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1.
Curr Opin Anaesthesiol ; 32(6): 743-748, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31503035

RESUMO

PURPOSE OF REVIEW: Although sedation traditionally has been regarded as an easy, straight forward and simple variety of general anaesthesia; the trends are to make sedation more sophisticated and dedicated. Also to have a critical look at old dogmas, as they are usually derived from the practice of general anaesthesia. Safety always has to be first priority, especially as the practice grows out of traditional theatres and frequently are being practiced by nonanaesthetic personnel. RECENT FINDINGS: Safety comes from learning of rare cases with severe problems as well as better guidelines and rules of accreditation. Further, there is a growing quest for evidence on pragmatic, high-quality, cost-effective practice; in terms of logistics, monitoring, choice of drugs and quality assurance. The traditional drugs, such as propofol, midazolam and remifentanil, are still defending their dominant position but are being challenged by ketamine and etomidate. Remimazolam and dexmedetomidine are new promising drugs in this area, whereas metoxyflurane may have a revival in some situations. Further, there is growing evidence into specific protocols, practice for special procedures and for patients with special challenges. SUMMARY: Procedural sedation deserves to have high degree of attention for further developments, both from a scientific and pragmatic point of view, as the practice is very diversified and growing.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Anestesia/tendências , Hipnóticos e Sedativos/uso terapêutico , Humanos
2.
Vet Clin North Am Exot Anim Pract ; 22(3): 419-439, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31395323

RESUMO

Even when performed by skilled operators, locating the nerves can be challenging in small exotic pets; in such cases, the use of an electrical nerve stimulator may be useful to confirm the correct identification of the target nerve. Exotic animal anesthesia and analgesia have dramatically progressed over the past decade and continue to do so as more research and technologies develop. Technological advancements such as airway devices, endoscopic intubation techniques, positive intermittent pressure ventilators, and invasive and noninvasive blood pressure monitors have played a significant role in improving patient safety and the anesthetic outcomes of exotic animals.


Assuntos
Analgesia/veterinária , Anestesia/veterinária , Animais Exóticos/fisiologia , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/normas , Manuseio das Vias Aéreas/veterinária , Analgesia/tendências , Anestesia/tendências , Anestésicos/administração & dosagem , Animais , Aves/fisiologia , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Determinação da Pressão Arterial/veterinária , Endoscopia/instrumentação , Endoscopia/métodos , Endoscopia/tendências , Endoscopia/veterinária , Humanos , Mamíferos/fisiologia , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Bloqueio Nervoso/tendências , Bloqueio Nervoso/veterinária , Manejo da Dor , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Respiração Artificial/tendências , Respiração Artificial/veterinária
3.
Ups J Med Sci ; 124(3): 199-202, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31119971

RESUMO

Background: Previous studies concerning sedation in Swedish intensive care units (ICU) have shown variability in drug choices and strategies. Currently, there are no national guidelines on this topic. As an update to a Nordic survey from 2004, and as a follow-up to a recently introduced quality indicator from the Swedish Intensive Care Registry, we performed a national survey. Methods: A digital survey was sent to the ICUs in Sweden, asking for sedation routines regarding hypnosedatives, analgosedatives, protocols, sedation scales, etc. Results: Fifty out of 80 ICUs responded to the survey. All units used sedation scales, and 88% used the RASS scale; 80% used written guidelines for sedation. Propofol and dexmedetomidine were the preferred short-term hypnosedatives. Propofol, dexmedetomidine, and midazolam were preferred for long-term hypnosedation. Remifentanil, morphine, and fentanyl were the most frequently used agents for analgosedation. Conclusions: All ICUs used a sedation scale, an increase compared with previous studies. Concerning the choice of hypno- and analgosedatives, the use of dexmedetomidine, clonidine, and remifentanil has increased, and the use of benzodiazepines has decreased since the Nordic survey in 2004.


