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1.
Medicine (Baltimore) ; 100(27): e26572, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232202

RESUMO

CONTEXT: There are no scientific reports unambiguously describing the efficacy of alternating magnetic field therapy in patients after anterior cruciate ligament (ACL) reconstruction in the early postoperative period. OBJECTIVE: This study aims to evaluate the efficacy of using an alternating magnetic field in the resorption of postoperative joint effusion in patients after ACL reconstruction. STUDY DESIGN: A randomized, double-blind placebo-controlled study. SETTING: Inpatients. PARTICIPANTS: Forty patients were enrolled in the trial. However, the final study group consisted of 38 patients (28 men and 10 women) after ACL reconstruction who were randomly divided into an experimental group (19 patients) and a control group (19 patients). INTERVENTION: Each group received magnetic field therapy in the postoperative period, but only 1 apparatus emitted a magnetic field (the experimental group). Patients used the apparatus every day for 30 minutes for the next 11 days. The parameters in both devices were the same-3 mT and 10 Hz. MAIN OUTCOME MEASURES: The measurement of the knee circumference and range of motion were made. The knee circumference measurement was performed before magnetic field therapy began and for 11 days after magnetic field treatment. The active knee range of motion was evaluated before and after magnetic field therapy was completed. RESULTS: There were no statistically significant differences between the groups in the reduction of post-operative joint effusion or knee joint function. CONCLUSION: In patients after ACL reconstruction, in whom an alternating magnetic field was used to treat postoperative joint effusion, there were no beneficial effects on the analyzed variables compared to the control group.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Articulação do Joelho/cirurgia , Campos Magnéticos , Complicações Pós-Operatórias/terapia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica/fisiologia , Adolescente , Adulto , Método Duplo-Cego , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Adulto Jovem
2.
Medicine (Baltimore) ; 100(25): e26372, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160410

RESUMO

RATIONALE: Idiopathic ventricular tachycardia (VT) occurs in individuals without structural abnormalities in the heart, accounts for approximately 10% of total VTs. Furthermore, approximately 70% of idiopathic VTs originate from Right ventricular outflow tract (RVOT). However, among perioperative arrhythmias, incidence of VT after surgery is extremely rare and most arrhythmias are atrial origin. PATIENT CONCERNS: A 69-year-old man with permanent pacemaker underwent colon surgery. DIAGNOSES: Patient suffered from low blood pressure and dizziness, sweating at post anesthetic care unit (PACU) and heart rate (HR) increased suddenly to 200 beats/min with monomorphic VT after bolus ephedrine administration and continuous dopamine infusion. INTERVENTIONS: Pacemaker interrogation followed by DC cardioversion was done. OUTCOMES: Patient's vital signs became normal and symptoms are subsided. LESSONS: RVOT VT can be caused by triggering activities, such as ephedrine, dopamine, and inadequate fluid management. These triggering activities are initiated by acceleration of HR from ventricles with infusion of catecholamine which lead monomorphic VT originating from RVOT.RVOT origin PVCs can be precipitated into monomorphic VT by administrating catecholamines such as ephedrine and dopamine even in patient with pacemaker. The mechanism of these VTs includes catecholamine induced acceleration of HR. Since RVOT PVCs can be recognize by 12 EKGs, we should be pay more attentions to the pre-operation EKG and be cautious using catecholamines.


Assuntos
Colectomia/efeitos adversos , Ventrículos do Coração/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Taquicardia Ventricular/diagnóstico , Idoso , Neoplasias do Colo/cirurgia , Ecocardiografia , Cardioversão Elétrica , Eletrocardiografia , Bloqueio Cardíaco/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Marca-Passo Artificial , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/terapia , Resultado do Tratamento
3.
Acta Orthop Traumatol Turc ; 55(3): 201-207, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34100359

RESUMO

OBJECTIVE: The aim of this study was to present mid-term functional and radiological outcomes of patients with physeal closure who underwent arthroscopic or open internal fixation with headless cannulated compressive screws due to unstable Osteochondritis Dissecans (OCD) lesions of the knee. METHODS: With a diagnosis of unstable OCD of the knee, ten consecutive patients (seven male, three female) with physeal closure (mean age: 23 years; range: 17-40), underwent arthroscopic or open internal fixation with headless cannulated compressive screws. The patients were retrospectively reviewed based on functional and radiological data, with a mean follow-up of 42 months (range: 27-61). The average size of the defects was 4.2 cm2 with a range from 1.7 to 8 cm2 . The study protocol consisted of the Range of Motion (ROM), Tegner-Lysholm Score, Modified Cincinnati Rating System Questionnaire, Short Form-12 (SF-12) in addition to the plain radiograph and Computed Tomography (CT). Any development of arthrosis was assessed at the final follow-up according to the Internation Knee Documention Committee score (IKDC). RESULTS: At the final follow-up, control plain radiographs and CT showed complete union of the fragments in nine patients; however, CT imaging illustrated nonunion of the fragment in one patient. The main Tegner-Lysholm Score increased from 59 (range: 11-63) preoperatively to 97 (range: 88-100) at the final follow-up. Modified Cincinnati Rating System Questionnaire and IKDC score were 97 (range: 93-100) and 96 (range: 92-100), respectively, at the final follow-up. In addition, in terms of SF-12, the mean physical component score was 47.5 (range: 42-49), and the mean mental component score was 57.25 (range: 48-63). CONCLUSION: In patients with physeal closure, internal fixation using cannulated compressive screws may be an influential procedure for the OCD lesions of the knee ranging in size from medium to large. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.


