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1.
BMJ Case Rep ; 14(4)2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33811094

RESUMO

A young male in his early 30s presented to us with increasing swelling at the umbilicus, and an umbilical hernia was diagnosed. At laparoscopic intraperitoneal onlay mesh (IPOM) repair, an unexpected finding of a thin innocuous-looking fibrous film over the small bowel was noted. This finding presented a dilemma as to the probable pathology of this material, and a decision had to be made on whether laparoscopic IPOM could be continued. It was prudently decided to abandon the plan of placing a mesh intraperitoneally and an open repair of the umbilical hernia was done. In retrospect this was a wise decision, as, after 7 months he had to have a laparotomy for intestinal obstruction, when the classic thick fibrous encapsulating abdominal cocoon was seen. Hence here we have followed the evolution of the abdominal cocoon from its original asymptomatic phase to the classic encapsulating sclerosing peritonitis with probably laparoscopic gas insufflation being the precipitating factor.


Assuntos
Hérnia Ventral , Insuflação , Obstrução Intestinal , Laparoscopia , Hérnia Ventral/cirurgia , Humanos , Insuflação/efeitos adversos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Masculino , Peritônio/cirurgia , Telas Cirúrgicas
2.
Medicine (Baltimore) ; 100(8): e24892, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663119

RESUMO

RATIONALE: Carbon dioxide pneumoperitoneum in laparoscopic surgery can bring about occult perioperative cerebral infarction, advancing our understanding of the causes of severe postoperative delayed recovery. PATIENT CONCERNS: Here, we report the case of a 35-year-old woman who underwent a right renal tumor resection in our institution, during which a raised pneumoperitoneum pressure (from 15 to 20 mm Hg) was adopted by the surgeon to prevent errhysis and to help stop the bleeding. Despite an accidental minor tearing of the inferior vena cava, vital signs remained stable throughout the procedure, and no obvious abnormality was observed in either end tidal carbon dioxide values or blood gas analysis. However, the patient unexpectedly suffered delayed recovery after the operation, presenting incomplete left hemiplegia and a positive Babinski sign. DIAGNOSES: Perioperative stroke was diagnosed by anesthesiologists, after excluding the effects of anesthesia. Cerebral hemorrhage was excluded, as no obvious abnormality was found in the density of brain parenchyma in the emergency computed tomography examination, and a digital subtraction angiography showed no abnormal thrombosis. Further magnetic resonance diagnosis led us to consider diffuse gas embolisms to be the cause of this acute stroke; a right echocardiography revealed that a patent foramen ovale (PFO) may account for the global cerebral gas embolisms. INTERVENTIONS: The patient received neuroprotective drugs (Vinpocetine, Edaravone, and Xingnaojing, which are commonly used as a standard of care in China), antiplatelets and other symptomatic treatments, plus dexamethasone to relieve edema. A contrast-enhanced echocardiography of the right heart was performed, the results of which were consistent with the sonography of a PFO. OUTCOMES: The patient was hospitalized for 14 days and eventually discharged after recovery. At the latest follow-up in August 2019, the patient recovered without residual neurological sequelae. LESSONS: Our results emphasize the need for vigilance regarding adverse cardiovascular and neurological events caused by carbon dioxide gas embolisms when encountering the inadvertent situation of vessels rupturing. Timely monitoring of paradoxical gas embolism by transoesophageal echocardiography is necessary and can avert the risk of severe complications. Urgent consideration should be given to stopping pneumoperitoneum and switching to laparotomy for hemostasis so that the patient can obtain the best benefit-risk ratio.


Assuntos
Dióxido de Carbono/análise , Infarto Cerebral/etiologia , Embolia Paradoxal/complicações , Nefrectomia/efeitos adversos , Veia Cava Inferior/lesões , Adulto , Infarto Cerebral/diagnóstico por imagem , Ecocardiografia Transesofagiana , Feminino , Humanos , Insuflação/efeitos adversos , Complicações Intraoperatórias , Imagem por Ressonância Magnética , Período Perioperatório , Veia Cava Inferior/diagnóstico por imagem
4.
Acute Med ; 19(3): 154-158, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33020760

RESUMO

A case report on a 36-year-old male patient presenting to the emergency department (ED) with chest tightness, nasal sounding voice and subcutaneous emphysema 72 hours after the nasal insufflation of approximately 0.5g of cocaine. A plain radiograph of the chest demonstrated an extensive pneumomediastinum with subcutaneous emphysema extending into his neck. A computerised tomography (CT) scan confirmed the above findings, along with a pneumorrhachis of the thoracic spine. He was admitted locally for further investigation and observation. Cocaine is the second most used illicit drug in the UK. The associated complications of cocaine can vary from acute coronary syndrome to acute psychosis. Pulmonological trauma secondary to cocaine misuse is commonly associated with inhalation of cocaine; we present this rare case of subcutaneous emphysema, pneumomediastinum and pneumorrhachis secondary to nasal insufflation. It is believed that deep nasal insufflation of cocaine is followed by forceful Valsalva manoeuvre, which allows for the rapid absorption of the drug and increases the euphoric effect. This forceful inhalation can lead to barotrauma and leakage of air into the posterior mediastinum.