Assuntos
Sedação Consciente/métodos , Dexmedetomidina/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Unidades de Terapia Intensiva/estatística & dados numéricos , Midazolam/administração & dosagem , Propofol/administração & dosagem , Anestesia/métodos , Anestesia/tendências , Intervalos de Confiança , Sedação Consciente/tendências , Testes Diagnósticos de Rotina , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Melhoria de Qualidade , Sistema de Registros , Estatísticas não Paramétricas , Suécia
5.
Curr Opin Anaesthesiol ; 32(4): 490-497, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31021895

RESUMO

PURPOSE OF REVIEW: Nonoperating room anesthesia (NORA) is the fastest growing segment of anesthetic practice. This review provides an overview of knowledge and trends that will need to be introduced to residents as part of their education. RECENT FINDINGS: Topics for the future include, but are not limited to, new medications, artificial intelligence and big data, monitoring depth of hypnosis, translational innovation and collaboration, demographic changes, financial driving forces, destination hubs, medical tourism, and new approaches to education training and self-management. SUMMARY: Implementing new medical technologies for anesthesia outside the operating room will help to successfully master this ever evolving subspecialty. Anesthesiologists require specific preparation for the diverse settings that they will encounter during their training. In this rapidly changing field, cognitive fitness must be factored into teaching and evaluation of residents. We describe the most important topics to consider when educating anesthesiology residents, and highlight research that addresses upcoming challenges.


Assuntos
Anestesia/tendências , Anestesiologia/educação , Tecnologia Biomédica/tendências , Previsões , Internato e Residência , Anestesia/métodos , Anestesiologistas/educação , Anestesiologistas/tendências , Anestesiologia/tendências , Anestésicos/administração & dosagem , Difusão de Inovações , Humanos
7.
BMC Anesthesiol ; 19(1): 46, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30935376

RESUMO

BACKGROUND: Patient satisfaction is a subjective and challenging perception, linking physical, expressive, psychological, societal, and cultural factors. Dissatisfaction arises if the patient feels an inconsistency between expected and delivered care. Usually health care satisfactions are very high and according to many studies levels of satisfaction are above 85% and patient's satisfaction in terms of anesthesia is not very different. The aim of this study was to assess patient's satisfaction with perioperative anesthesia service and associated factors. METHODS: Institution-based cross-sectional study was conducted from December to January, 2017/8 at the Ayder Comprehensive Specialize Hospital. The data were collected using structured interviewer-administered questionnaire prepared to collect data on demographic character of the patients, determinant factors which could affect the patient satisfaction level on anesthesia service. Epi Info version 6 was used to record the data and SPSS version 20 was used for the analysis. Descriptive statistics were used to explore the socio-demographic characteristics of patients; factors possibly related to satisfaction level and overall satisfaction were summarized as frequencies and percentages. RESULTS: One hundred twenty consecutive patients were originally enrolled in the study that took over 1 Month. The overall proportion of patients who satisfied with anaesthesia services was 88.33%. Nausea and vomiting, pain, shortness of breath and cold were factors which affected patient satisfaction negatively. CONCLUSION AND RECOMMENDATION: Compared with the other studies done at home and abroad; the overall proportion of patients, in Ayder comprehensive specialized hospital, who responded for satisfaction with perioperative anesthesia service is low. Patient satisfaction level should be determined regularly and all bodies should work to decrease the factors which decrease the satisfaction level.


Assuntos
Anestesia/psicologia , Procedimentos Cirúrgicos Eletivos/psicologia , Hospitais Universitários , Satisfação do Paciente , Assistência Perioperatória/psicologia , Adolescente , Adulto , Idoso , Anestesia/tendências , Estudos Transversais , Procedimentos Cirúrgicos Eletivos/tendências , Etiópia/epidemiologia , Feminino , Hospitais Universitários/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/tendências , Estudos Prospectivos , Adulto Jovem
8.
BMC Anesthesiol ; 19(1): 49, 2019 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-30967113

