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1.
Anaesthesia ; 76 Suppl 1: 27-39, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33426662

RESUMO

Despite advances in clinical practice, local anaesthetic systemic toxicity continues to occur with the therapeutic use of local anaesthesia. Patterns of presentation have evolved over recent years due in part to the increasing use of ultrasound which has been demonstrated to reduce risk. Onset of toxicity is increasingly delayed, a greater proportion of clinical reports are secondary to fascial plane blocks, and cases are increasing where non-anaesthetist providers are involved. The evolving clinical context presents a challenge for diagnosis and requires education of all physicians, nurses and allied health professionals about these changing patterns and risks. This review discusses: mechanisms; prevention; diagnosis; and treatment of local anaesthetic systemic toxicity. The local anaesthetic and dose used, site of injection and block conduct and technique are all important determinants of local anaesthetic systemic toxicity, as are various patient factors. Risk mitigation is discussed including the care of at-risk groups, such as: those at the extremes of age; patients with cardiac, hepatic and specific metabolic diseases; and those who are pregnant. Advances in the changing clinical landscape with novel applications and settings for the use of local anaesthesia are also described. Finally, we signpost future directions to potentially improve the management of local anaesthetic systemic toxicity. The utility of local anaesthetics remains unquestionable in clinical practice, and thus maximising the safe and appropriate use of these drugs should translate to improvements in patient care.


Assuntos
Anestesia por Condução/efeitos adversos , Anestésicos Locais/efeitos adversos , Anestésicos Locais/toxicidade , Humanos , Complicações Intraoperatórias/induzido quimicamente , Complicações Intraoperatórias/terapia , Bloqueio Nervoso/efeitos adversos , Segurança do Paciente
2.
Am J Cardiol ; 143: 37-45, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33387472

RESUMO

Ellis grade III coronary artery perforations (G3-CAP) remain a life-threatening complication of percutaneous coronary intervention (PCI), with high morbidity and mortality and lack of consensus regarding optimal treatment strategies. We reviewed all PCIs performed in 10 European centers from 1993 to 2019 recording all G3-CAP along with management strategies, in-hospital and long-term outcome according to Device-related perforations (DP) and Guidewire-related perforations (WP). Among 106,592 PCI (including 7,773 chronic total occlusions), G3-CAP occurred in 311 patients (0.29%). DP occurred in 194 cases (62.4%), more commonly in proximal segments (73.2%) and frequently secondary to balloon dilatation (66.0%). WP arose in 117 patients (37.6%) with chronic total occlusions guidewires involved in 61.3% of cases. Overall sealing success rate was 90.7% and usually required multiple maneuvers (80.4%). The most commonly adopted strategies to obtain hemostasis were prolonged balloon inflation (73.2%) with covered stent implantation (64.4%) in the DP group, and prolonged balloon inflation (53.8%) with coil embolization (41%) in the WP group.  Procedural or in-hospital events arose in 38.2% of cases: mortality was higher after DP (7.2% vs 2.6%, p = 0.05) and acute stent thrombosis 3-fold higher (3.1% vs 0.9%, p = 0.19). At clinical follow-up, median 2 years, a major cardiovascular event occurred in one-third of cases (all-cause mortality 8.2% and 7.1% respectively, without differences between groups). In conclusion, although rare and despite improved rates of adequate perforation sealing G3-CAP cause significant adverse events. DP and WP result in different patterns of G3-CAP and management strategies should be based on this classification.


