Severe pancytopenia and coagulopathy discovered during anesthesia after pre-anesthetic evaluation - A report of two cases.

BACKGROUND: Pre-anesthetic evaluation is an important aspect of perioperative patient management. However, anesthesiologists often encounter challenges during anesthesia due toconditions that are not detected during pre-anesthetic evaluations. CASE: Case 1 involved a 74-year-old female patient scheduled for cranioplasty and meningioma excision. Severe pancytopenia was detected during anesthesia. Cranioplasty was onlyperformed, the surgery was terminated, and drug-induced pancytopenia was diagnosed andtreated. The pre-anesthetic test results were normal, except for anemia. Case 2 involved a71-year-old male patient who discovered large ecchymosis during general anesthesia preparation in the operating room for choledochal cyst surgery. Surgery was canceled to evaluatethe bleeding tendency, and acquired coagulation factor VIII deficiency was diagnosed andtreated. The pre-anesthetic tests were normal, except for prolongation of the activated partial thromboplastin time. CONCLUSIONS: Abrupt hematologic and hemostatic changes may occur during anesthesiaeven though pre-anesthetic evaluation findings are normal.

Fuzzy Logic Preanesthetic Risk Evaluation of Laparoscopic Cholecystectomy Operations.

BACKGROUND AND OBJECTIVE: Pre-operative risk classification of patients undergoing anesthesia is an essential interest and has been the focus of many research and categorizations. On the other hand, the ideal categorization system, based on medical doctors' clinical experience and cooperation with other disciplines, has not been developed yet. METHODS: In this study, 218 consecutive patient undergoing laparoscopic cholecystectomy operations were included. A novel fuzzy logic evaluation model consisting of 270 rules was constructed. Five major (pulmonary, cardiac, diabetes mellitus and renal or liver disease) and three minor criteria (patients' age, cigarette smoking and body mass index) were chosen to be used during high-risk groups determination. RESULTS: The verification of the success of risk value decision with the proposed novel fuzzy logic algorithm is the main goal of this study. On the other hand, though not essential aim, a statistical consistency check was also included to have a deeper understanding and evaluation of the graphical results. During the statistical analysis the 0-30%, 30-60% and 60-90% risk ranges were found to be in a very strong positive relationship with complication occurrence. In this study, 172, 31, 15 patients were in 0-30, 30-60 and 60-90% risk ranges, respectively. Complication rates were 7/172 (4.07%) in 0-30% range, 3/31 (9.68%) in 30-60% range; and 2/15 (13.33%) in 60-90% range. CONCLUSIONS: Fuzzy based risk classification model was successfully used to predict medical results for patients undergoing laparoscopic cholecystectomy operations and reliable deductions were reached.

La valoración preanestésica del paciente pediátrico durante la pandemia por COVID-19 / Preanesthetic assessment of the pediatric patient during the COVID-19 pandemic

Resumen: En la pandemia actual por SARS-CoV-2, poca atención se ha puesto a la población pediátrica debido a su baja morbimortalidad. Debido al amplio espectro de presentación de esta enfermedad en los pacientes pediátricos, es necesario reconocer sus diferentes presentaciones clínicas y la importancia de la valoración preanestésica en procedimientos electivos y de urgencia a fin de evitar la exposición del personal de salud a pacientes contagiados y disminuir la morbilidad perioperatoria en el paciente pediátrico con COVID-19.

Abstract: In the current SARS-CoV-2 pandemic, little attention has been paid to the pediatric population due to its low morbidity and mortality. Due to the wide spectrum of presentation of this disease, in pediatric patients, it is necessary to recognize its different clinical presentations and the importance of pre-anesthetic evaluation in elective and emergency procedures in order to avoid the exposure of health personnel with infected patients and to reduce the perioperative morbidity in the pediatric patient with COVID-19.