RESUMO

BACKGROUND: Although several anesthesia procedures have been explored for orthopedic surgery, the complications of anesthesia remain not well resolved. This study aimed to explore the influence of different anesthesia methods on the complications after orthopedic surgery. METHODS: According to the searching strategy, anesthesia associated studies in orthopedic surgery were screened from Pubmed, Embase, and the Cochrane Library up to Mar. 10th, 2018. Then, complications and demographic data were extracted and quality of studies was assessed using Cochrane Collaboration recommendations. ADDIS software was used to perform the network meta-analysis. Pooled effect size was calculated using random effective model or consistency model, and presented with odds ratio (OR) and 95% confidence interval (CI). RESULTS: According to the selective criteria, a total of 23 studies with 2393 patients were enrolled in this study. Quality assessment revealed all studies had an ordinary quality. Network meta-analyses revealed that nerve block analgesia (NBA) presented a lower effect on the occurrence of post-operative nausea or vomiting (PONV; OR = 0.17, 95% CI: 0.06-0.39) and urine retention (OR = 0.07, 95% CI: 0.01-0.37) compared with epidural anesthesia (EA). Interscalene block (ISB) and local infiltration analgesia (LIA) could significantly reduce the occurrence of back pain compared with EA (OR = 0.00, 95% CI = 0.00-0.30; OR = 0.00, 95% CI = 0.00-0.25). CONCLUSION: NBA presented an effective role in reliving the occurrence of PONV and urine retention, and ISB and LIA relieved the back pain compared with EA after orthopedic surgery.


Assuntos
Anestesia/efeitos adversos , Procedimentos Ortopédicos/efeitos adversos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/prevenção & controle , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Anestesia/tendências , Teorema de Bayes , Humanos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/tendências , Meta-Análise em Rede , Procedimentos Ortopédicos/tendências , Náusea e Vômito Pós-Operatórios/diagnóstico , Náusea e Vômito Pós-Operatórios/etiologia
10.
J Clin Monit Comput ; 33(2): 195-200, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30652254

RESUMO

Clinical monitoring and technology are at the heart of anesthesiology, and new technological developments will help to define how anesthesiology will evolve as a profession. Anesthesia related research published in the JCMC in 2018 mainly pertained to ICU sedation with inhaled agents, anesthesia workstation technology, and monitoring of different aspects of depth of anesthesia.


Assuntos
Anestesia/métodos , Anestesiologia/métodos , Monitorização Intraoperatória/métodos , Monitorização Neurofisiológica/métodos , Anestesia/tendências , Anestesia Dentária , Anestesia por Inalação , Anestesiologia/tendências , Animais , Potenciais Evocados , Hemodinâmica , Humanos , Monitorização Intraoperatória/tendências , Monitorização Neurofisiológica/tendências , Publicações
11.
Anesth Analg ; 129(1): 141-146, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30004933

RESUMO

BACKGROUND: Virtually all anesthesiologists care for patients who sustain traumatic injuries; however, the frequency with which operative anesthesia care is provided to this specific patient population is unclear. We sought to better understand the degree to which anesthesia providers participate in operative trauma care and how this differs by trauma center designation (levels I-V), using data from a comprehensive, regional database-the Washington State Trauma Registry (WSTR). We also sought to specifically assess operative anesthesia care frequency vis a vis the American College of Surgeons guidelines for continuous anesthesiology coverage for Level II trauma center accreditation. METHODS: We conducted a retrospective analysis measuring the frequency of operative anesthesia care among patients enrolled in the WSTR. Univariate comparisons were made between trauma patients who had surgery during their admission and those who did not (medical management only). In addition, clinical factors associated with surgical intervention were measured. We also measured the average times from hospital admission to surgery and compared these times across trauma centers, grouped level I, II, and III-V. RESULTS: From 2004 to 2014, there were approximately 176,000 encounters meeting WSTR inclusion criteria. Approximately 60% of these trauma encounters included exposure to operative anesthesia during the admission. Among all surgical procedures during the trauma admission, approximately 33% occurred within a level I trauma center, 23% occurred within a level II trauma center, and 44% occurred in a trauma center with a III, IV, or V designation. The predominant procedure category during a trauma admission was orthopedic. The presence of hypotension on admission (P < .01), increasing injury severity score (P < .01) and higher emergency department Glasgow Coma Score (P < .01) were all associated with surgical intervention during the trauma hospitalization, after adjustment for potential confounders. In level I trauma centers, for general surgical procedures, the median time to surgery was 2.5 hours; in level II trauma centers, the median time was 1.7 hours. CONCLUSIONS: This study highlights the frequent role anesthesiologists play in caring for patients who sustain traumatic injuries, in trauma centers levels I-V. In level II trauma centers, in-house anesthesiology coverage might have benefit for those patients requiring surgery within 1 hour, whereas the former American College of Surgeons requirement of 30-minute response time for out-of-hospital anesthesiology coverage is likely sufficient to provide satisfactory care to patients requiring surgery within 3 hours. Whether the increased cost of such in-house anesthesiology coverage at level II trauma centers is justified by its clinical benefit remains an unanswered question.