Assuntos
Doença da Artéria Coronariana/cirurgia , Oclusão Coronária/cirurgia , Vasos Coronários/lesões , Complicações Intraoperatórias/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Lesões do Sistema Vascular/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/efeitos adversos , Stents Farmacológicos , Embolização Terapêutica/métodos , Feminino , Hemostasia Cirúrgica/métodos , Humanos , Incidência , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/instrumentação , Sistema de Registros , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/terapia
3.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431473

RESUMO

A 26-year-old man underwent laparoscopic appendicectomy for acute appendicitis that was carried out uneventfully after initial urethral catheterisation to empty the bladder. Postoperatively, he developed oliguria associated with high drain output and elevated drain fluid creatinine. A contrast-enhanced computed tomography urography scan showed a small amount of contrast in the intraperitoneal space. A diagnostic laparoscopy performed for a suspected bladder injury revealed that the drain (inserted via the suprapubic port) had traversed the bladder. The drain was removed, and the bladder defects were repaired. The catheter was removed 2 weeks later uneventfully. It is important to recognise and avoid the urinary bladder during suprapubic port insertion during laparoscopic appendicectomy. This complication can be minimised via initial bladder decompression and introduction of the suprapubic port lateral to the umbilical ligaments. A high index of suspicion is required to diagnose a small bladder injury.


Assuntos
Apendicectomia/efeitos adversos , Apendicite/cirurgia , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Laparoscopia/efeitos adversos , Bexiga Urinária/lesões , Adulto , Humanos , Doença Iatrogênica , Complicações Intraoperatórias/terapia , Masculino , Tomografia Computadorizada por Raios X , Urografia
5.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370965

RESUMO

Tracheal tear after endotracheal intubation is extremely rare. The role of silicone Y-stent in the management of tracheal injury has been documented in the previous studies. However, none of the studies have mentioned the deployment of silicone Y-stent via rigid bronchoscope with the patient solely supported by extracorporeal membrane oxygenation (ECMO) without general anaesthesia delivered via the side port of the rigid bronchoscope. We report a patient who had a tracheal tear due to endotracheal tube migration following a routine video-assisted thoracoscopic surgery sympathectomy, which was successfully managed with silicone Y-stent insertion. Procedure was done while she was undergoing ECMO; hence, no ventilator connection to the side port of the rigid scope was required. This was our first experience in performing Y-stent insertion fully under ECMO, and the patient had a successful recovery.


Assuntos
Oxigenação por Membrana Extracorpórea , Complicações Intraoperatórias/terapia , Intubação Intratraqueal/efeitos adversos , Lacerações/terapia , Traqueia/lesões , Broncoscopia , Falha de Equipamento , Feminino , Humanos , Doença Iatrogênica , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Intubação Intratraqueal/instrumentação , Lacerações/diagnóstico , Lacerações/etiologia , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/terapia , Ventilação Monopulmonar/instrumentação , Stents , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Traqueia/diagnóstico por imagem , Adulto Jovem
6.
Angiol. (Barcelona) ; 72(6): 308-311, nov.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-199691

RESUMO

Descripción de una complicación en una reparación de AAA con dispositivo anaconda fenestrada (Vascutek, Teru­mo(R)) por desconexión de stent renal en la que se plantearon estrategias de manejo para su corrección con un adecuado desenlace angiográfico y clínico


Description of complication in repair of AAA with fenestrated anaconda device (Vascutek Ltd./Terumo(R)), due to disconnection of renal stent where management strategies were proposed for its correction with an adequate angiographic and clinical outcome


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Stents/efeitos adversos , Complicações Intraoperatórias/terapia , Falha de Tratamento , Falha de Prótese , Artéria Renal/diagnóstico por imagem , Angiografia
7.
Anesth Analg ; 131(5): 1485-1490, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079871

