutic option. Different studies have proven the efficiency and safety profile of the drug on various scenarios and populations; thereby considering levosimendan a real and safe alternative treatment for patients with acute or chronic ventricular failure that need intravenous pharmacological support.


Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Hidrazonas/uso terapêutico , Piridazinas/uso terapêutico , Vasodilatadores/uso terapêutico , Hemodinâmica/efeitos dos fármacos , Humanos , Simendana
14.
Arch Cardiol Mex ; 75(3): 260-6, 2005.
Artigo em Espanhol | MEDLINE | ID: mdl-16294814

RESUMO

OBJECTIVE: To determine the impact of the intra-aortic balloon pump in the mortality due to cardiogenic shock post-acute myocardial infarction. METHODS: In a two-year period, 292 patients with acute myocardial infarction were admitted to the coronary intensive care unit, 40 were included in the study. Afterwards, patients were divided in two groups: early cardiogenic and late cardiogenic shock, and they were assigned randomly and blind to treatment with inotropics and inotropics plus intra-aortic balloon pump. RESULTS: There were significant differences in the measurements of pulmonary wedge pressure (20.4 +/- 1.6 vs 24.4 +/- 1.50, p = 0.0004) and the cardiac index (2.06 +/- 0.7 vs 1.65 +/- 0.18, p = 0.0002) between the two groups. The late cardiogenic shock group showed an increased mortality (25.9% vs 61.5%, p < 0.05). Patients treated with inotropics + balloon, in both early and late shock groups, showed a reduction in mortality of 66% and 69%, respectively. CONCLUSIONS: The use of the intra-aortic balloon pump in the treatment of cardiogenic shock post acute myocardial infarction reduces the mortality when associated with the use of inotropics and reperfusion.


Assuntos
Balão Intra-Aórtico , Infarto do Miocárdio/complicações , Choque Cardiogênico/mortalidade , Choque Cardiogênico/terapia , Idoso , Cardiotônicos/administração & dosagem , Cardiotônicos/uso terapêutico , Unidades de Cuidados Coronarianos , Interpretação Estatística de Dados , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Choque Cardiogênico/tratamento farmacológico , Choque Cardiogênico/etiologia , Fatores de Tempo
15.
Arch. cardiol. Méx ; 75(3): 260-266, jul.-sep. 2005. graf, tab
Artigo em Espanhol | LILACS | ID: lil-631899

RESUMO

Propósito del trabajo: Determinar el impacto del balón intra-aórtico de contrapulsación en la mortalidad por choque cardiogénico postinfarto agudo del miocardio. Método: 292 pacientes con infarto agudo del miocardio ingresaron a la unidad de cuidados intensivos coronarios en el período comprendido de febrero de 2001 a febrero del 2003, de los cuales 40 cumplieron los criterios de inclusión y exclusión, posteriormente fueron divididos en 2 grupos: choque cardiogénico temprano y tardío, se les asignó al azar y de forma ciega a recibir tratamiento a base de inotrópicos aislados e inotrópicos más balón intra-aórtico de contrapulsación. Resultados: Se observaron diferencias significativas en ambos grupos en los valores de la presión en cuña de la pulmonar (20.4 ± 1.6 vs 24.4 ± 1.50, p = 0.0004) y el índice cardíaco (2.06 ± 0.7 vs 1.65 ± 0.18, p = 0.0002). El grupo de choque tardío presentó una mayor mortalidad (25.9% vs 61.5%, p < 0.05), los pacientes que recibieron apoyo con balón mostraron una disminución en la mortalidad del 66% y 69% en choque temprano y tardío respectivamente. Conclusiones: El uso del balón intra-aórtico de contrapulsación en los pacientes que desarrollan choque cardiogénico post IAM disminuye la mortalidad, como coadyuvante con el uso de inotrópicos y angioplastía primaria.


Objective: To determine the impact of the intra-aortic balloon pump in the mortality due to cardiogenic shock post-acute myocardial infarction. Methods: In a two-year period, 292 patients with acute myocardial infarction were admitted to the coronary intensive care unit, 40 were included in the study. Afterwards, patients were divided in two groups: early cardiogenic and late cardiogenic shock, and they were assigned randomly and blind to treatment with inotropics and inotropics plus intra-aortic balloon pump. Results: There were significant differences in the measurements of pulmonary wedge pressure (20.4 ± 1.6 vs 24.4 ± 1.50, p = 0.0004) and the cardiac index (2.06 ± 0.7 vs 1.65 ± 0.18, p = 0.0002) between the two groups. The late cardiogenic shock group showed an increased mortality (25.9% vs 61.5%, p < 0.05). Patients treated with inotropics + balloon, in both early and late shock groups, showed a reduction in mortality of 66% and 69%, respectively. Conclusions: The use of the intra-aortic balloon pump in the treatment of cardiogenic shock post acute myocardial infarction reduces the mortality when associated with the use of inotropics and reperfusion. (Arch Cardiol Mex 2005; 75: 260-266).


