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1.
Curr Opin Anaesthesiol ; 33(6): 711-717, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33002957

RESUMO

PURPOSE OF REVIEW: Implementation of enhanced recovery pathways have allowed migration of complex surgical procedures from inpatient setting to the outpatient setting. These programs improve patient safety and patient-reported outcomes. The present article discusses the principles of enhanced recovery pathways in adults undergoing ambulatory surgery with an aim of improving patient safety and postoperative outcomes. RECENT FINDINGS: Procedure and patient selection is one of the key elements that influences perioperative outcomes after ambulatory surgery. Other elements include optimization of comorbid conditions, patient and family education, minimal preoperative fasting and adequate hydration during the fasting period, use of fast-track anesthesia technique, lung-protective mechanical ventilation, maintenance of fluid balance, and multimodal pain, nausea, and vomiting prophylaxis. SUMMARY: Implementation of enhanced recovery pathways requires a multidisciplinary approach in which the anesthesiologist should take a lead in collaborating with surgeons and perioperative nurses. Measuring compliance with enhanced recovery pathways through an audit program is essential to evaluate success and need for protocol modification. The metrics to assess the impact of enhanced recovery pathways include complication rates, patient reported outcomes, duration of postoperative stay in the surgical facility, unplanned hospital admission rate, and 7-day and 30-day readmission rates.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Anestesia , Procedimentos Clínicos , Recuperação Pós-Cirúrgica Melhorada , Complicações Pós-Operatórias/prevenção & controle , Adulto , Anestesia/efeitos adversos , Procedimentos Clínicos/normas , Medicina Baseada em Evidências , Humanos , Tempo de Internação , Seleção de Pacientes , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/epidemiologia , Recuperação de Função Fisiológica
2.
Curr Opin Anaesthesiol ; 33(6): 815-822, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33002960

RESUMO

PURPOSE OF REVIEW: Recent research points to considerable rates of preventable perioperative patient harm and anaesthesiologists' concerns about eroding patient safety. Anaesthesia has always been at the forefront of patient safety improvement initiatives. However, factual local safety improvement requires local measurement, which may be afflicted by barriers to data collection and improvement activities. Because many of these barriers are related to mandatory reporting, the focus of this review is on measurement methods that can be used by practicing anaesthesiologists as self-improvement tools, even independently from mandatory reporting, and using basic techniques widely available in most institutions. RECENT FINDINGS: Four mutually complementary measurement approaches may be suited for local patient safety learning: incident and rate-based measurements, staff surveys and patient surveys. Reportedly, individual methods have helped to tailor problem solutions and to reduce patient harm, morbidity, and mortality. SUMMARY: Considering the potential for perioperative patient safety measurements to improve patient outcomes, the absence of a generally accepted measurement standard and manifold barriers to reporting, a pragmatic approach to locally measuring patient safety appears advisable.


Assuntos
Anestesia/efeitos adversos , Anestesiologistas/psicologia , Monitorização Fisiológica , Segurança do Paciente , Humanos , Assistência Perioperatória , Período Perioperatório , Inquéritos e Questionários
3.
Curr Opin Anaesthesiol ; 33(6): 740-745, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33027074

RESUMO

PURPOSE OF REVIEW: Preoperative fasting guidelines are generalized to elective procedures and usually do not distinguish between the ambulatory and inpatient setting. Prevalence of aspiration is low while prolonged preoperative fasting is common clinical reality. Recently, changes in preoperative fasting guidelines have been widely discussed. RECENT FINDINGS: Rates of prolonged clear fluid fasting (>4 h) prior to surgery are reported in up to 80% of patients with mean fasting duration of up to 16 h and beyond. Prolonged fasting may result in adverse effects such as intraoperative hemodynamic instability, postoperative delirium, patient discomfort, and extended hospital length of stay. Liberal approaches allowing clear fluids up to 1 h prior to anesthesia or until premedication/call to the operating room have shown no increase in adverse events among children. Various anesthesia societies now encourage clear fluid intake up to 1 h prior to pediatric elective anesthesia. Similar reports in the adult cohort are scarce. SUMMARY: Allowing sips of water until call to the operating room may help reducing prolonged preoperative fasting and improving patient comfort while keeping a flexibility in operating room schedule. The feasibility and safety of a liberal clear fluid fasting regimen among adults undergoing elective anesthesia needs to be evaluated in future studies.