Assuntos
Cocaína , Insuflação , Enfisema Mediastínico , Pneumorraque , Enfisema Subcutâneo , Adulto , Humanos , Insuflação/efeitos adversos , Masculino , Enfisema Mediastínico/induzido quimicamente , Enfisema Mediastínico/diagnóstico por imagem , Pneumorraque/diagnóstico por imagem , Pneumorraque/etiologia , Enfisema Subcutâneo/induzido quimicamente , Enfisema Subcutâneo/diagnóstico por imagem
5.
Medicine (Baltimore) ; 99(27): e20986, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629713

RESUMO

RATIONALE: Cerebral carbon dioxide embolism (CCDE) is a rare cause of stroke and is a recognized life-threatening complication.CCDE may result from direct intravascular CO2 insufflation during surgery. Due to the lack of typical clinical manifestations, the disease is often missed or mistaken for another condition. The clinical signs and symptoms depend on the speed and volume of embolized gas entering the blood and the patient's condition. In particular, patent foramen ovale has been found to be associated, in rare cases, with the intraoperative entry of gas into the arterial system. PATIENT CONCERNS: In this report, we present the case of a 35-year-old woman with kidney cancer who underwent laparoscopic right partial nephrectomy. DIAGNOSIS: After the laparoscopic surgery, the patient was initially diagnosed with acute cerebral infarction. INTERVENTIONS: The patient was treated according to the standard method for treatment of acute cerebrovascular disease. OUTCOMES: Three days after the laparoscopic procedure, the patient gained consciousness, and she was discharged without any neurologic sequelae on postoperative day 12. LESSONS SUBSECTIONS AS PER STYLE: Due to the low incidence and sudden occurrence of CCDE, there is a strong likelihood of missed diagnosis or misdiagnosis, and it is; therefore, important to be aware of the risk. The findings from this report would be highly useful as a reference to clinicians in the future.


Assuntos
Dióxido de Carbono/efeitos adversos , Embolia Aérea/etiologia , Insuflação/efeitos adversos , Embolia Intracraniana/etiologia , Laparoscopia/efeitos adversos , Adulto , Dióxido de Carbono/sangue , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Embolia Intracraniana/diagnóstico por imagem , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Nefrectomia/efeitos adversos
6.
PLoS One ; 15(6): e0228693, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574159

RESUMO

BACKGROUND: Sustained inflation (SI) during chest compression (CC = CC+SI) has been recently shown as an alternative method during cardiopulmonary resuscitation in neonates. However, the optimal peak inflation pressure (PIP) of SI during CC+SI to improve ROSC and hemodynamic recovery is unknown. OBJECTIVE: To examine if different PIPs of SI during CC+SI will improve ROSC and hemodynamic recovery in severely asphyxiated piglets. METHODS: Twenty-nine newborn piglets (1-3 days old) were anesthetized, intubated, instrumented and exposed to 30-min normocapnic hypoxia followed by asphyxia. Piglets were randomized into four groups: CC+SI with a PIP of 10 cmH2O (CC+SI_PIP_10, n = 8), a PIP of 20 cmH2O (CC+SI_PIP_20, n = 8), a PIP of 30 cmH2O (CC+SI_PIP_30, n = 8), and a sham-operated control group (n = 5). Heart rate, arterial blood pressure, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. RESULTS: Baseline parameters were similar between all groups. There was no difference in asphyxiation (duration and degree) between intervention groups. PIP correlated positively with tidal volume (VT) and inversely with exhaled CO2 during cardiopulmonary resuscitation. Time to ROSC and rate of ROSC were similar between piglets resuscitated with CC+SI_PIP_10, CC+SI_PIP_20, and CC+SI_PIP_30 cmH2O: median (IQR) 75 (63-193) sec, 94 (78-210) sec, and 85 (70-90) sec; 5/8 (63%), 7/8 (88%), and 3/8 (38%) (p = 0.56 and p = 0.12, respectively). All piglets that achieved ROSC survived to four hours post-resuscitation. Piglets resuscitated with CC+SI_PIP_30 cmH2O exhibited increased concentrations of pro-inflammatory cytokines interleukin-1ß and tumour necrosis factor-α in the frontoparietal cerebral cortex (both p<0.05 vs. sham-operated controls). CONCLUSION: In asphyxiated term newborn piglets resuscitated by CC+SI, the use of different PIPs resulted in similar time to ROSC, but PIP at 30 cmH2O showed a larger VT delivery, lower exhaled CO2 and increased tissue inflammatory markers in the brain.