Assuntos
Fixação Interna de Fraturas , Lâmina de Crescimento , Articulação do Joelho , Osteoartrite , Osteocondrite Dissecante , Complicações Pós-Operatórias , Adulto , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Lâmina de Crescimento/diagnóstico por imagem , Lâmina de Crescimento/patologia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Osteoartrite/diagnóstico , Osteoartrite/etiologia , Osteoartrite/fisiopatologia , Osteocondrite Dissecante/diagnóstico , Osteocondrite Dissecante/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
4.
Acta Orthop Traumatol Turc ; 55(3): 213-219, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34100361

RESUMO

OBJECTIVE: The aim of this study was to analyze the risk factors for the development of re-tear following Arthroscopic Rotator Cuff Repair (aRCR). METHODS: This retrospective clinical study included 196 consecutive aRCRs with a minimum 3-year follow-up. Pre- and postoperative clinical and functional outcomes were measured using the Visual Analog Scale (VAS), the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the University of California at Los Angeles Shoulder Rating Scale (UCLA), the Constant-Murley Score (CMS), and the Douleur Neuropathique (DN4) questzionnaire. The Goutallier staging of fatty infiltration, Occupational Ratio (OR), the Acromiohumeral Interval (AHI), Acromioclavicular Joint (ACJ) arthritis, acromion type, Critical Shoulder Angle (CSA), and tangent sign (tan- sign) were evaluated as radiological parameters. Different subgroup parameters were evaluated after dividing the patients into re-tear (-) and re-tear (+) groups, according to clinical and radiological outcomes as well as patient and intraoperative characteristics. RESULTS: The mean follow-up period was 72.0 ± 15.8 months. The mean age at the time of surgery was 58.4 ± 8.9 years. A significant improvement was found in clinical and functional scores in the re-tear (-) group (P < 0.001 for all). However, the retear (+) group had poorer outcome scores than the re-tear (-) group. Twenty patients (10.2%) had re-tear at the last follow-up. There was a significant difference between groups regarding pre-and postoperative clinical scores, with worse scores in the retear (+) group (P < 0.001 for all). Also, pre-and postoperative pseudoparalysis (P = 0.001 for both), acromioclavicular joint arthritis (ACJ) (P = 0.001), intraoperative rotator cuff wear (P = 0.007) or stiffness (P = 0.025), a longer time period between symptom onset and surgery (P = 0.031), larger tear size (P = 0.010), preoperative shoulder stiffness (P = 0.001), higher duration of postoperative analgesia use (P < 0.001), higher degrees of preoperative Occupational Ratio (OR) (P < 0.001), and higher degrees of fatty degeneration (P < 0.001) were found to be associated with re- tear development. CONCLUSION: Surgeons should consider the preoperative degree of fatty degeneration, clinical and functional scores, presence of ACJ arthritis, intraoperative tendon quality, tear size and chronicity as well as postoperative prolong analgesic requirement, and development of pseudoparalysis as factors regarding re-tear development risk following aRCR. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.


Assuntos
Artroscopia , Complicações Pós-Operatórias , Risco Ajustado/métodos , Lesões do Manguito Rotador , Manguito Rotador/cirurgia , Artroscopia/efeitos adversos , Artroscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Recuperação de Função Fisiológica , Recidiva , Estudos Retrospectivos , Lesões do Manguito Rotador/diagnóstico , Lesões do Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/cirurgia , Resultado do Tratamento
5.
Medicine (Baltimore) ; 100(23): e25754, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34114982