Assuntos
Anestesia/tendências , Anestesiologistas/tendências , Cuidados Intraoperatórios/tendências , Equipe de Assistência ao Paciente/tendências , Padrões de Prática Médica/tendências , Ferimentos e Lesões/cirurgia , Adulto , Idoso , Anestesia/efeitos adversos , Feminino , Humanos , Cuidados Intraoperatórios/efeitos adversos , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas , Duração da Cirurgia , Papel do Médico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Cirurgiões , Fatores de Tempo , Centros de Traumatologia , Resultado do Tratamento , Washington
12.
Anesth Analg ; 128(2): 335-341, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29958214

RESUMO

BACKGROUND: The use of cognitive aids, such as emergency manuals (EMs), improves team performance on critical steps during crisis events. In our large academic anesthesia practice, we sought to broadly implement an EM and subsequently evaluate team member performance on critical steps. METHODS: We observed the phases of implementing an EM at a large academic anesthesia practice from 2013 to 2016, including the formation of the EM implementation team, identification of preferred EM characteristics, consideration of institution-specific factors, selection of the preferred EM, recognition of logistical barriers, and staff education. Utilization of the EM was tested in a regular clinical environment with all available resources using a standardized verbal simulation of 3 crisis events both preimplementation and 6 months postimplementation. Individual members of the anesthesia team were asked to verbalize interventions for specific crisis events over 60 seconds. RESULTS: We introduced a customized version of the Stanford Emergency Manual on January 26, 2015. Fifty-nine total participants (equal proportion of anesthesiology attending physicians, resident physicians, certified registered nurse anesthetists, and student registered nurse anesthetist staff) were surveyed in the preimplementation phase and 60 in the 6-month postimplementation phase. In the postimplementation phase, a minority (41.7%) utilized the EM for the verbal-simulated crisis events. Those who used the EM performed better than those who did not (median 21.0 critical steps out of a possible 30 total steps [70.0%], interquartile range 19-25 vs 18.0 critical steps verbalized [60.0%], interquartile range 16-20; P < .001). Among all subjects, the median number of critical steps verbalized was 16 (53.3%) preimplementation and 19.5 critical steps (65.0%) postimplementation. CONCLUSIONS: Implementation of an EM in a large academic anesthesia practice is not without challenges. While full integration of the EM was not achieved 6 months after implementation, verbalization of critical steps on 3 simulated crisis events improved when the EM was utilized.


Assuntos
Centros Médicos Acadêmicos/normas , Anestesia/normas , Competência Clínica/normas , Serviços Médicos de Emergência/normas , Manuais como Assunto/normas , Centros Médicos Acadêmicos/tendências , Anestesia/tendências , Serviços Médicos de Emergência/tendências , Humanos , Fluxo de Trabalho
13.
J Cardiothorac Vasc Anesth ; 33(3): 808-816, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30064852

RESUMO

Opioids have played in a key role in cardiac anesthesia and analgesia since the early years of cardiac surgery. Today, opioids continue to be the primary mode for analgesia in cardiac surgery, yet there is considerable variability in the choice, dose and route of used. A history of the use of opioids in cardiothoracic anesthesia is presented, followed by an examination of the differences among current opioids in use and of outcome variables important in cardiac anesthesia, such as postoperative analgesia, extubation times, fast-track cardiac anesthesia, chronic neuropathic pain, and cardioprotection. Topical issues such as the role of perioperative opioid use in the global opioid crisis, opioid-sparing techniques and novel opioids in development are also discussed.