Assuntos
Asfixia/terapia , Reanimação Cardiopulmonar/efeitos adversos , Insuflação/efeitos adversos , Pressão , Animais , Animais Recém-Nascidos , Lesões Encefálicas/etiologia , Hemodinâmica , Recuperação de Função Fisiológica , Respiração , Suínos
8.
J Vasc Interv Radiol ; 31(7): 1139-1142.e1, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32534976

RESUMO

Gastric distension through insufflation is a key step in creating a safe percutaneous window during gastrostomy/gastrojejunostomy (G/GJ) placement; however, poor or incomplete gastric distention can occur, despite the use of glucagon, and lead to rapid egress of air from the stomach into the duodenum. This report describes the adjunctive technique using postpyloric balloon occlusion in 29 patients to maximize gastric insufflation during G/GJ tube placement after failure of conventional methods. Balloon occlusion was successful in salvaging 23 of 29 (79.3%) of G/GJ tube placements without any complications.


Assuntos
Oclusão com Balão/instrumentação , Nutrição Enteral/instrumentação , Derivação Gástrica/instrumentação , Gastrostomia/instrumentação , Insuflação/instrumentação , Adolescente , Fatores Etários , Oclusão com Balão/efeitos adversos , Criança , Pré-Escolar , Nutrição Enteral/efeitos adversos , Feminino , Derivação Gástrica/efeitos adversos , Obstrução da Saída Gástrica/etiologia , Gastrostomia/efeitos adversos , Humanos , Lactente , Recém-Nascido , Insuflação/efeitos adversos , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
BMC Cardiovasc Disord ; 20(1): 219, 2020 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-32397961

RESUMO

BACKGROUND: Atrioesophageal fistula (AEF) is the most fatal complication associated with catheter ablation for atrial fibrillation and cannot be easily detected when thoracic contrast-enhanced computed tomography (CT) is normal. CASE PRESENTATION: In this report, we described a diagnostic tool for detecting AEF with doubtful chest CT in which we introduced CO2-insufflation esophageal endoscopy with transthoracic echocardiography monitoring. Using this modified esophageal endoscopy, AEF was established due to the presence of both esophageal lesions and bubbles into the left atrium. That way, our patient accepted to be operated in time with good clinical prognosis. CONCLUSIONS: This modified esophageal endoscopy is an alternative tool for early detection of AEF when normal or doubtful CT findings present.


Assuntos
Dióxido de Carbono/administração & dosagem , Ecocardiografia , Embolia Aérea/prevenção & controle , Fístula Esofágica/diagnóstico , Esofagoscopia , Fístula/diagnóstico , Cardiopatias/diagnóstico , Doença Iatrogênica , Insuflação , Dióxido de Carbono/efeitos adversos , Ablação por Cateter/efeitos adversos , Diagnóstico Precoce , Ecocardiografia/efeitos adversos , Embolia Aérea/etiologia , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Esofagoscopia/efeitos adversos , Fístula/etiologia , Fístula/cirurgia , Cardiopatias/etiologia , Cardiopatias/cirurgia , Humanos , Insuflação/efeitos adversos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
10.
Medicine (Baltimore) ; 99(8): e19084, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080082

RESUMO

BACKGROUND: Sustained Inflations (SI) and Intermittent Positive Pressure Ventilation (IPPV) are two interventions to prevent Bronchopulmonary dysplasia (BPD). The aim of this study is to assess the effect of these two interventions. METHODS: The databases of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) will be comprehensively searched from inception to September 2019. All RCTs and quasi-RCTs which compare the efficacy of SI vs IPPV among preterm infants are eligible. We will assess the methodological quality using the Cochrane Handbook version 5.1.0. A meta-analysis will be performed using RevMan 5.3 software and the results will be presented using risk ratios (RRs) and 95% confidence intervals (CIs). CONCLUSIONS: This study will provide strong evidence for assessing the effect of SI and IPPV on BPD or death among preterm infants. PROSPERO REGISTRATION NUMBER: CRD42019135816.