Frequência de via aérea difícil em pacientes submetidos à anestesia geral em um hospital do Sul de Santa Catarina / Frequency of difficult airway tract in pacients submitted to general anesthesia in South Santa Catarina hospital

Justificativa e Objetivos: Avaliar via aérea difícil nos pacientes submetidos à ventilação e intubação orotraqueal sob anestesia geral para operações eletivas. Método: Estudo observacional com desenho transversal. Foram estudados um total de 163 pacientes, de 18 a 80 anos submetidos à ventilação sob máscara facial e intubação traqueal em operações com uso de anestesia geral. Os dados foram coletados na consulta pré-anestésica através de questionário que continha os parâmetros antropométricos e clínicos para intubação difícil. Resultados e Conclusões: Foram investigados 163 pacientes. Houve a presença de via aérea difícil em 19% dos pacientes, e a grande maioria não teve complicações. Ainda, houve uma maior frequência de via aérea difícil em pacientes com maior IMC e maior circunferência cervical, sendo ambos estatisticamente significativos. Foi observado também que quanto maior a classe do Mallampati maior a prevalência de encontrar-se uma classe maior que três na classificação de Cormack e Lehane, assim como maior a chance de se ter uma via aérea difícil, sendo significativo. Por fim, a prevalência de via aérea difícil encontrada é baixa, e quando presente geralmente está relacionado com fatores que podem ser prevenidos. As classificações quando utilizadas juntas tem maior chance de prever a via aérea difícil.

Rationale and Objectives: To evaluate difficult airway in patients submitted to ventilation and orotracheal intubation under general anesthesia for elective operations. Method: Observational study with cross-sectional design. A total of 163 patients, 18 to 80 years old undergoing ventilation under face mask and tracheal intubation in operations using general anesthesia were studied. The data were collected in the pre-anesthetic consultation through a questionnaire that contained the anthropometric and clinical parameters for difficult intubation. Results and Conclusions: 163 patients were investigated. There was a difficult airway presence in 19% of the patients, and the vast majority had no complications. Also, there was a higher frequency of difficult airway in patients with higher BMI and greater cervical circumference, both of which were statistically significant. It was also observed that the higher the Mallampati class the higher the prevalence of finding a class higher than three in the classification of Cormack and Lehane, as well as the greater the chance of having a difficult airway, being significant. Finally, the prevalence of difficult airways found is low, and when present geographically it is related to factors that can be prevented. Classifications when used together have a greater chance of predicting difficult airway.

Preoperative education reduces preoperative anxiety in cancer patients undergoing surgery: Usefulness of the self-reported Beck anxiety inventory / A informação no pré-operatório reduz a ansiedade pré-operatória em pacientes com câncer submetidos à cirurgia: utilidade do Inventário Beck de Ansiedade

Abstract Background and objectives: Preoperative instruction is known to significantly reduce patient anxiety before surgery. The present study aimed to investigate the effects of preoperative education on the level of anxiety of cancer patients undergoing surgery using the self-reported Beck anxiety inventory. Methods: This study is a short-term observational study, including 72 female patients with a diagnosis of endometrial cancer who were scheduled to undergo surgical treatment under general anesthesia. During the pre-anesthetic consultation 15 days before surgery, one group of patients (Group A, n = 36) was given comprehensive information about their scheduled anesthetic and surgical procedures, while the other group of patients (Group B, n = 36) did not receive any information pertaining to these variables. The Beck anxiety inventory, blood pressure and heart rate were evaluated before and after the preoperative education in Group A. In Group B, these parameters were evaluated at the beginning and at the end of the consultation. Results: The hemodynamic values were lower in the group that received preoperative education, in comparison with the group that did not receive preoperative education. Educating the patients about the procedure resulted in a reduction in the levels of anxiety from mild to minimum, whereas there was no change in the group that did not receive the preoperative education. This latter group kept the same level of anxiety up to the end of pre-anesthetic consultation. Conclusions: Patient orientation in the preoperative setting should be the standard of care to minimize patient anxiety prior to surgery, especially for patients with cancer.