Assuntos
Anestesia/efeitos adversos , Procedimentos Cirúrgicos Eletivos/normas , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/normas , Aspiração Respiratória de Conteúdos Gástricos/prevenção & controle , Jejum , Humanos , Pré-Medicação
5.
Curr Opin Anaesthesiol ; 33(6): 808-814, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33044235

RESUMO

PURPOSE OF REVIEW: The purpose is to show the advantages of a Bowtie diagram as a versatile tool for displaying and understanding the evolvement and management of critical incidents. RECENT FINDINGS: The Bowtie diagram has been used recently in anesthesia to depict critical incidents having been used in high-risk industries for several decades. This diagram displays the progression from latent factors to potential harm in five steps. SUMMARY: The Bowtie diagram combines the features of a fault tree and an event tree with the adverse event, known as the Top Event separating the two sections. The fault tree is similar in concept to a Swiss Cheese diagram and the event tree similar in concept to an emergency management algorithm. Preventive barriers and escalation measures are used to detect and trap abnormal states. If these fail, the event proceeds to a crisis, leading to the Top Event, a time for making decisions. A recovery state follows, which depicts an emergency state mandating immediate life or limb-saving management to recover from the crisis. Finally, in the aftermath state, a time for reflection and learning, ultimate outcomes are shown in the right-hand column. VIDEO ABSTRACT: The Bowtie Diagram. Designed and created by Yasmin Endlich, Martin D. Culwick and Stavros N. Prineas, http://links.lww.com/COAN/A68.


Assuntos
Anestesia , Anestesiologia , Medição de Risco/métodos , Gestão de Riscos/métodos , Algoritmos , Anestesia/efeitos adversos , Humanos
6.
Anesth Analg ; 131(5): 1342-1354, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079853

RESUMO

Many health care systems around the world continue to struggle with large numbers of SARS-CoV-2-infected patients, while others have diminishing numbers of cases following an initial surge. There will most likely be significant oscillations in numbers of cases for the foreseeable future, based on the regional epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Less affected hospitals and facilities will attempt to progressively resume elective procedures and surgery. Ramping up elective care in hospitals that deliberately curtailed elective care to focus on SARS-CoV-2-infected patients will present unique and serious challenges. Among the challenges will be protecting patients and providers from recurrent outbreaks of disease while increasing procedure throughput. Anesthesia providers will inevitably be exposed to SARS-CoV-2 by patients who have not been diagnosed with infection. This is particularly concerning in consideration that aerosols produced during airway management may be infective. In this article, we recommend an approach to routine anesthesia care in the setting of persistent but variable prevalence of SARS-CoV-2 infection. We make specific recommendations for personal protective equipment and for the conduct of anesthesia procedures and workflow based on evidence and expert opinion. We propose practical, relatively inexpensive precautions that can be applied to all patients undergoing anesthesia. Because the SARS-CoV-2 virus is spread primarily by respiratory droplets and aerosols, effective masking of anesthesia providers is of paramount importance. Hospitals should follow the recommendations of the Centers for Disease Control and Prevention for universal masking of all providers and patients within their facilities. Anesthesia providers should perform anesthetic care in respirator masks (such as N-95 and FFP-2) whenever possible, even when the SARS-CoV-2 test status of patients is negative. Attempting to screen patients for infection with SARS-CoV-2, while valuable, is not a substitute for respiratory protection of providers, as false-negative tests are possible and infected persons can be asymptomatic or presymptomatic. Provision of adequate supplies of respirator masks and other respiratory protection equipment such as powered air purifying respirators (PAPRs) should be a high priority for health care facilities and for government agencies. Eye protection is also necessary because of the possibility of infection from virus coming into contact with the conjunctiva. Because SARS-CoV-2 persists on surfaces and may cause infection by contact with fomites, hand hygiene and surface cleaning are also of paramount importance.


Assuntos
Anestesia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Exposição por Inalação/prevenção & controle , Intubação Intratraqueal , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Aerossóis , Anestesia/efeitos adversos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Contaminação de Equipamentos/prevenção & controle , Dispositivos de Proteção dos Olhos , Higiene das Mãos , Interações Hospedeiro-Patógeno , Humanos , Exposição por Inalação/efeitos adversos , Intubação Intratraqueal/efeitos adversos , Exposição Ocupacional/efeitos adversos , Saúde do Trabalhador , Segurança do Paciente , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Fatores de Proteção , Dispositivos de Proteção Respiratória , Medição de Risco , Fatores de Risco , Vestimenta Cirúrgica
7.
Can Vet J ; 61(10): 1092-1100, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33012826

RESUMO

As a result of the various restrictions associated with the current COVID-19 pandemic, the practice of veterinary telehealth is likely to grow substantially. One area in which high quality care can be maintained while respecting physical distancing is teleconsulting, which describes the relationship between an attending and off-site consulting veterinarian. This guide uses a dentistry case to illustrate the provision of real-time anesthesia consulting, with a focus on the technological considerations central to facilitating live, 2-way video-communication. Case selection, teamwork, and patient safety are also discussed.