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Balão Intra-Aórtico , Infarto do Miocárdio/complicações , Choque Cardiogênico/mortalidade , Choque Cardiogênico/terapia , Unidades de Cuidados Coronarianos , Cardiotônicos/administração & dosagem , Cardiotônicos/uso terapêutico , Interpretação Estatística de Dados , Eletrocardiografia , Choque Cardiogênico/tratamento farmacológico , Choque Cardiogênico/etiologia , Fatores de Tempo
16.
Arch. cardiol. Méx ; 75(supl.3): 130-139, jul.-sep. 2005. tab
Artigo em Espanhol | LILACS | ID: lil-631933

RESUMO

La insuficiencia cardíaca congestiva se ha considerado como un grave problema de salud. De manera tradicional, la insuficiencia cardíaca ha sido manejada con diferentes fármacos, como son los diuréticos, digital, inotrópicos del tipo de las catecolaminas y no catecolaminas; sin embargo, el manejo de los mismos, también tienen efectos secundarios en donde se incluyen la génesis de las arritmias e incluso la muerte. Un nuevo grupo de drogas recientemente ha impactado en el manejo de los pacientes con insuficiencia cardíaca aguda y crónica, estos son los sensibilizadores de calcio, que actúan incrementando la contractilidad miocárdica, sin aumentar la liberación del calcio citosólico. El levosimendan, es un sensibilizador de calcio que además de aumentar la contractilidad, posee efecto vasodilatador por activación de los canales de K(ATP), siendo ambos mecanismos los que ofrecen una opción terapéutica en la falla cardíaca. Varios estudios han comprobado la eficacia y seguridad de la droga en diferentes estadios y poblaciones, por lo que se considera en la actualidad que el uso del levosimendan es una alternativa real y segura de tratamiento en aquellos pacientes con falla ventricular aguda o crónica que necesiten soporte farmacológico endovenoso.


Congestive heart failure is a long standing health issue. Traditionally, heart failure has been treated with a wide array of drugs such as diuretics, digitalis, catecholamine and non catecholamine inotropics, although treatment with these drugs bears adverse effects, such as the generation of arrhythmia and even death. A new class of drugs has recently exerted a positive impact on the treatment of patients with heart failure; these are the calcium sensitizers that enhance myocardial contractility without increasing cytosolic calcium. Levosimendan is a calcium sensitizer that, besides increasing contractility, has a vasodilating effect due to the activation of K(ATP) channels, being both mechanisms responsible for an advantageous therapeutic option. Different studies have proven the efficiency and safety profile of the drug on various scenarios and populations; thereby considering levosimendan a real and safe alternative treatment for patients with acute or chronic ventricular failure that need intravenous pharmacological support.


Assuntos
Humanos , Insuficiência Cardíaca/tratamento farmacológico , Hidrazonas/uso terapêutico , Piridazinas/uso terapêutico , Vasodilatadores/uso terapêutico , Hemodinâmica/efeitos dos fármacos
17.
Arch Cardiol Mex ; 72(3): 249-60, 2002.
Artigo em Espanhol | MEDLINE | ID: mdl-12418301

RESUMO

Vasopressin is secreted by the neurohypophysis influenced by many variables; among them the most important and known is the osmotic pressure (osmotic regulation) of body fluid. Other factors that modify this hormone's secretion are changes in blood volume and blood pressure, which contribute significantly to hemodynamic recovery. Vasopressin receptors are located in different sites, and their stimulation generate also generates different physiological responses. The receptors are of two types, V1 and V2. The usefulness of exogenous vasopressin has been proven in many clinical situations, refractory cardiac arrest, septic shock, vasodilator shock, postcardiotomy shock, and vasoplegic shock, with promising results. At present, enough scientific support exists for the use of this antidiuretic hormone (vasopressin) in clinical practice.


Assuntos
Parada Cardíaca/tratamento farmacológico , Choque Cardiogênico/tratamento farmacológico , Choque Séptico/tratamento farmacológico , Vasopressinas/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/fisiopatologia , Hemodinâmica/fisiologia , Humanos , Receptores de Vasopressinas/fisiologia , Vasopressinas/metabolismo , Vasopressinas/fisiologia
18.
Rev. mex. anestesiol ; 21(4): 258-72, oct.-dic. 1998. graf, tab
Artigo em Espanhol | LILACS | ID: lil-248395

RESUMO

La frecuencia de incidentes o accidentes críticos son difíciles de determinar debido a que éstos son raros y algunos de ellos no se encuentran reportados. Existen ciertos estudios que han examinado éstos incidentes o accidentes durante anestesia. En un estudio clásico, Cooper y cols, entrevistaron al personal de anestesia de manera retrospectiva y encontraron 345 incidentes críticos previsibles. Algunas personas argumentan que todos los accidentes relacionados con la práctica de la anestesia, son previsibles, lo cual implica que el error humano se encuentra siempre involucrado. La realidad es que la evidencia indica que en las complicaciones más desastrosas se encuentra implícito el error humano. Las causas más frecuentes de accidentes son: desconexión del circuito de ventilación, dosis incorrectas de medicamentos, error en la administración de los mismos, error en el aporte de gases y falla del ventilador. Los errores humanos que más comúnmente producen incidentes críticos son: revisión inadecuada del equipo, falta de experiencia, distracción, falta de familiaridad con los equipos, hastío y fatiga. Otros factores que contribuyen al error humano son la sobrecarga de información, falta de comunicación entre el personal, estrés emocional y una variedad de factores ambientales tales como salas pequeñas y ruidosas. Algunos accidentes resultan del fenómeno relativamente reciente denominado "presión de producción". En un esfuerzo por tener mejores ingresos, disminuir los reembolsos, lograr una mayor eficiencia en la sala de operaciones, ahorrar costos y complacer económicamente a los administradores, los anestesiólogos toman riesgos innecesarios