Resumo: Justificativa e objetivos: A informação transmitida no pré-operatório é conhecida por reduzir de modo significativo a ansiedade do paciente antes da cirurgia. O presente estudo teve como objetivo investigar os efeitos da orientação pré-operatória sobre o nível de ansiedade de pacientes com câncer submetidos à cirurgia, utilizando o inventário Beck de ansiedade. Métodos: Estudo observacional de curto prazo, incluindo 72 pacientes do sexo feminino com diagnóstico de câncer endometrial, programadas para receber tratamento cirúrgico sob anestesia geral. Durante a consulta pré-anestésica, 15 dias antes da cirurgia, um grupo de pacientes (Grupo A, n = 36) recebeu informações abrangentes sobre seus procedimentos anestésicos e cirúrgicos, enquanto o outro grupo de pacientes (Grupo B, n = 36) não recebeu qualquer informação referente a essas variáveis. O inventário Beck de ansiedade, a pressão arterial e a frequência cardíaca foram avaliados antes e após a transmissão de informações ao Grupo A. No Grupo B, esses parâmetros foram avaliados no início e no final da consulta. Resultados: Os valores hemodinâmicos foram menores no grupo que recebeu informação pré-operatória, em comparação com o grupo que não recebeu informação pré-operatória. Informar os pacientes sobre o procedimento resultou em uma redução dos níveis de ansiedade de leve a mínimo, enquanto não houve mudança no grupo que não recebeu informação pré-operatória. Esse último grupo manteve o mesmo nível de ansiedade até o final da consulta pré-anestésica. Conclusões: A orientação do paciente no período pré-operatório deve ser o atendimento padrão para minimizar a ansiedade dos pacientes antes da cirurgia, especialmente os pacientes com câncer.

[Preoperative education reduces preoperative anxiety in cancer patients undergoing surgery: Usefulness of the self-reported Beck anxiety inventory]. / A informação no pré­operatório reduz a ansiedade pré­operatória em pacientes com câncer submetidos à cirurgia: utilidade do Inventário Beck de Ansiedade.

BACKGROUND AND OBJECTIVES: Preoperative instruction is known to significantly reduce patient anxiety before surgery. The present study aimed to investigate the effects of preoperative education on the level of anxiety of cancer patients undergoing surgery using the self-reported Beck anxiety inventory. METHODS: This study is a short-term observational study, including 72 female patients with a diagnosis of endometrial cancer who were scheduled to undergo surgical treatment under general anesthesia. During the pre-anesthetic consultation 15 days before surgery, one group of patients (Group A, n=36) was given comprehensive information about their scheduled anesthetic and surgical procedures, while the other group of patients (Group B, n=36) did not receive any information pertaining to these variables. The Beck anxiety inventory, blood pressure and heart rate were evaluated before and after the preoperative education in Group A. In Group B, these parameters were evaluated at the beginning and at the end of the consultation. RESULTS: The hemodynamic values were lower in the group that received preoperative education, in comparison with the group that did not receive preoperative education. Educating the patients about the procedure resulted in a reduction in the levels of anxiety from mild to minimum, whereas there was no change in the group that did not receive the preoperative education. This latter group kept the same level of anxiety up to the end of pre-anesthetic consultation. CONCLUSIONS: Patient orientation in the preoperative setting should be the standard of care to minimize patient anxiety prior to surgery, especially for patients with cancer.

Classificação anestésica do estado físico e mortalidade anestésico-cirúrgica em cães / Anesthetic classification of the physical status and surgical-anesthetic mortality in dogs

A classificação de estado físico ASA (Sociedade Americana de Anestesiologistas) é uma ferramenta importante para a avaliação pré-anestésica do paciente. Assim, é utilizada em diversos estudos por possuir estreita relação com a morbidade e a mortalidade anestésica. Realizou-se tal classificação em 243 pacientes caninos submetidos a procedimentos cirúrgicos em um Hospital Veterinário Universitário. Os resultados obtidos foram os seguintes: ASA I (38; 15,64%), ASA II (53; 21,81%), ASA II emergencial (E) (2; 0,82%), ASA III (78; 32,10%), ASA III E (23; 9,46%), ASA IV (11; 4,53%), ASA IV E (36; 14,81%) e ASA V (2; 0,82%). Verificou-se que a maior parte dos pacientes foram classificados como ASA III (doença sistêmica moderada), o que demonstra que, no serviço analisado, a maioria dos animais submetidos à cirurgia são portadores de enfermidades. A mortalidade foi de 2,46%, com a maioria dos óbitos ocorridos no pós-operatório e em pacientes com emergências. Concluiu-se que, no serviço analisado, os maiores riscos estão relacionados aos pacientes com categorias ASA de maior gravidade, em cirurgias emergenciais e, especialmente, no período pós-operatório.(AU)