Assuntos
Anestesia , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Telemedicina , Anestesia/efeitos adversos , Anestesia/veterinária , Animais , Betacoronavirus
8.
Rev Assoc Med Bras (1992) ; 66(7): 924-930, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32844951

RESUMO

OBJECTIVE To explore the feasibility of health competence cultivation on the prevention and control of Inadvertent Perioperative Hypothermia (IPH). METHODS Patients with expected spinal surgery were divided into group A and group B by the random number method. Group B followed routine IPH management, and health training measures for performance and ability were implemented in Group A. The scores of the health competence questionnaire, the temperature at different times, IPH complications, and hospitalization for the two groups were observed and compared. RESULTS The main evaluation indexes, such as the health competence questionnaire score, temperature fluctuations, and IPH complications, during the perioperative period in group A were significantly better than those in group B (p < 0.05). The indexes of anesthesia, total hospital expenses, and health service satisfaction in group A were also significantly better than those in group B, which shows the advantages of cultivating health capabilities in both doctors and patients. CONCLUSION Through health competence cultivation and feasible health management measures, the medical staff can improve the quality of IPH prevention and management.


Assuntos
Anestesia , Hipotermia , Período Perioperatório , Anestesia/efeitos adversos , Humanos , Complicações Intraoperatórias , Temperatura
9.
Adv Exp Med Biol ; 1252: 107-114, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816269

RESUMO

Non-obstetric surgery is needed in 0.75-2% of pregnant women, and safety of anesthesia for mother and child are key points at this time. Some breast diseases need to be approached in a short time interval, and surgery must be performed during pregnancy . In these cases, the technique of anesthesia regarding local, regional or general anesthesia and type of anesthetic medicine are selected based on the extent of the procedure, gestational age, and condition of the mother and child. The ideal timing for any surgery during pregnancy is in the second trimester because the risk of fetal adverse effects as well as preterm labor are lower. However, surgery of breast cancer during pregnancy is performed in any trimester as guided by treatment guidelines and is not deferred based on anesthesia preferences. Various types of anesthesia for breast surgery during pregnancy , preoperative and postoperative considerations are discussed in this chapter.


Assuntos
Anestesia/efeitos adversos , Anestesia/métodos , Anestésicos , Mama/cirurgia , Complicações na Gravidez , Neoplasias da Mama/cirurgia , Feminino , Feto/efeitos dos fármacos , Humanos , Trabalho de Parto Prematuro/induzido quimicamente , Trabalho de Parto Prematuro/etiologia , Trabalho de Parto Prematuro/prevenção & controle , Gravidez , Complicações na Gravidez/induzido quimicamente , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle
11.
Curr Opin Anaesthesiol ; 33(5): 639-645, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32796169

RESUMO

PURPOSE OF REVIEW: To provide an overview of acute and chronic repeated concussion. We address epidemiology, pathophysiology, anesthetic utilization, and provide some broad-based care recommendations. RECENT FINDINGS: Acute concussion is associated with altered cerebral hemodynamics. These aberrations can persist despite resolution of signs and symptoms. Multiple repeated concussions can cause chronic traumatic encephalopathy, a disorder associated with pathologic findings similar to some organic dementias. Anesthetic utilization is common following concussion, especially soon after injury, a time when the brain may be most vulnerable to secondary injury. SUMMARY: Brain physiology may be abnormal following concussion and these abnormalities may persist despite resolutions of clinical manifestations. Those with recent concussion or chronic repeated concussion may be susceptible to secondary injury in the perioperative period. Clinicians should suspect concussion in any patient with recent trauma and strive to maintain cerebral homeostasis in the perianesthetic period.


Assuntos
Anestesia/efeitos adversos , Concussão Encefálica/diagnóstico , Anestesia/métodos , Encéfalo , Humanos , Período Perioperatório
13.
Curr Opin Anaesthesiol ; 33(4): 554-560, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32628402