Assuntos
Humanos , Anestésicos/efeitos adversos , Anestesia/efeitos adversos , Erros de Diagnóstico , Epinefrina/uso terapêutico , Parada Cardíaca , Erros de Medicação , Monitorização Intraoperatória , Anestesiologia , Anestesiologia/instrumentação , Anestesiologia , Reanimação Cardiopulmonar , Fatores de Risco
19.
Rev. mex. anestesiol ; 21(3): 159-66, jul.-sept. 1998. tab, graf
Artigo em Espanhol | LILACS | ID: lil-248383

RESUMO

El uso en la administración de sangre y sus derivados, se ha visto disminuida por el riesgo de transmisión de enfermedades infecciosas y de sensibilización a los diferentes componentes de ésta. Los coloides se han convertido en una alternativa muy prometedora en la reposición del volumen intravascular en el paciente crítico. Durante cirugía cardiaca con colocación extracorpórea (CEC), el cebado de la bomba se realiza en forma habitual con solución cristaloide, disminuyéndose en forma importante la Presión Coloidosmótica del Plasma (PCO) y favoreciéndose el paso de líquido al intersticio. En el presente estudio se analizaron 20 pacientes de ambos sexos, con edades comprendidas entre los 20 y 70 años, con estado físico ASA II-III, sometidos a cirugía cardíaca de revascularización coronaria, con circulación extracorpórea se efectuó con pentalmidon 10 por ciento y en el Grupo 2 con Albúmina 10 por ciento; se midieron la PCO, osmolaridad sérica, proteínas totales, tiempos de coagulación, plaquetas, cantidad de sangrado y transfusión de productos sanguíneos entre otros, en el período preoperatorio, antes de iniciar la CEC previo a la administración de la hepatina, 10 minutos después de administrada la protamina, 1 hora después de la llegada a la UCI y 24 hrs. después de llegar a la UCI. El uso clínico del pentalmidón 10 por ciento como solución de cebamiento del circuito de circulación extracorpórea tiene mayor poder oncótico que la albúmina, sin alterar significativamente la función respiratoria y el sistema de la coagulación, siendo, por tanto, seguro y eficaz para este propósito


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Albuminas/administração & dosagem , Amido/farmacocinética , Amido/uso terapêutico , Cirurgia Torácica/métodos , Coloides/farmacocinética , Coloides/uso terapêutico , Circulação Extracorpórea , Concentração Osmolar , Volume Plasmático
20.
Rev. mex. anestesiol ; 21(1): 38-54, ene.-mar. 1998. ilus, graf
Artigo em Espanhol | LILACS | ID: lil-248364

RESUMO

Cuando hablamos acerca de cirugía de invasión mínima tenemos que analizar dos aspectos muy importantes, el primero de ellos es el abordaje quirúrgico, y el segundo es la práctica de By-Pass cardiopulmonar. Con relación al abordaje quirúrgico, éste determina la longitud de la incisión en piel y el tipo de cicatrización posteriormente. De la misma forma, determina el grado de retracción de la cavidad torácica que es necesaria para llevar a cabo el acto quirúrgico y el grado de agresión y contusión al músculo, tejido conectivo y hueso. Así mismo, puede ser determinante en la cantidad de sangre que se pierde durante el procedimiento y la necesidad de una eficiente hemostasia. La desestabilización de la cavidad torácica puede también determinar el nivel de dolor y la cantidad de analgésicos utilizados. La instalación de By-Pass cardiopulmonar, ha sido objeto de varios inconvenientes como lo es la hemólisis, rebote de heparina, activación de complemento y deterioro del sistema inmune. Alteraciones subjetivas son más difíciles de cuantificar, pero son obvias: falta de apetito, insomnio, depresión emocional, déficit intelectual o memoria visual y pérdida del apetito sexual. Es por ello, el interés reciente por evitar el By-Pass cardiopulmonar en cierta población de pacientes, dejando claro que son dos aspectos diferentes "petite incisión y petite chirugien"


Assuntos
Humanos , Anastomose Cirúrgica , Anestesia Epidural , Ponte Cardiopulmonar , Cirurgia Torácica/instrumentação , Cirurgia Torácica/métodos , Monitoramento de Medicamentos , Circulação Extracorpórea , Revascularização Miocárdica , Toracotomia , Toracotomia/instrumentação
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