The classification ASA (American Society of Anesthesiologists) is an important tool for assessing a patient's pre anesthetic. Thus, it is used in many studies because it has close relation with anesthetic morbidity and mortality. This classification was performed on 243 canine patients undergoing surgical procedures at the Veterinary Teaching Hospital. The results obtained were as follows: ASA I (38, 15.64%), ASA II (53; 21.81%), ASA II Emergency (E) (2; 0.82%), ASA III (78; 32.10%), ASA III E (23; 9.46%), ASA IV (11; 4.53 %), ASA IV E (36; 14.81%), and ASA V (2; 0.82%). Most patients were ASA III (moderate systemic disease), demonstrating that in the analyzed service the most operated animals are carriers of disease. The mortality rate was 2.46%, with most deaths occurring postoperatively and in patients with an emergency. The greatest risks are related to patients with more severe categories of the classification ASA, in emergency surgery, and especially in the postoperative period.(AU)

Principais preocupações dos pacientes sobre as complicações mais frequentes na sala de recuperação pós-anestésica / Principales preocupaciones de los pacientes sobre las complicaciones más frecuentes en la sala de recuperación postanestésica / Main concerns of patients regarding the most common complications in the post-anesthetic care unit

Justificativa e objetivos: Eventos considerados "menores" têm assumido papel fundamental na determinação da qualidade do serviço prestado na área da Anestesiologia. O objetivo do presente estudo foi avaliar as principais preocupações dos pacientes em relação ao período pós-anestésico e testar a hipótese de que os efeitos mais indesejados podem ser influenciados...

Background and objectives: "Minor" events have a fundamental role in the determination of the quality of the Anesthesiology service. The objective of the present study was to evaluate the main concerns of patients regarding the post-anesthetic period and to test the hypothesis that the most undesirable effects can be influenced...

Justificativa y objetivos: Los eventos considerados "menores", han asumido un rol fundamental en la determinación de la calidad del servicio prestado en el área de la Anestesiología. El objetivo del presente estudio, fue evaluar las principales preocupaciones de los pacientes con relación al período postanestésico y comprobar la hipótesis de que los efectos menos deseados pueden sufrir el influjo...

Avaliação da ansiedade e depressão no período pré-operatório em pacientes submetidos a procedimentos cardíacos invasivos / Evaluación de la ansiedad y depresión en el período preoperatorio en pacientes sometidos a procedimientos cardíacos / Evaluation of preoperative anxiety and depression in patients undergoing invasive cardiac procedures

JUSTIFICATIVA E OBJETIVOS: A avaliação específica da ansiedade e da depressão não está incluída na rotina de avaliação pré-operatória, o que faz com que em situações como as doenças cardíacas, em que o estado emocional dos pacientes pode estar modificado pela própria doença, possam não ser diagnosticadas. O objetivo do estudo foi comparar o nível e a prevalência de ansiedade e depressão em pacientes com doença cardíaca a serem submetidos a procedimentos invasivos e/ou cirúrgicos, utilizando a Escala Hospitalar de Ansiedade e Depressão (Hospital Anxiety and Depression Scale - HAD). MÉTODO: Após a aprovação pelos Comitês de Ética, foram incluídos 96 pacientes, estado físico ASA II e III, que constituíram três grupos: estudo eletrofisiológico (EEF), implante de marcapasso (MP) e revascularização do miocárdio (RM). Os escores considerados "ponto de corte" foram: escala HAD-ansiedade (HAD-A) com ansiedade > 9; escala HAD-depressão (HAD-D) com depressão > 9. RESULTADOS: Os grupos foram homogêneos quanto às variáveis sociodemográficas. Observou-se diferença estatística significativa entre os três grupos (p = 0,006; p = 0,034) quanto ao nível e prevalência de ansiedade (HAD-A) e na comparação do nível de ansiedade grupo a grupo verificou-se diferença significativa entre os grupos EEF × RM e EEF × MP (p < 0,05). A comparação dos três grupos quanto ao nível e prevalência de depressão (HAD-D) não mostrou diferença estatística significativa. CONCLUSÕES: Os pacientes com doença cardíaca a serem submetidos a estudo eletrofisiológico, implante de marcapasso e revascularização do miocárdio têm diferença dos níveis e prevalência de ansiedade, mas não apresentam diferença em relação aos níveis e prevalência de depressão.