RESUMO

PURPOSE OF REVIEW: With an ageing population, mounting pressure on the healthcare dollar, significant advances in medical technology, and now in the context of coronavirus disease 2019, the traditional paradigm in which operative procedures are undertaken is changing. Increasingly, procedures are performed in more distant, isolated and less familiar locations, challenging anaesthesiologists and requiring well developed situational awareness. This review looks at implications for the practitioner and patient safety, outlining considerations and steps involved in translation of systems and processes well established in the operating room to more unfamiliar environments. RECENT FINDINGS: Despite limited nonoperating room anaesthesia outcome data, analysis of malpractice claims, anaesthesia-related medical disputes and clinical outcome registries have suggested higher morbidity and mortality. Complications were often associated with suboptimal monitoring, nonadherence to recommended guidelines and sedationist or nonanaesthesiologist caregivers. More recently, clear monitoring guidelines, global patient safety initiatives and widespread implementation of cognitive aids may have contributed to nonoperating room anaesthesia (NORA) outcomes approaching that of traditional operating rooms. SUMMARY: As NORA caseloads increase, understanding structural and anaesthetic requirements is essential to patient safety. The severe acute respiratory syndrome coronavirus 2 pandemic has provided an opportunity for anaesthesiologists to implement lessons learned from previous analyses, share expertise as patient safety leaders and provide valuable input into protecting patients and caregivers.


Assuntos
Anestesia/normas , Anestesiologia/normas , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Anestesia/efeitos adversos , Betacoronavirus , Lista de Checagem , Cognição , Humanos , Salas Cirúrgicas , Segurança do Paciente
15.
Curr Opin Anaesthesiol ; 33(4): 589-593, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32618686

RESUMO

PURPOSE OF REVIEW: The number of elderly patients receiving non-operating room anaesthesia (NORA) has substantially increased because of clinical, epidemiological, social and economic reasons. Considering the high risk of anaesthesia-related adverse events in this population, along with the limitations of NORA, more specific knowledge and skills are required. RECENT FINDINGS: Advanced age appears to be an independent risk factor for anaesthesia-related adverse events in a NORA setting, similar to the traditional operating room. As significant changes occur in the pharmacological effects of anaesthetic agents with aging, reducing dosage and carefully titrating drugs are essential. Because NORA-related injury is frequently related to airway obstruction/respiratory depression, non-invasive respiratory activity monitoring is more useful for sedation of elderly patients. Additionally, advanced age increases the risk of aspiration and cognitive complications, even during sedation. SUMMARY: Elderly patients may greatly benefit from the lower invasiveness and faster recovery offered by interventional procedures. However, as they represent a highly heterogeneous population with large variations in physiological reserves and comorbidities, anaesthesiologists should strive to maintain the same practice standards throughout all anaesthetizing locations. Knowledge of the unique hazards associated with NORA in elderly patients may further enhance patient safety.Video abstract: NORA for elderly patients.mp4: http://links.lww.com/COAN/A66.


Assuntos
Anestesia/efeitos adversos , Anestesiologia/estatística & dados numéricos , Anestésicos/efeitos adversos , Assistência ao Paciente/métodos , Fatores Etários , Idoso , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Anestesia/métodos , Anestesia/tendências , Anestesiologistas , Anestésicos/farmacologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Assistência ao Paciente/tendências , Segurança do Paciente
17.
Anaesth Crit Care Pain Med ; 39(3): 395-415, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32512197

RESUMO

OBJECTIVES: The world is currently facing an unprecedented healthcare crisis caused by the COVID-19 pandemic. The objective of these guidelines is to produce a framework to facilitate the partial and gradual resumption of intervention activity in the context of the COVID-19 pandemic. METHODS: The group has endeavoured to produce a minimum number of recommendations to highlight the strengths to be retained in the 7 predefined areas: (1) protection of staff and patients; (2) benefit/risk and patient information; (3) preoperative assessment and decision on intervention; (4) modalities of the preanaesthesia consultation; (5) specificity of anaesthesia and analgesia; (6) dedicated circuits and (7) containment exit type of interventions. RESULTS: The SFAR Guideline panel provides 51 statements on anaesthesia management in the context of COVID-19 pandemic. After one round of discussion and various amendments, a strong agreement was reached for 100% of the recommendations and algorithms. CONCLUSION: We present suggestions for how the risk of transmission by and to anaesthetists can be minimised and how personal protective equipment policies relate to COVID-19 pandemic context.