Assuntos
Analgesia/métodos , Analgésicos Opioides/administração & dosagem , Anestesia/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Adulto , Analgesia/tendências , Analgésicos Opioides/efeitos adversos , Anestesia/tendências , Procedimentos Cirúrgicos Cardíacos/tendências , Humanos , Hiperalgesia/induzido quimicamente , Hiperalgesia/diagnóstico , Hiperalgesia/epidemiologia , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor/métodos , Manejo da Dor/tendências , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle
14.
Anesth Analg ; 128(2): 315-327, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30346358

RESUMO

BACKGROUND: There are few comparative data on the analgesic options used to manage patients undergoing minimally invasive repair of pectus excavatum (MIRPE). The Society for Pediatric Anesthesia Improvement Network was established to investigate outcomes for procedures where there is significant management variability. For our first study, we established a multicenter observational database to characterize the analgesic strategies used to manage pediatric patients undergoing MIRPE. Outcome data from the participating centers were used to assess the association between analgesic strategy and pain outcomes. METHODS: Fourteen institutions enrolled patients from June 2014 through August 2015. Network members agreed to an observational methodology where each institution managed patients based on their institutional standards and protocols. There was no requirement to standardize care. Patients were categorized based on analgesic strategy: epidural catheter (EC), paravertebral catheter (PVC), wound catheter (WC), no regional (NR) analgesia, and intrathecal morphine techniques. Primary outcomes, pain score and opioid consumption by postoperative day (POD), for each technique were compared while adjusting for confounders using multivariable modeling that included 5 covariates: age, sex, number of bars, Haller index, and use of preoperative pain medication. Pain scores were analyzed using repeated-measures analysis of variance with Bonferroni correction. Opioid consumption was analyzed using a multivariable quantile regression. RESULTS: Data were collected on 348 patients and categorized based on primary analgesic strategy: EC (122), PVC (57), WC (41), NR (120), and intrathecal morphine (8). Compared to EC, daily median pain scores were higher in patients managed with PVC (POD 0), WC (POD 0, 1, 2, 3), and NR (POD 0, 1, 2), respectively (P < .001-.024 depending on group). Daily opioid requirements were higher in patients managed with PVC (POD 0, 1), WC (POD 0, 1, 2), and NR (POD 0, 1, 2) when compared to patients managed with EC (P < .001). CONCLUSIONS: Our data indicate variation in pain management strategies for patients undergoing MIRPE within our network. The results indicate that most patients have mild-to-moderate pain postoperatively regardless of analgesic management. Patients managed with EC had lower pain scores and opioid consumption in the early recovery period compared to other treatment strategies.


Assuntos
Tórax em Funil/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Pediatria/normas , Assistência Perioperatória/normas , Sistema de Registros/normas , Sociedades Médicas/normas , Adolescente , Anestesia/normas , Anestesia/tendências , Criança , Gerenciamento Clínico , Feminino , Tórax em Funil/diagnóstico , Hospitalização/tendências , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Pediatria/tendências , Assistência Perioperatória/tendências , Estudos Prospectivos , Relatório de Pesquisa/normas , Sociedades Médicas/tendências , Resultado do Tratamento
15.
Scott Med J ; 64(1): 22-24, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30336741

RESUMO

Our current global health structure has not yet evolved to do what the world needs of it. Despite significant advances in some areas of public health over the past few decades, disparities in health have worsened in many areas. The historical approach of global health governance to health issues has been overwhelmingly led by vertical, single disease efforts. Yet, this structure cannot effectively implement broad-reaching international development goals set forth by the United Nations. The solution requires a rapid evolution of the present health system conceptualisation. As the Cambrian period brought skeletal infrastructure to life on our planet with vertebrates, allowing life to take on new capabilities never before witnessed on earth, so will surgery, obstetrics and anaesthesia provide the much needed healthcare delivery infrastructure that will allow health system strengthening to take global healthcare along a new path. Surgery, anaesthesia and obstetrics form the core foundation upon which the whole of global health is built and serve as the skeletal structure and indicator of robust health systems. Integrating these domains as the backbone of health system strengthening will finally allow global health to stand and support all sectors of healthcare delivery as an equal partner in health.


Assuntos
Anestesia/tendências , Assistência à Saúde/tendências , Saúde Global/tendências , Procedimentos Cirúrgicos Obstétricos/tendências , Obstetrícia/tendências , Humanos
16.
Korean J Anesthesiol ; 72(2): 156-163, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30301317