RESUMO

The double-lumen tubes (DLTs) are the most widely used devices to provide perioperative lung isolation. Airway rupture is a rare but life-threatening complication of DLTs. The primary aim of this review was to collect all cases reported in the literature about airway rupture caused by DLTs and to describe the reported possible contributors, diagnosis, treatment, and outcomes of this complication. Another aim of this review was to assess the possible factors associated with mortality after airway rupture by DLTs. A comprehensive literature search for all cases of airway rupture caused by DLTs was performed in the PubMed, EMBASE, Ovid, Wanfang Database, and CNKI. The extracted data included age, sex, height, weight, type of operation, type and size of DLT, site of airway rupture, possible contributors, clinical presentation, diagnosis timing, treatment, and outcome. We included 105 single case reports and 22 case series with a total number of 187 patients. Most of the ruptures were in the trachea (n = 98, 52.4%) and left main bronchus (n = 70, 37.4%). The common possible contributors include use of a stylet, cuff overdistention, multiple attempts to adjust the position of a DLT, difficult intubation, and use of an oversized DLT. Most of the airway ruptures were diagnosed intraoperatively (n = 138, 82.7%). Pneumomediastinum, air leakage, hypoxemia, and subcutaneous emphysema were the common clinical manifestations. Most patients were treated with surgical repair (n = 147, 78.6%). The mortality of the patients with airway rupture by DLTs was 8.8%. Age, sex, site of rupture, diagnosis timing, and method of treatment were not found to be associated with mortality.


Assuntos
Manuseio das Vias Aéreas/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/terapia , Intubação Intratraqueal/efeitos adversos , Sistema Respiratório/lesões , Idoso , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Intubação Intratraqueal/instrumentação , Masculino , Pessoa de Meia-Idade , Ruptura
8.
Anesth Analg ; 131(5): 1540-1550, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079877

RESUMO

BACKGROUND: Continuous blood pressure monitoring may facilitate early detection and prompt treatment of hypotension. We tested the hypothesis that area under the curve (AUC) mean arterial pressure (MAP) <65 mm Hg is reduced by continuous invasive arterial pressure monitoring. METHODS: Adults having noncardiac surgery were randomly assigned to continuous invasive arterial pressure or intermittent oscillometric blood pressure monitoring. Arterial catheter pressures were recorded at 1-minute intervals; oscillometric pressures were typically recorded at 5-minute intervals. We estimated the arterial catheter effect on AUC-MAP <65 mm Hg using a multivariable proportional odds model adjusting for imbalanced baseline variables and duration of surgery. Pressures <65 mm Hg were categorized as 0, 1-17, 18-91, and >91 mm Hg × minutes of AUC-MAP <65 mm Hg (ie, no hypotension and 3 equally sized groups of increasing hypotension). RESULTS: One hundred fifty-two patients were randomly assigned to arterial catheter use and 154 to oscillometric monitoring. For various clinical reasons, 143 patients received an arterial catheter, while 163 were monitored oscillometrically. There were a median [Q1, Q3] of 246 [187, 308] pressure measurements in patients with arterial catheters versus 55 (46, 75) measurements in patients monitored oscillometrically. In the primary intent-to-treat analysis, catheter-based monitoring increased detection of AUC-MAP <65 mm Hg, with an estimated proportional odds ratio (ie, odds of being in a worse hypotension category) of 1.78 (95% confidence interval [CI], 1.18-2.70; P = .006). The result was robust over an as-treated analysis and for sensitivity analyses with thresholds of 60 and 70 mm Hg. CONCLUSIONS: Intraoperative blood pressure monitoring with arterial catheters detected nearly twice as much hypotension as oscillometric measurements.


Assuntos
Pressão Arterial , Cateteres , Hipotensão/diagnóstico , Complicações Intraoperatórias/diagnóstico , Monitorização Intraoperatória/métodos , Idoso , Área Sob a Curva , Diagnóstico Precoce , Feminino , Humanos , Hipotensão/terapia , Complicações Intraoperatórias/terapia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Oscilometria , Sensibilidade e Especificidade , Procedimentos Cirúrgicos Operatórios , Resultado do Tratamento
11.
Actas urol. esp ; 44(5): 357-366, jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-188228

RESUMO

Describimos las complicaciones más frecuentes de la cirugía de implante de prótesis de pene haciendo hincapié en su manejo práctico. Hemos dividido las complicaciones en intraoperatorias y postoperatorias. Entre las complicaciones intraoperatorias destacan: la perforación de los cuerpos a cavernosos durante la dilñatación, el cross-ver de los cilindros o colocación cruzada y la lesión uretral durante el implante. Las complicaciones más frecuentes postoperatorias son el fallo mecánico de la prótesis, la erosión de cilindros y la infección las prótesis haciendo énfasis en la cirugía de rescate y en las técnicas de reimplante en fibrosis de tejido cavernoso