RESUMO

ABSTRACT: Our objective was to identify independent risk factors for predicting which patients in the Chinese population would likely develop respiratory failure.A descriptive analysis was conducted of demographic and clinical data of patients with tuberculous empyema (TE) admitted to the Beijing Chest Hospital, Capital Medical University between January 2001 and January 2020. Risk factors associated with postsurgical respiratory failure in TE patients were identified based on results of analyses based on univariable and multivariable logistic regression models.A total of 139 TE patients who underwent surgical treatment in the Beijing Chest Hospital, Capital Medical University from January 2001 to January 2020 were enrolled in this study. Cases included 109 male and 30 female patients, with an overall mean age (range 17-73) of 39.3 years. Of 139 TE patients, 26 (18.7%) experienced respiratory failure after surgery. Among significant risk factors for postsurgical respiratory failure, intraoperative blood loss volume greater than 1000 mL had the highest odds ratio value of 6.452. In addition, a pathologic preoperative pulmonary function test result showing a high partial pressure of carbon dioxide level was an independent risk factor for respiratory failure. Moreover, the presence of tuberculosis lesions in the contralateral lung was another significant risk factor for respiratory failure, as determined using multivariate analysis.Respiratory failure is a predominant complication experienced by TE patients undergoing surgery. High intraoperative blood loss, high preoperative high partial pressure of carbon dioxide level, and tuberculosis lesion(s) in the contralateral lung of TE patients were associated with increased risk of postoperative respiratory failure.


Assuntos
Perda Sanguínea Cirúrgica , Empiema Tuberculoso/cirurgia , Complicações Pós-Operatórias , Insuficiência Respiratória , Medição de Risco , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Tuberculose Pulmonar , Adulto , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Dióxido de Carbono/análise , China/epidemiologia , Empiema Tuberculoso/sangue , Empiema Tuberculoso/diagnóstico , Empiema Tuberculoso/epidemiologia , Feminino , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Testes de Função Respiratória/métodos , Testes de Função Respiratória/estatística & dados numéricos , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Procedimentos Cirúrgicos Torácicos/métodos , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/cirurgia
6.
Medicine (Baltimore) ; 100(23): e26322, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115046

RESUMO

RATIONALE: Severe tension pneumocephalus can lead to drowsiness, coma, and even brain hernia and death. The occurrence of delayed pneumocephalus after spinal surgery is rarely reported and often ignored. Herein, we report a case of delayed pneumocephalus after repeated percutaneous aspiration following spinal surgery. PATIENT CONCERNS: A 55-year-old man was admitted in October 2020 because of aggravation in bilateral lower limb weakness and dysuria for seven days. He was diagnosed with liver cancer a year ago, and he underwent several operations because of tumor recurrence. The patient underwent thoracic vertebrae tumor excision on this admission, and no cerebrospinal fluid leakage was discovered during surgery. After the third drainage by percutaneous aspiration, the patient complained of severe headache and vomiting on postoperative day 16. DIAGNOSIS: Emergency brain computed tomography revealed massive pneumocephalus. INTERVENTIONS: Thereafter, suction drainage was discontinued, and he was placed on bed rest and administered intravenous mannitol. OUTCOMES: Repeated computed tomography showed complete resolution of the pneumocephalus after five days. LESSONS: Wound exudates and cystic fluid after spinal surgery should be differentiated from cerebrospinal fluid leakage. Reckless percutaneous aspirations can form pneumocephalus in patients with an occult dural injury, and pneumocephalus can occur up to 16 days after surgery. Early diagnosis of pneumocephalus is crucial to avoid severe consequences.


Assuntos
Neoplasias Ósseas , Descompressão Cirúrgica/efeitos adversos , Drenagem/efeitos adversos , Procedimentos Ortopédicos , Complicações Pós-Operatórias , Vértebras Torácicas , Neoplasias Ósseas/patologia , Neoplasias Ósseas/secundário , Neoplasias Ósseas/cirurgia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Descompressão Cirúrgica/métodos , Diuréticos Osmóticos/administração & dosagem , Drenagem/métodos , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Manitol/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neuroimagem/métodos , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Pneumocefalia/diagnóstico , Pneumocefalia/etiologia , Pneumocefalia/fisiopatologia , Pneumocefalia/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Reoperação/efeitos adversos , Reoperação/métodos , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Resultado do Tratamento
7.
Best Pract Res Clin Anaesthesiol ; 35(2): 241-253, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34030808

RESUMO

The application of Enhanced Recovery After Surgery (ERAS) in neurosurgical practice is a relatively new concept. A limited number of studies involving ERAS protocols within neurosurgery, specifically for elective craniotomy, have been published, contrary to the ERAS spine surgery pathways that are now promoted by numerous national and international dedicated surgical societies and hospitals. In this review, we want to present the patient surgical journey from an anaesthesia perspective through the key components that can be included in the ERAS pathways for neurosurgical procedures, both craniotomies and major spine surgery.