RESUMO

BACKGROUND: To identify trends in injuries and substandard care associated with anesthesia, we analyzed the Korean Society of Anesthesiologists database for anesthesia-related case files from July 2009 to June 2018. METHODS: Case characteristics, injuries, and outcomes were compared between the first part (July 2009-June 2014, n = 105) and the second part (July 2014-June 2018, n = 92) of the analyzed time period. RESULTS: Overall, 132 cases resulted in death. The proportion of fatal cases for sedation was similar to general anesthesia (66.2% vs. 76.3%). The proportion of cases with permanent injury or death decreased significantly in the second part of the period compared with the first part (76.1% vs. 93.3%, P = 0.002). With a growing trend in the proportion of sedation cases, a similar number of sedation and general anesthesia cases were referred during the overall period (77 and 76 cases, respectively). Propofol-based regimens remained the dominant sedation method (89.7% in the first part vs. 78.9% in the second part). The most common adverse event in cases of permanent injury or death was identified as being respiratory in origin (98/182, 53.8%). Permanent injuries or deaths were related to local anesthetic systemic toxicity (LAST) and beach-chair positioning for shoulder surgery, in 8 and 5 cases, respectively. CONCLUSIONS: Despite the decreasing trend in injury severity with time, several characteristic injury profiles were identified: lack of vigilance in propofol-based sedation, neurological injuries related to the beach-chair position, and LAST occurring during tumescent anesthesia or brachial plexus block.


Assuntos
Anestesia/tendências , Anestesiologistas/tendências , Bases de Dados Factuais/tendências , Dissidências e Disputas , Sociedades Médicas/tendências , Adulto , Anestesia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos
18.
Eur J Anaesthesiol ; 36(3): 175-184, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30507621

RESUMO

BACKGROUND: Prenatal myelomeningocele repair by open surgery can improve the neurological prognosis of children with this condition. A shift towards a fetoscopic approach seems to reduce maternal risks and improve obstetric outcomes. OBJECTIVE: The aim of this study was to report on the anaesthetic management of women undergoing prenatal open or fetoscopic surgery for neural tube defects. DESIGN: A retrospective cohort study. SETTING: Prenatal myelomeningocele repair research group, Vall d'Hebron University Hospital, Spain. INTERVENTION: Intra-uterine foetal repairs of spina bifida between 2011 and 2016 were reviewed. Anaesthetic and vasoconstrictor drugs, fluid therapy, maternal haemodynamic changes during surgery, blood gas changes during CO2 insufflation for fetoscopic surgery, and maternal and foetal complications were noted. RESULTS: Twenty-nine foetuses with a neural tube defect underwent surgery, seven (24.1%) with open and 22 (75.9%) with fetoscopic surgery. There were no significant differences in maternal doses of opioids or neuromuscular blocking agents. Open surgery was associated with higher dose of halogenated anaesthetic agents [maximum medium alveolar concentration (MAC) sevoflurane 1.90 vs. 1.50%, P = 0.01], higher need for intra-operative tocolytic drugs [five of seven (71.4%) and two of 22 (9.1%) required nitroglycerine, P = 0.001], higher volume of colloids (500 vs. 300 ml, P = 0.036) and more postoperative tocolytic drugs (three drugs in all seven cases (100%) of open and in one of 21 (4.76%) of fetoscopic surgery, P < 0.001). Median mean arterial pressure was lower in open than in fetoscopic surgery. SBP, DBP and mean blood pressure decreased during uterine exposure, and this descent was more acute in open surgery. Use of vasoconstrictor drugs was related to the time of uterine exposure, but not to surgical technique. Blood gas analysis was not affected by CO2 insufflation during fetoscopic surgery. CONCLUSION: Open surgery was associated with more maternal haemodynamic changes and higher doses of halogenated anaesthetic and tocolytics agents than fetoscopic surgery.


Assuntos
Anestesia/métodos , Fetoscopia/métodos , Histerectomia/métodos , Monitorização Intraoperatória/métodos , Defeitos do Tubo Neural/cirurgia , Analgésicos Opioides/administração & dosagem , Anestesia/efeitos adversos , Anestesia/tendências , Estudos de Coortes , Feminino , Fetoscopia/efeitos adversos , Fetoscopia/tendências , Hemodinâmica/efeitos dos fármacos , Hemodinâmica/fisiologia , Humanos , Histerectomia/efeitos adversos , Histerectomia/tendências , Monitorização Intraoperatória/tendências , Defeitos do Tubo Neural/diagnóstico , Defeitos do Tubo Neural/fisiopatologia , Bloqueadores Neuromusculares/administração & dosagem , Gravidez , Estudos Retrospectivos , Adulto Jovem
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