We describe the most frequent complications associated with penile implant surgery, paying special attention to their practical management. We have analyzed preoperative complications and postoperative complications separately. The intraoperative include perforation of the corpora cavernosa during dilation, cylinder cross-over or cross-placement and urethral injury during implantation. The most frequent postoperative complications are mechanical failure, cylinder erosion and prosthesis infection. We emphasize on rescue surgery and reimplantation techniques in cavernous tissue fibrosis


Assuntos
Humanos , Masculino , Implante Peniano/efeitos adversos , Prótese de Pênis/efeitos adversos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia
12.
Anesth Analg ; 131(2): 497-507, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32427660

RESUMO

BACKGROUND: Unanticipated hospital admission is regarded as a measure of adverse perioperative patient care. However, previously published studies for risk prediction after ambulatory procedures are sparse compared to those examining readmission after inpatient surgery. We aimed to evaluate the incidence and reasons for unplanned admission after ambulatory surgery and develop a prediction tool for preoperative risk assessment. METHODS: This retrospective cohort study included adult patients undergoing ambulatory, noncardiac procedures under anesthesia care at 2 tertiary care centers in Massachusetts, United States, between 2007 and 2017 as well as all hospitals and ambulatory surgery centers in New York State, United States, in 2014. The primary outcome was unplanned hospital admission within 30 days after discharge. We created a prediction tool (the PREdicting admission after Outpatient Procedures [PREOP] score) using stepwise backward regression analysis to predict unplanned hospital admission, based on criteria used by the Centers for Medicare & Medicaid Services, within 30 days after surgery in the Massachusetts hospital network registry. Model predictors included patient demographics, comorbidities, and procedural factors. We validated the score externally in the New York state registry. Reasons for unplanned admission were assessed. RESULTS: A total of 170,983 patients were included in the Massachusetts hospital network registry and 1,232,788 in the New York state registry. Among those, the observed rate of unplanned admission was 2.0% (3504) and 1.7% (20,622), respectively. The prediction model showed good discrimination in the training set with C-statistic of 0.77 (95% confidence interval [CI], 0.77-0.78) and satisfactory discrimination in the validation set with C-statistic of 0.71 (95% CI, 0.70-0.71). The risk of unplanned admission varied widely from 0.4% (95% CI, 0.3-0.4) among patients whose calculated PREOP scores were in the first percentile to 21.3% (95% CI, 20.0-22.5) among patients whose scores were in the 99th percentile. Predictions were well calibrated with an overall ratio of observed-to-expected events of 99.97% (95% CI, 96.3-103.6) in the training and 92.6% (95% CI, 88.8-96.4) in the external validation set. Unplanned admissions were most often related to malignancy, nonsurgical site infections, and surgical complications. CONCLUSIONS: We present an instrument for prediction of unplanned 30-day admission after ambulatory procedures under anesthesia care validated in a statewide cohort comprising academic and nonacademic hospitals as well as ambulatory surgery centers. The instrument may be useful in identifying patients at high risk for 30-day unplanned hospital admission and may be used for benchmarking hospitals, ambulatory surgery centers, and practitioners.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/tendências , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/epidemiologia , Admissão do Paciente/tendências , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Incidência , Complicações Intraoperatórias/terapia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo
13.
J Cardiothorac Surg ; 15(1): 73, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375864