Assuntos
Anestesia/métodos , Recuperação Pós-Cirúrgica Melhorada , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Anestesia/efeitos adversos , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia
8.
Best Pract Res Clin Anaesthesiol ; 35(2): 255-266, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34030809

RESUMO

Cerebral complications are common in perioperative settings even in non-neurosurgical procedures. These include postoperative cognitive dysfunction or delirium as well as cerebrovascular accidents. During surgery, it is essential to ensure an adequate degree of sedation and analgesia, and at the same time, to provide hemodynamic and respiratory stability in order to minimize neurological complications. In this context, the role of neuromonitoring in the operating room is gaining interest, even in the non-neurolosurgical population. The use of multimodal neuromonitoring can potentially reduce the occurrence of adverse effects during and after surgery, and optimize the administration of anesthetic drugs. In addition to the traditional focus on monitoring hemodynamic and respiratory systems during general anesthesia, the ability to constantly monitor the activity and maintenance of brain homeostasis, creating evidence-based protocols, should also become part of the standard of care: in this challenge, neuromonitoring comes to our aid. In this review, we aim to describe the role of the main types of noninvasive neuromonitoring such as those based on electroencephalography (EEG) waves (EEG, Entropy module, Bispectral Index, Narcotrend Monitor), near-infrared spectroscopy (NIRS) based on noninvasive measurement of cerebral regional oxygenation, and Transcranial Doppler used in the perioperative settings in non-neurosurgical intervention. We also describe the advantages, disadvantage, and limitation of each monitoring technique.


Assuntos
Anestesia Geral/métodos , Eletroencefalografia/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Anestesia Geral/efeitos adversos , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Ultrassonografia Doppler Transcraniana/métodos
9.
Best Pract Res Clin Anaesthesiol ; 35(2): 159-169, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34030801

RESUMO

With the widespread use of electroencephalogram [EEG] monitoring during surgery or in the Intensive Care Unit [ICU], clinicians can sometimes face the pattern of burst suppression [BS]. The BS pattern corresponds to the continuous quasi-periodic alternation between high-voltage slow waves [the bursts] and periods of low voltage or even isoelectricity of the EEG signal [the suppression] and is extremely rare outside ICU and the operative room. BS can be secondary to increased anesthetic depth or a marker of cerebral damage, as a therapeutic endpoint [i.e., refractory status epilepticus or refractory intracranial hypertension]. In this review, we report the neurophysiological features of BS to better define its role during intraoperative and critical care settings.


Assuntos
Anestésicos/administração & dosagem , Eletroencefalografia/métodos , Monitorização Intraoperatória/métodos , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/fisiopatologia , Anestésicos/efeitos adversos , Eletroencefalografia/efeitos dos fármacos , Humanos , Complicações Pós-Operatórias/etiologia
10.
Int Heart J ; 62(3): 710-714, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34054004

RESUMO

We present the case of a 1-year-old boy who developed protein-losing enteropathy (PLE) within 2 months of a fenestrated Fontan procedure. His fenestration rapidly closed despite bilateral pulmonary stenosis (BPS). Subsequent to PLE onset, both fenestration and the bilateral pulmonary artery were reconstructed, and the patient's PLE had been in remission, with additive use of medications, for more than 2 years. Notably, although fenestration closed again and central venous pressure (CVP) reduction was minimal, the surrogates of venous return resistance were markedly suppressed as shown by increased blood volume, reduced estimated mean circulatory filling pressure, and suppressed CVP augmentation against a contrast agent. Taken together, dynamic characteristics of venous stagnation, rather than the absolute value of CVP, were ameliorated by the pulmonary reconstruction and use of medications, suggesting a significant role of venous property in the physiology of PLE. In addition, simultaneous measures of CVP and ventricular end-diastolic pressure during the abdominal compression procedure suggested a limited therapeutic role of fenestration against PLE in this patient.


Assuntos
Pressão Venosa Central/fisiologia , Técnica de Fontan/efeitos adversos , Enteropatias Perdedoras de Proteínas/complicações , Estenose da Valva Pulmonar/etiologia , Hemodinâmica/fisiologia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Lactente , Masculino , Complicações Pós-Operatórias/fisiopatologia , Enteropatias Perdedoras de Proteínas/fisiopatologia , Estenose da Valva Pulmonar/fisiopatologia , Remissão Espontânea
11.
Clin Interv Aging ; 16: 823-831, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34040359

RESUMO

Purpose: To determine the relationships between postoperative delirium (POD) and postoperative activities of daily living (ADL) and mortality in patients undergoing laryngectomy. We hypothesized that POD would reduce postoperative ADL and increase postoperative mortality. Patients and Methods: The prospective study included older participants (age ≥65 y) undergoing total laryngectomy, partial laryngectomy, total laryngectomy plus neck dissection, or partial laryngectomy plus neck dissection under general anesthesia. The diagnosis of delirium was based on the Confusion Assessment Method algorithm, which was administered on postoperative days 1 through 6. ADL were evaluated using the Chinese version of the Index of ADL scale. Follow-up assessments of ADL and mortality were conducted 24 months after surgery. Results: Of 127 participants (aged 70.3 ± 4.1 y), 19 (15.0%) developed POD. POD was not associated with a decrease in ADL after laryngectomy (p=0.599) nor with an increase in postoperative mortality [3/19 (15.8%) vs 12/108 (11.1%), p=0.560, Log rank test]. However, longer surgery duration was significantly associated with worse overall survival (OR, 3.262; 95% CI, 1.261-9.169, p=0.025). Conclusion: POD was not associated with long-term ADL or mortality after laryngectomy. Prolonged surgery was the only factor associated with a higher postoperative mortality rate.