Assuntos
Analgesia/normas , Anestesia/normas , Betacoronavirus , Infecções por Coronavirus , Controle de Infecções/normas , Pandemias , Pneumonia Viral , Adulto , Manuseio das Vias Aéreas , Analgesia/efeitos adversos , Analgesia/métodos , Anestesia/efeitos adversos , Anestesia/métodos , Criança , Técnicas de Laboratório Clínico , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Procedimentos Clínicos , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Desinfecção , Procedimentos Cirúrgicos Eletivos , Contaminação de Equipamentos/prevenção & controle , Acesso aos Serviços de Saúde , Humanos , Controle de Infecções/métodos , Consentimento Livre e Esclarecido , Doenças Profissionais/prevenção & controle , Salas Cirúrgicas/normas , Pandemias/prevenção & controle , Isolamento de Pacientes , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Cuidados Pré-Operatórios , Comitê de Profissionais , Risco , Avaliação de Sintomas , Precauções Universais
18.
Artigo em Alemão | MEDLINE | ID: mdl-32590859

RESUMO

The processes of anaesthesia during operations enable surgical disciplines to perform a wide range of procedures. However, anaesthesia procedure may also represent a potential risk of infection for the surgical patient. Important hygiene measures concern the following topics: hand hygiene, surface disinfection, administration of parenteral drugs, dealing with catheters, intubation, perioperative antibiotic prophylaxis, temperature management, change intervals, OR workflow organization. The selection of hygiene measures for anaesthesia staff in the operating theatre listed in this article is presented in the sequence of the work flow, whereby certain topics such as hand hygiene naturally play an important role in all work phases.


Assuntos
Anestesia , Infecção Hospitalar , Higiene das Mãos , Infecção da Ferida Cirúrgica , Anestesia/efeitos adversos , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Desinfecção , Humanos , Higiene
19.
Chem Biol Interact ; 327: 109164, 2020 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-32524992

RESUMO

General anaesthetics are some of the most widely used and essential therapeutic agents. However, despite over a century of research, the molecular mechanisms of general anaesthesia in the central nervous system remain elusive. Ketamine (ketamine hydrochloride) has been approved for use in general anaesthesia either alone or in combination with other medications. It is a superb drug for use in short-term medical procedures that do not require skeletal muscle relaxation, and it has approval for the induction of general anaesthesia as a pre-anaesthetic to other general anaesthetic agents. However, Several questions remain unsolved, including the exact identification of the neural substrate of consciousness and its components, the pharmacodynamic interactions between anaesthetic agents, the mechanisms of cognitive alterations that follow an anaesthetic procedure, the identification of an eventual unitary mechanism of anaesthesia-induced alteration of consciousness, the relationship between network effects and the biochemical targets of anaesthetic agents, leading to difficulties in between-studies comparisons. Thus, the glutamate and dopamine systems play distinct roles in terms of neuronal signalling, yet both have proposed to contribute significantly to the pathophysiology of neuropsychiatric diseases. Imaging of the glutamate system and other aspects of research on the dopamine system have produced less consistent findings, potentially due to methodological limitations and the heterogeneity of the disorder. In this review, we discuss the neural circuits through which the two systems interact and how their disruption may cause psychotic symptoms. We also summarize from a molecular perspective of mechanisms of action of ketamine as general anaesthetics on ligand-gated ion channels mediated modulation of dopamine in the brain region.


Assuntos
Anestésicos Dissociativos/farmacologia , Dopamina/metabolismo , Ácido Glutâmico/metabolismo , Ketamina/farmacologia , Anestesia/efeitos adversos , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Neurônios Dopaminérgicos/efeitos dos fármacos , Humanos , Transtornos Psicóticos/fisiopatologia , Receptores de N-Metil-D-Aspartato/antagonistas & inibidores , Receptores de N-Metil-D-Aspartato/metabolismo , Esquizofrenia/fisiopatologia
20.
Pol Merkur Lekarski ; 48(285): 215-220, 2020 Jun 17.
Artigo em Polonês | MEDLINE | ID: mdl-32564050

RESUMO

Demographic data clearly show the progressive aging of societies. Problems and specificity of anaesthesia in the elderly becomes a particularly important issue in this context. Spinal anesthesia is a method often used to anesthetize elderly patients, and hypotension is one of its most common early complications. Untreated or improperly treated hypotension increases the risk of perioperative complications such as myocardial infarction, ischemic stroke or acute renal failure. The prevention of hypotension consists of intravenous fluid therapy and pre-emptive use of vasoconstrictor drugs. Among vasoconstrictors, ephedrine and phenylephrine are commonly used to treat hypotension due to spinal anaesthesia. Both drugs are available in Poland. Issues related to their use in the treatment of hypotension caused by spinal anaesthesia in the elderly, including the features of both drugs, their method of administration and dosage based on the literature and own experience are the subject of this study. It should be noted, however, that most studies in the use of ephedrine and phenylephrine as a targeted treatment for hypotension concern the obstetric patient population while the elderly population is underrepresented and the results are inconclusive.


Assuntos
Anestesia , Hipotensão , Idoso , Anestesia/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Cesárea , Feminino , Humanos , Hipotensão/etiologia , Fenilefrina , Polônia , Gravidez
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