RESUMO

BACKGROUND: Left atrial dissection is an extremely rare complication of mitral valve replacement. Because of its severity, its prompt diagnosis and treatment is mandatory. The most effective treatment (i.e. surgical vs. non-surgical) for left atrial dissection has not been fully established yet. CASE PRESENTATION: Herein, we have reported left atrial dissection after mitral valve replacement in a 68-year-old obese woman. After closing the thorax, transesophageal echocardiography (TEE) revealed an atrial mass of 3 cm × 2 cm, visualized as an oval hypoechoic appearance extending from the posterior annulus of the mitral valve to the posterior wall of the left atrium. Because hemodynamic conditions were stable, surgery was ruled out and conservative treatment with close observation was selected. On postoperative day 2, TEE revealed that the atrial mass had vanished and the broken piece of the endocardium merely remained fluttering in the atrium. On postoperative day 6, the appearance of the left atrium was normalized completely, leaving no traces of left atrial dissection. The patient recovered uneventfully. Serial TEE was a very effective imaging modality during the non-surgical treatment of left atrial dissection. CONCLUSIONS: It is crucial to accurately define diagnosis and optimally consider therapeutic strategies for left atrial dissection based on the hemodynamic conditions of the patient and serial TEE follow-up examinations. In our case study, left atrial dissection was successfully treated with conservative treatment; therefore, we believe that TEE could be a feasible modality for the early diagnosis of this condition.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Endocárdio/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca , Complicações Intraoperatórias/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Idoso , Aneurisma Dissecante/terapia , Fibrilação Atrial/complicações , Tratamento Conservador , Ecocardiografia Transesofagiana , Feminino , Insuficiência Cardíaca/etiologia , Hemodinâmica , Humanos , Complicações Intraoperatórias/terapia , Insuficiência da Valva Mitral/complicações , Remissão Espontânea , Resultado do Tratamento
14.
Plast Reconstr Surg ; 145(4): 880-887, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221194

RESUMO

BACKGROUND: The authors present their stacked flap breast reconstruction experience to facilitate selection of either caudal internal mammary vessels or intraflap vessels for the second recipient anastomosis. METHODS: A retrospective review was conducted of multiflap breast reconstructions (double-pedicled deep inferior epigastric perforator, stacked profunda artery perforator, and stacked profunda artery perforator/deep inferior epigastric perforator) performed at the authors' institution from 2011 to 2018. Data collected included demographics, recipient vessels used, and intraoperative/postoperative flap complications. Complications were compared between cranial, caudal, and intraflap anastomoses. RESULTS: Four hundred stacked flaps were performed in 153 patients. Of 400 arterial anastomoses, 200 (50 percent) were to cranial internal mammary vessels, 141 (35.3 percent) were to caudal internal mammary vessels, and 59 (14.8 percent) were to intraflap vessels. Of 435 venous anastomoses, 145 (33.3 percent) were to caudal internal mammary vessels, 201 (46.2 percent) were to cranial internal mammary vessels, and 89 (20.5 percent) were to intraflap vessels. Intraoperative revision for thrombosis occurred in 12 of 141 caudal (8.5 percent), 14 of 20 cranial (7 percent), and seven of 59 intraflap (11.9 percent) arterial anastomoses (p = 0.373), and in none of caudal, three of 201 cranial (1.5 percent), and two of 89 intraflap (2.2 percent) venous anastomoses (p = 0.559). Postoperative anastomotic complications occurred in 12 of 400 flaps (3 percent) and were exclusively attributable to venous compromise; seven of 12 (58.3 percent) were salvaged, and five of 12 (41.7 percent) were lost. More lost flaps were caused by caudal [four of five (80 percent)] versus cranial [one of five (20 percent)] or intraflap (zero of five) thrombosis (p = 0.020). CONCLUSION: If vessel features are equivalent between the caudal internal mammary vessels and intraflap vessels, intraflap vessels should be used for second site anastomosis in stacked flap reconstructions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Neoplasias da Mama/cirurgia , Artérias Epigástricas/cirurgia , Mamoplastia/métodos , Artéria Torácica Interna/cirurgia , Retalho Perfurante/transplante , Trombose/epidemiologia , Algoritmos , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Mama/irrigação sanguínea , Mama/cirurgia , Feminino , Sobrevivência de Enxerto , Humanos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Mamoplastia/efeitos adversos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Retalho Perfurante/irrigação sanguínea , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Prospectivos , Estudos Retrospectivos , Trombose/etiologia , Trombose/terapia , Resultado do Tratamento
15.
J Surg Res ; 252: 47-56, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32222593