Assuntos
Atividades Cotidianas , Delírio/fisiopatologia , Laringectomia/estatística & dados numéricos , Complicações Pós-Operatórias/fisiopatologia , Idoso , Anestesia Geral , Delírio/mortalidade , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo
12.
Acta Orthop Traumatol Turc ; 55(2): 166-170, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33847580

RESUMO

OBJECTIVE: This study aimed to investigate the therapeutic effects of full endoscopic spine surgery on clinical and radiological outcomes in elderly patients over 70 years with lumbar spinal stenosis, without any obvious segmental instability. METHODS: A total of 47 patients (27 males, 20 females; the mean age=74.23±5.16) above 70 years who underwent a transforaminal percutaneous endoscopic decompression with the diagnosis of lumbar spinal stenosis, were included in this retrospective study. The mean follow-up was 26±2.97 months. The clinical efficacy of the surgical procedure was assessed by the Oswestry disability index (ODI) and the visual analog scale (VAS) of the leg and lower back at 1 week, 3 months, and 1 year postoperatively, and at the final follow-up examination. Modified MacNab criteria was also performed to assess the clinical efficiency of surgery at the final follow-up. RESULTS: An excellent outcome as per modified MacNab criteria was obtained in 9 patients (19.1%), a good outcome in 33 patients (70.2%), a fair outcome in 3 patients (6.4%), and poor results in 2 patients (4.3%). The mean ODI score significantly improved from 71.29±5.69 preoperatively to 32.05±10.71 at postoperative 1 week, 30.27±9.89 at 3 months, 27.23±8.47 at 1 year, and 23.11±9.97 at the final follow-up (p<0.05 for each evaluation point). The mean VAS score of the leg and lower back significantly decreased from 6.10±0.96 and 5.71±1.13 preoperatively to 1.69±0.96, 2.24±1.01 at postoperative 1 week, 1.69±0.84, 2.45±0.87 at 3 months, 1.71±0.81, 2.38±0.79 at 1 year, and 1.71±0.92, 2.48±0.67 at the final follow-up, respectively (p<0.05 for each evaluation term). Postoperative computed tomography or magnetic resonance imaging showed adequate decompression of the central or lateral recess and removal of combined herniated discs. CONCLUSION: The results of our preliminary study have demonstrated that full endoscopic spine surgery is a safe and efficient technique for the therapy of neurogenic claudication and radiculopathy in elderly patients with lumbar spinal stenosis. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.


Assuntos
Descompressão Cirúrgica , Endoscopia , Vértebras Lombares/diagnóstico por imagem , Complicações Pós-Operatórias , Estenose Espinal , Idoso , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Avaliação da Deficiência , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Humanos , Masculino , Medição da Dor/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Estenose Espinal/diagnóstico , Estenose Espinal/cirurgia , Resultado do Tratamento
13.
Medicine (Baltimore) ; 100(17): e25698, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907149

RESUMO

RATIONALE: Peripheral nerve injury related to vascular complications associated with extracorporeal membrane oxygenation (ECMO) is perhaps underappreciated. Compared to the well-described central nervous system complications of ECMO, brachial plexopathy and lumbosacral plexopathy have rarely been reported. We report this case to heighten awareness of lumbosacral plexus injury due to pelvic hematoma formation after ECMO. PATIENT CONCERNS: A 53-year-old woman developed a large pelvic hematoma with significant mass effect on intrapelvic structures after receiving lifesaving venoarterial ECMO for cardiogenic shock following a cardiac arrest. During her hospital course, she developed bilateral foot drop that was attributed to critical illness. Her lack of neurological recovery after 6 months prompted referral to neuromuscular medicine for consultation. DIAGNOSIS: The patient was retrospectively diagnosed with bilateral lumbosacral plexopathy due to the large pelvic hematoma. INTERVENTION: Electromyography/nerve conduction study (EMG/NCS) obtained at the time of referral to neuromuscular medicine localized her neurological deficits to the bilateral lumbosacral plexus and demonstrated no volitional motor unit action potentials in her lower leg muscles. OUTCOMES: The patient had minimal recovery of strength at the level of the ankles but was ambulatory with solid ankle-foot orthoses due to spared proximal lower extremity strength. Unfortunately, the absence of any volitionally activated motor unit action potentials in her lower leg muscles on EMG performed 6 months after the initial injury was a poor prognostic indicator for successful reinnervation and future neurological recovery. LESSONS: Neurological deficits occurring during the course of administration of ECMO require accurate localization. Neurology consultation and/or EMG/NCS may be useful if localization is not clear. Lesions localizing to the lumbosacral plexus should prompt radiographic evaluation with computed tomography of the abdomen and pelvis. Hemostasis of a retroperitoneal hematoma may be achieved with embolization. However, if neurological deficits do not improve, surgical consultation for hematoma evacuation may be warranted.