BACKGROUND AND OBJECTIVES: Specific assessment of anxiety and depression is not included in routine preoperative evaluation; therefore, in cases of cardiac diseases in which the emotional status of the patient may be modified by the disease those disorders may not be diagnosed. The objective of the present study was to compare the level and prevalence of anxiety and depression in patients with cardiac disease undergoing invasive and/or surgical procedures using the Hospital Anxiety and Depression Scale - HAD. METHODS: After approval by the Ethics Committee, 96 patients, physical status ASA II and III, were divided in three groups: electrophysiological study (EPS), pacemaker (PM) placement, and myocardial revascularization (MR). "Cutting points" were as follows: HAD-anxiety scale (HAD-A) with anxiety > 9; HAD-depression scale (HAD-D) with depression > 9. RESULTS: All three groups were homogenous regarding sociodemographic parameters. Statistically significant differences were observed among the three groups (p = 0.006; p = 0.034) in the level and prevalence of anxiety (HAD-A); and in the intergroup comparison of the anxiety level significant differences were observed between the EPS x MR and EPS x PM groups (p < 0.05). Significant differences in the level and prevalence of depression (HAD-D) among the study groups were not observed. CONCLUSIONS: Patients with cardiac diseases undergoing electrophysiological studies, pacemaker implantation, and myocardial revascularization have different levels and prevalence of anxiety, but they do not show differences in the level and prevalence of depression.

JUSTIFICATIVA Y OBJETIVOS: La evaluación específica de la ansiedad y de la depresión no está incluida en la rutina de evaluación preoperatoria, lo que hace con que en algunas situaciones como las enfermedades cardiacas, en que el estado emocional de los pacientes puede estar modificado por la propia enfermedad, puedan no quedar diagnosticadas. El objetivo del estudio fue comparar el nivel y la prevalencia de ansiedad y depresión en pacientes con enfermedad cardiaca a ser sometidos a procedimientos invasivos y/o quirúrgicos, utilizando la Escala Hospitalaria de Ansiedad y Depresión (Hospital Anxiety and Depression Scale - HAD). MÉTODO: Después de la aprobación por parte de los Comités de Ética, se incluyeron 96 pacientes, estado físico ASA II y III, que constituyeron tres grupos: estudio electrofisiológico (EEF), implante de marcapaso (MP) y revascularización del miocardio (RM). Las puntuaciones consideradas "punto de corte" fueron las siguientes: escala HAD-ansiedad (HAD-A): con ansiedad > 9; escala HAD-depresión (HAD-D): con depresión > 9. RESULTADOS: Los grupos fueron homogéneos en cuanto a las variables sociodemográficas. Se observó una diferencia estadística significativa entre los tres grupos (p = 0,006; p = 0,034) en lo concerniente al nivel y a la prevalencia de ansiedad (HAD-A) y en la comparación del nivel de ansiedad grupo a grupo, se verificó la diferencia significativa entre los grupos EEF x RM y EEF x MP (p < 0,05). La comparación de los tres grupos en cuanto al nivel y a la prevalencia de Depresión (HAD-D) no arrojó diferencia estadística significativa. CONCLUSIONES: Los pacientes con enfermedad cardiaca a ser sometidos a estudio electrofisiológico, implante de marcapaso y revascularización del miocardio, tienen diferencia de los niveles y prevalencia de ansiedad, pero no presentan diferencia con relación a los niveles y a la prevalencia de depresión.