RESUMO

BACKGROUND: Perioperative blood transfusions in children are associated with patient morbidity and are often overutilized. In this study, we identify procedures most commonly associated with the use of red blood cells (RBC) in childrens surgery and develop risk-adjusted models for benchmarking. METHODS: Data from the 2012-2015 National Surgical Quality Improvement Program-Pediatric participant use data files were used. CPT (Current Procedural Terminology) codes were grouped to identify the procedures where transfusions were allocated and associated patient demographics and comorbidities. Patients were stratified in two age groups (0-3 mo and 3 mo to 18 y), and a logistic regression model was developed for each age group. RESULTS: Of 369,176 total cases, 21,410 (5.8%) were associated with a perioperative transfusion. 659 CPT codes were grouped in 207 clusters according to their similarities. The most common procedures associated with transfusion were arthrodesis for spinal deformity (n = 9533, 44.5%), followed by craniectomy for craniosynostosis (n = 1853, 8.7%). The logistic regression model for patients <3 mo included 18 variables and had excellent discriminatory performance (area under the curve 0.866). The model for patients ≥3 mo to 18 y had 21 variables and an area under the curve of 0.911. CONCLUSIONS: The majority of transfusions used in children's surgery are concentrated within a relatively few procedural groups. These findings can help centers in focusing blood optimization efforts on common surgeries with high transfusion rates. In addition, multiple preoperative factors have been built into a risk-adjusted model that can be used for benchmarking blood transfusions among hospitals.


Assuntos
Benchmarking/métodos , Transfusão de Eritrócitos/estatística & dados numéricos , Hospitais Pediátricos/organização & administração , Complicações Intraoperatórias/terapia , Complicações Pós-Operatórias/terapia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adolescente , Austrália , Criança , Pré-Escolar , Transfusão de Eritrócitos/efeitos adversos , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Complicações Intraoperatórias/etiologia , Modelos Logísticos , Masculino , Modelos Organizacionais , Assistência Perioperatória/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Emirados Árabes Unidos , Estados Unidos
16.
World Neurosurg ; 137: 416-420, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32084615

RESUMO

BACKGROUND: Osteoporosis has become an important issue owing to the increasing elderly population. It is the most common cause of vertebral compression fracture. Conservative treatment is often ineffective, whereas surgical treatment has a vital role in compression fracture. Vesselplasty is a new surgical alternative to traditional vertebroplasty and kyphoplasty. It uses a polyethylene terephthalate balloon that functions as both a vertebral body expander and a bone cement container. We present a rare but catastrophic case of cement leakage during vesselplasty resulting in devastating neurologic compromise. This case highlights the need for awareness of vesselplasty safety and the importance of using a low-temperature bone cement. CASE DESCRIPTION: A 77-year-old woman presented with debilitating back pain owing to acute T6 compression fracture as detected by magnetic resonance imaging. Under biplanar fluoroscopy, vesselplasty using a polyethylene terephthalate balloon container was performed at the T6 vertebrae. During cement injection, balloon rupture and cement leakage occurred compromising the spinal canal. Emergent laminectomy and cement removal were performed. Paraplegia developed postoperatively. CONCLUSIONS: Though vesselplasty is claimed to be safe, cement leakage related to balloon rupture occurred in our case. Furthermore, thermal effects were difficult to observe during polymethyl methacrylate polymerization. Heat not only might cause irreversible complications but also might make the balloon rupture more easily.