Assuntos
Oxigenação por Membrana Extracorpórea , Parada Cardíaca/cirurgia , Hematoma , Plexo Lombossacral/lesões , Pelve , Traumatismos dos Nervos Periféricos , Neuropatias Fibulares , Estado Terminal/terapia , Eletromiografia/métodos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Parada Cardíaca/etiologia , Hematoma/complicações , Hematoma/fisiopatologia , Humanos , Pessoa de Meia-Idade , Condução Nervosa , Pelve/irrigação sanguínea , Pelve/patologia , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Neuropatias Fibulares/diagnóstico , Neuropatias Fibulares/etiologia , Neuropatias Fibulares/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Choque Cardiogênico/complicações
14.
Anesth Analg ; 132(5): 1231-1243, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33857965

RESUMO

The prevalence of obstructive sleep apnea (OSA) has reached 1 billion people worldwide, implying significant risk for the perioperative setting as patients are vulnerable to cardiopulmonary complications, critical care requirement, and unexpected death. This review summarizes main aspects and considerations for the perioperative management of OSA, a condition of public health concern. Critical determinants of perioperative risk include OSA-related changes in upper airway anatomy with augmented collapsibility, diminished capability of upper airway dilator muscles to respond to airway obstruction, disparities in hypoxemia and hypercarbia arousal thresholds, and instability of ventilatory control. Preoperative OSA screening to identify patients at increased risk has therefore been implemented in many institutions. Experts recommend that in the absence of severe symptoms or additional compounding health risks, patients may nevertheless proceed to surgery, while heightened awareness and the adjustment of postoperative care is required. Perioperative caregivers should anticipate difficult airway management in OSA and be prepared for airway complications. Anesthetic and sedative drug agents worsen upper airway collapsibility and depress central respiratory activity, while the risk for postoperative respiratory compromise is further increased with the utilization of neuromuscular blockade. Consistently, opioid analgesia has proven to be complex in OSA, as patients are particularly prone to opioid-induced respiratory depression. Moreover, basic features of OSA, including intermittent hypoxemia and repetitive sleep fragmentation, gradually precipitate a higher sensitivity to opioid analgesic potency along with an increased perception of pain. Hence, regional anesthesia by blockade of neural pathways directly at the site of surgical trauma as well as multimodal analgesia by facilitating additive and synergistic analgesic effects are both strongly supported in the literature as interventions that may reduce perioperative complication risk. Health care institutions are increasingly allocating resources, including those of postoperative enhanced monitoring, in an effort to increase patient safety. The implementation of evidence-based perioperative management strategies is however burdened by the rising prevalence of OSA, the large heterogeneity in disease severity, and the lack of evidence on the efficacy of costly perioperative measures. Screening and monitoring algorithms, as well as reliable risk predictors, are urgently needed to identify OSA patients that are truly in need of extended postoperative surveillance and care. The perioperative community is therefore challenged to develop feasible pathways and measures that can confer increased patient safety and prevent complications in patients with OSA.


Assuntos
Anestesia , Pulmão/fisiopatologia , Assistência Perioperatória , Respiração , Apneia Obstrutiva do Sono/terapia , Sono , Procedimentos Cirúrgicos Operatórios , Anestesia/efeitos adversos , Humanos , Segurança do Paciente , Assistência Perioperatória/efeitos adversos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Medição de Risco , Fatores de Risco , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos
15.
Anesth Analg ; 132(5): 1287-1295, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33857970

RESUMO

Obstructive sleep apnea (OSA) has been shown to increase risk of adverse perioperative events. More recently, investigators have begun to examine other common sleep disorders to assess how they may be impacted by the perioperative environment, as well as influence postoperative outcomes. There are a number of mechanisms by which such common sleep disorders (eg, insomnia, restless legs syndrome, narcolepsy, and parasomnias) may have consequences in the perioperative setting, both related to the underlying pathophysiology of the diseases as well as their treatments. This review will highlight the current state of the literature and offer recommendations for management of these conditions during the perioperative journey.


Assuntos
Narcolepsia/terapia , Parassonias/terapia , Assistência Perioperatória , Síndrome das Pernas Inquietas/terapia , Distúrbios do Início e da Manutenção do Sono/terapia , Sono , Procedimentos Cirúrgicos Operatórios , Humanos , Narcolepsia/complicações , Narcolepsia/diagnóstico , Narcolepsia/fisiopatologia , Parassonias/complicações , Parassonias/diagnóstico , Parassonias/fisiopatologia , Assistência Perioperatória/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Síndrome das Pernas Inquietas/complicações , Síndrome das Pernas Inquietas/diagnóstico , Síndrome das Pernas Inquietas/fisiopatologia , Medição de Risco , Fatores de Risco , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Resultado do Tratamento
16.
Anesth Analg ; 132(5): 1306-1313, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33857972

RESUMO

The perioperative use of continuous positive airway pressure (CPAP) therapy has increased substantially in recent years, particularly in relationship to the treatment of patients with known or suspected obstructive sleep apnea (OSA). OSA is common in the surgical population and is reported as an independent risk factor for postoperative complications, intensive care unit admission, and increased length of hospital stay. A large proportion of OSA patients are undiagnosed at the time of surgery and can therefore not be optimized preoperatively. Nowadays, golden standard treatment of moderate to severe OSA is nightly CPAP at home, often with an autotitration mode. Unfortunately, there are only a handful of randomized clinical trials investigating the effect of preoperative and/or postoperative CPAP treatment in OSA patients, so the perioperative guidelines are based on a combination of randomized clinical trials, observational studies, case studies, and expert opinions. In this review, we have summarized the current evidence regarding the use of perioperative CPAP therapy with an emphasis on patients with OSA. We identified 21 randomized, controlled trials that investigated the effect of CPAP on postoperative physiology and complications in surgical patients. Our review reveals evidence, suggesting that CPAP after surgery improves oxygenation and reduces the need for reintubation and mechanical ventilation after surgery. It is also evident that CPAP reduces apnea and hypopnea frequency and related hypoxemia after surgery. Poor adherence to CPAP in the perioperative setting is a limiting factor in assessing its potential to optimize postoperative cardiorespiratory outcomes. Studies of postoperative outcomes in patients who have previously been prescribed CPAP for OSA and are therefore familiar with its use could help to address this shortcoming, but they are unfortunately lacking. This shortcoming should be addressed in future studies. Furthermore, many of the studies of the postoperative effect of CPAP in OSA patents are small, and therefore, single-center studies and larger randomized, controlled multicenter studies are warranted.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Pulmão/fisiopatologia , Assistência Perioperatória , Respiração , Apneia Obstrutiva do Sono/terapia , Sono , Procedimentos Cirúrgicos Operatórios , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Humanos , Assistência Perioperatória/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Resultado do Tratamento
17.
Anesth Analg ; 132(5): 1314-1320, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33857973

RESUMO

Adequate sleep is essential to health and well-being. Adverse effects of sleep loss are evident acutely and are cumulative in their effect. These include impairment of cognition, psychomotor function, and mood, as well as cardiovascular, metabolic, and immune dysfunction including proinflammatory effects and increased catabolic propensity. Such effects are counterproductive to recovery from illness and operation, yet hospitalization challenges sleep through the anxieties, discomforts, and sleep environmental challenges faced by patients, the inadequate attention given to the needs of patients with preexisting sleep disorders, and the lack of priority these issues receive from hospital staff and their leaders. Mitigation of the adverse effects of noise, light, uncomfortable bedding, intrusive observations, anxiety, and pain together with attention to specific sleep needs and monitoring of sleep quality are steps that would help address the issue and potentially improve patient outcomes.


Assuntos
Hospitalização , Transtornos do Sono-Vigília/complicações , Sono , Procedimentos Cirúrgicos Operatórios , Humanos , Pacientes Internados , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Transtornos do Sono-Vigília/fisiopatologia , Transtornos do Sono-Vigília/terapia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Resultado do Tratamento
18.
Anesth Analg ; 132(5): 1321-1327, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33857974

RESUMO

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder, and the difficult airway is perhaps the anesthesiologists' quintessential concern. OSA and the difficult airway share certain similar anatomical, morphological, and physiological features. Individual studies and systematic reviews of retrospective, case-control, and large database studies have shown a likely association between patients with OSA and the difficult airway; OSA patients have a 3- to 4-fold higher risk of difficult intubation, difficult mask ventilation, or a combination of both. The presence of OSA should initiate proactive perioperative management in anticipation of a difficult airway. Prudent intraoperative management comprises the use of regional anesthesia where possible and considering an awake intubation technique where there is the presence of notable difficult airway predictors and risk of rapid desaturation following induction of general anesthesia. Familiarity with difficult airway algorithms, cautious extubation, and appropriate postoperative monitoring of patients with OSA are necessary to mitigate perioperative risks.