Assuntos
Cimentos para Ossos , Fraturas por Compressão/cirurgia , Complicações Intraoperatórias/etiologia , Cifoplastia/efeitos adversos , Fraturas por Osteoporose/cirurgia , Traumatismos da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Idoso , Feminino , Fluoroscopia , Glucocorticoides/uso terapêutico , Humanos , Pseudo-Obstrução Intestinal/etiologia , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/terapia , Laminectomia , Paraplegia/etiologia , Polimetil Metacrilato , Traumatismos da Medula Espinal/terapia
17.
World Neurosurg ; 139: e13-e22, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32059965

RESUMO

OBJECTIVE: We sought to review the types of incidental durotomies (IDs) that occurred during the endoscopic stenosis lumbar decompression through interlaminar approach (ESLD) and discuss the management strategies according to our classification. METHODS: A retrospective evaluation was performed for patients with spinal stenosis who underwent ESLD. Out of 330 patients, 27 patients of ID were clinically evaluated preoperatively and postoperatively on the basis of a visual analog scale score, Oswestry Disability Index, and MacNab's criteria. ID patterns are classified according to the size, location, and involvement of neural elements. Intraoperative and postoperative surgical management was evaluated. RESULTS: Intraoperative incidence of ID was 8.2%. According to lumbar levels, 11 (40.7%) occurred at L3-4, 12 (44.4%) at L4-5, and 4 (14.8%) at L5-S1 ID cases. IDs were divided into 4 types: 29.6% are type 1, 70% are type 2, 7.4% are type 3, and 3.7% are type 4. Overall for mean and standard deviation preoperative, 1 week postoperative, 3 months, and final follow-up for visual analog scale are 7.6 ± 1.4, 3.3 ± 1.1, 2.6 ± 1.1, and 1.9 ± 1.3, and for Oswestry Disability Index are 74.5 ± 9.0, 32.3 ± 9.4, 27.3 ± 7.2, and 24.4 ± 6.5 after patch blocking dura repair of ID. CONCLUSIONS: ID is a more common surgical complication in ESLD compared with the transforaminal approach. The endoscopic patch blocking dura repair technique should be considered in type 1 to type 3A of dura tear with good prognosis and clinical outcome. Consideration is made for conversion to open repair in types 3B, 3C and 4 dura tears with fair to poor outcome.


Assuntos
Descompressão Cirúrgica , Dura-Máter/lesões , Endoscopia , Complicações Intraoperatórias/epidemiologia , Lacerações/epidemiologia , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Conversão para Cirurgia Aberta , Feminino , Adesivo Tecidual de Fibrina/uso terapêutico , Humanos , Complicações Intraoperatórias/classificação , Complicações Intraoperatórias/terapia , Lacerações/classificação , Lacerações/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Instrumentos Cirúrgicos , Adesivos Teciduais/uso terapêutico
18.
Curr Urol Rep ; 21(1): 7, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32020365

RESUMO

PURPOSE OF REVIEW: To update the most relevant literature regarding complex cases during kidney transplant setting that recipient presents by himself, especially during implantation surgery due to vascular diseases and/or urinary tract anomalies. RECENT FINDINGS: Increasing age of donors and recipients is leading to an increased complexity of kidney transplant implantation surgery. In addition, the high peripheral vascular disease prevalence worldwide increases difficulty of surgery and decreases long-term outcomes as well. Moreover, it also increases transplant morbidity and mortality, both overall and cardiovascular, and finally clearly decreases graft survival. However, dialysis alternative has even worse outcomes in terms of mortality, with a proportional risk of death 2.66 higher compared with transplanted patients. Aorto-iliac prosthesis and 3rd and 4th transplants in occupied iliac fossae do also represent a challenging situation with a clearly increased morbidity and mortality. In some of those particular conditions, orthotopic kidney transplant technique is an alternative with good functional and survival outcomes, but not exempt of complications. Kidney transplant in vascular complex recipients has worse outcomes compared with conventional non-risky population. It remains a challenging surgical and medical procedure with higher morbidity and mortality, and decreased graft survival. However, dialysis mortality is still even greater and a transplant attempt might be justified. Orthotopic kidney transplant technique might play a role in selected patients with aorto-iliac unworkable segments or even in patients with special urinary tract conditions.