Assuntos
Manuseio das Vias Aéreas , Anestesia , Pulmão/fisiopatologia , Respiração , Apneia Obstrutiva do Sono/fisiopatologia , Sono , Procedimentos Cirúrgicos Operatórios , Manuseio das Vias Aéreas/efeitos adversos , Manuseio das Vias Aéreas/instrumentação , Anestesia/efeitos adversos , Tomada de Decisão Clínica , Humanos , Intubação Intratraqueal , Máscaras Laríngeas , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Respiração Artificial , Medição de Risco , Fatores de Risco , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Resultado do Tratamento
19.
Anesth Analg ; 132(5): 1328-1337, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33857975

RESUMO

Obstructive sleep apnea (OSA) is a common comorbidity in patients undergoing surgical procedures. Patients with OSA are at heightened risk of postoperative complications. Current treatments for OSA focus on alleviating upper airway collapse due to impaired upper airway anatomy. Although impaired upper airway anatomy is the primary cause of OSA, the pathogenesis of OSA is highly variable from person to person. In many patients, nonanatomical traits play a critical role in the development of OSA. There are 4 key traits or "phenotypes" that contribute to OSA pathogenesis. In addition to (1) impaired upper airway anatomy, nonanatomical contributors include: (2) impaired upper airway dilator muscle responsiveness; (3) low respiratory arousal threshold (waking up too easily to minor airway narrowing); and (4) unstable control of breathing (high loop gain). Each of these phenotypes respond differently to postoperative factors, such as opioid medications. An understanding of these phenotypes and their highly varied interactions with postoperative risk factors is key to providing safer personalized care for postoperative patients with OSA. Accordingly, this review describes the 4 OSA phenotypes, highlights how the impact on OSA severity from postoperative risk factors, such as opioids and other sedatives, is influenced by OSA phenotypes, and outlines how this knowledge can be applied to provide individualized care to minimize postoperative risk in surgical patients with OSA.


Assuntos
Anestesia/efeitos adversos , Pulmão/fisiopatologia , Complicações Pós-Operatórias/etiologia , Respiração , Apneia Obstrutiva do Sono/complicações , Sono , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Humanos , Fenótipo , Complicações Pós-Operatórias/fisiopatologia , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Resultado do Tratamento
20.
J Cardiothorac Surg ; 16(1): 96, 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33879210

RESUMO

PURPOSE: The present study aimed to explore the clinical characteristics of heparin-induced thrombocytopenia (HIT) after surgery for acute type A aortic dissection and perform a relevant prognostic analysis. METHODS: After continuous observation and analysis of 204 patients who underwent acute type A aortic dissection, we found that blood platelets decreased significantly after surgery and that these patients can be suspected to suffer HIT based on relevant 4Ts scores. For these suspected HIT patients, a latex particle-enhanced immunoturbidimetric assay was conducted to detect heparin-induced antibodies. Perioperative clinical data of patients in HIT and non-HIT groups were recorded as were blood platelet counts, HIT antibody test results, 4Ts scores, thromboembolic complications, clinical prognosis and outcomes. RESULTS: In the present study, 38 suspected HIT patients, 16 HIT patients and 188 non-HIT patients were selected in the clinical setting. Among them, HIT patients were found to have prolonged cardiopulmonary bypass time (223 min on average vs. 164 min) and delayed aortic cross-clamp time (128 min on average vs. 107 min), and these differences between HIT patients and non-HIT patients were significant (P < 0.05). Additionally, the HIT group required longer operation time and higher dose of heparin, but showing no statistical differences (P > 0.05). The transfusions of blood platelets in the HIT group and non-HIT group were 18.7 ± 5.0u and 15.6 ± 7.34 u, respectively. In the HIT group, the mechanic ventilation time and the length of ICU stay were longer comparing the non-HIT group(P < 0.05), though no significant differences in total length of stay or In-hospital mortality were observed (P > 0.05). The incidence of continuous renal replacement therapy in HIT group was higher than the non-HIT group (P < 0.05). Additionally,there were no significant differences in 24-h postoperative drainage or reoperation for bleeding in both group(P > 0.05). However, the HIT antibody titer in the HIT group was significantly higher than that in the Suspected HIT group (2.7 ± 0.8 U/mL vs. 0.3 ± 0.2 U/mL) (P < 0.05). Among patients diagnosed with HIT, the incidence of thromboembolism reached 31.5%.For example, two HIT patients newly developed thromboembolism in both lower extremities,and three patients experienced cerebral infarction. CONCLUSIONS: After surgery for acute type A aortic dissection, HIT patients developed postoperative complications, the duration of ventilatory support and length of ICU stay were extended, and the incidence of thromboembolism increased. HIT antibody detection and risk classification should be implemented for high-risk patients showing early clinical characteristics.


Assuntos
Aneurisma Dissecante/cirurgia , Anticoagulantes/efeitos adversos , Aneurisma Aórtico/cirurgia , Heparina/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Trombocitopenia/induzido quimicamente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Estudos Prospectivos , Medição de Risco , Trombocitopenia/diagnóstico , Trombocitopenia/fisiopatologia , Trombocitopenia/prevenção & controle
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