Assuntos
Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Anormalidades Urogenitais/cirurgia , Doenças Vasculares/cirurgia , Malformações Vasculares/cirurgia , Lesões do Sistema Vascular/cirurgia , Anastomose Cirúrgica/efeitos adversos , Humanos , Doença Iatrogênica , Complicações Intraoperatórias/terapia , Rim/irrigação sanguínea , Rim/cirurgia , Falência Renal Crônica/complicações , Transplante de Rim/efeitos adversos , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/cirurgia , Reoperação , Transplantes/irrigação sanguínea , Transplantes/cirurgia , Resultado do Tratamento , Doenças Vasculares/complicações , Malformações Vasculares/complicações
19.
Spine Deform ; 8(2): 327-331, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32030641

RESUMO

STUDY DESIGN: Case report. OBJECTIVES: To describe intraoperative administration of albumin as a cause of immunoglobulin E (IgE)-mediated anaphylaxis and cardiac arrest in an adolescent with adolescent idiopathic scoliosis. BACKGROUND: Albumin is considered the reference intraoperative colloidal solution, and is used commonly as a volume expander for treating hypovolemia. Albumin rarely causes an anaphylactic reaction, with a documented rate of only 0.099%. METHOD: An adolescent with scoliosis experienced acute, intraoperative hypotension during exposure for planned T5-L4 posterior spinal fusion shortly after infusion of albumin. She was treated rapidly and successfully with CPR and epinephrine. RESULTS: Intraoperative transesophageal echocardiogram, chest radiograph, and serum histamine, serum tryptase, and urine N-methyl-histamine laboratory tests confirmed albumin anaphylaxis to be the etiology of the intraoperative event. Further postoperative complications were avoided as a result of the rapid diagnosis and treatment. CONCLUSIONS: Although rare, IgE-mediated anaphylaxis to albumin, if administered, must be considered a possible cause of acute, intraoperative hypotension. Rapid management of anaphylaxis with communication between the surgeon, anesthesia team, and operative staff are essential if additional complications are to be avoided.


Assuntos
Albuminas/administração & dosagem , Albuminas/efeitos adversos , Anafilaxia/diagnóstico , Anafilaxia/etiologia , Cuidados Intraoperatórios/efeitos adversos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Escoliose/cirurgia , Fusão Vertebral/métodos , Doença Aguda , Adolescente , Albuminas/imunologia , Anafilaxia/imunologia , Anafilaxia/terapia , Reanimação Cardiopulmonar , Diagnóstico Precoce , Epinefrina/uso terapêutico , Feminino , Humanos , Hipotensão/etiologia , Imunoglobulina E , Complicações Intraoperatórias/terapia , Período Intraoperatório , Resultado do Tratamento
20.
J Am Acad Orthop Surg ; 28(12): e510-e516, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32097134

RESUMO

Understanding the anatomy and biomechanics of the medial collateral ligament (MCL) is crucial in producing good outcomes after total knee arthroplasty. A solid grasp of the surgical techniques that address the MCL are necessary to ensure good coronal plane ligament balance. Furthermore, intraoperative injury to the MCL in total knee arthroplasty is an uncommon yet serious complication which often goes unrecognized. Loss of the integrity of the MCL can lead to instability, loosening, and accelerated polyethylene wear. There is still controversy regarding the ideal method of treatment of intraoperative MCL injuries with suggested treatment modalities ranging from conservative management to use of varus-valgus constrained implants.


Assuntos
Artroplastia do Joelho , Ligamento Colateral Médio do Joelho/anatomia & histologia , Ligamento Colateral Médio do Joelho/lesões , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Fenômenos Biomecânicos , Humanos , Doença Iatrogênica/prevenção & controle , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Complicações Intraoperatórias/terapia , Ligamento Colateral Médio do Joelho/fisiologia , Prognóstico
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