Assuntos
Displasia Broncopulmonar/prevenção & controle , Insuflação/efeitos adversos , Ventilação com Pressão Positiva Intermitente/efeitos adversos , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle , Peso ao Nascer , Displasia Broncopulmonar/mortalidade , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Insuflação/instrumentação , Ventilação com Pressão Positiva Intermitente/instrumentação , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Lesão Pulmonar Induzida por Ventilação Mecânica/mortalidade
11.
J Vet Med Sci ; 82(1): 94-100, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31801923

RESUMO

This study assessed the effects of retroperitoneal carbon dioxide (CO2) insufflation on cardiopulmonary variables and intra-abdominal pressure (IAP) in mechanically ventilated dogs in sternal recumbency with the abdomen unsupported, following placement of a positioning kit and towels under the pectoral and pelvic regions. General anesthesia was induced in eight healthy adult male Beagles. A Swan-Ganz catheter was placed in the pulmonary artery via the jugular vein for cardiac output measurements. A Foley urethral catheter was placed to monitor transvesical IAP. A 10 mm balloon blunt-tip trocar was inserted into the retroperitoneal space. With a fixed respiratory rate and tidal volume by mechanical ventilation, insufflation pressure was sequentially increased from 0 to 10 mmHg in 5 mmHg increments, followed by desufflation. All variables were measured before insufflation, 5 min after the establishment of each insufflation pressure, and after desufflation. At 10 mmHg, the IAP was nearly equal to insufflation pressure. Cardiopulmonary function was not compromised at any point, although the cardiac index (CI), heart rate, mean arterial pressure (MAP), and mean pulmonary arterial pressure increased within normal ranges. End-tidal CO2 concentration, arterial CO2 partial pressure, and oxygen delivery index (DO2I) increased, whereas pH decreased, at 10 mmHg. CI, MAP, and DO2I did not recover to baseline after decompression. Thus, retroperitoneal CO2 insufflation up to 10 mmHg is well tolerated by mechanically ventilated dogs positioned in sternal recumbency with the abdomen unsupported, although sympathetic changes may occur with an insufflation pressure increase.


Assuntos
Dióxido de Carbono , Insuflação/veterinária , Posicionamento do Paciente/veterinária , Espaço Retroperitoneal , Cavidade Abdominal , Anestesia Geral/veterinária , Animais , Débito Cardíaco , Cães , Frequência Cardíaca , Insuflação/efeitos adversos , Insuflação/métodos , Masculino , Posicionamento do Paciente/métodos , Pressão , Respiração Artificial/veterinária , Bexiga Urinária
12.
Am J Emerg Med ; 38(6): 1137-1140, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31685304

RESUMO

BACKGROUND: To determine the level of inspiratory pressure minimizing the risk of gastric insufflation while providing adequate pulmonary ventilation. METHODS: In this prospective, randomized, double-blind study, patients were allocated to one of the two groups (P10, P15) defined by the inspiratory pressure applied during controlled-pressure ventilation: 10 and 15 cm H2O. Anesthesia was induced using propofol and sufentanil; no neuromuscular-blocking agent was administered. Once loss of eyelash reflex occurred, facemask ventilation was started for a 2-min period. The cross-sectional antral area was measured using ultrasonography before and after facemask ventilation. Respiratory parameters were recorded. RESULTS: Forty patients were analyzed. Mean tidal volume was about 7 ml/kg in group P10, and was >11 ml/kg in group P15 in the same period. As indicated by ultrasonography test, the antral area in P15 group was markedly incresed compared with P10 group. CONCLUSION: Inspiratory pressure of 10 cm H2O allowed for reduced occurrence of gastric insufflation with proper lung ventilation during induction of anesthesia with sufentanil and propofol in nonparalyzed and nonobese patients.


Assuntos
Anestesia Geral/métodos , Insuflação/efeitos adversos , Complicações Intraoperatórias/prevenção & controle , Máscaras Laríngeas/normas , Respiração Artificial/instrumentação , Estômago/lesões , Pressão do Ar , Estudos Transversais , Método Duplo-Cego , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estômago/diagnóstico por imagem , Volume de Ventilação Pulmonar , Ultrassonografia
13.
J Thorac Cardiovasc Surg ; 159(3): 958-968, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31200936

RESUMO

OBJECTIVE: Carbon dioxide field flooding during open-heart surgery is intended to avoid blood-air contact, bubble formation, and embolism, and therefore potential neurologic and other ischemic complications. The inert gas is invisible, and thus its use and effectiveness are heavily debated. We intended to provide better insight in the behavior of the gas via direct concentration measurements and visualization of the gas cloud. METHODS: A transparent rectangular model of the open thorax was created, foreseen with carbon dioxide concentration sensors in 2 locations (atrial and aortic incisions), and placed in an optical test bench that amplifies the diffraction gradients. Six different commonly used carbon dioxide diffusors (3 commercial, 3 improvised) were tested with different flow rates of gas delivery (1, 4, 7, 10 standard liter per minute [SLPM]) and combined with the application of suction. RESULTS: The imaging reveals that commercially available diffusors generally create less turbulent flow than improvised diffusors, which is supported by the concentration measurements where improvised diffusors cannot generate a 100% carbon dioxide atmosphere at the aorta incision location. The atrial incision is easier to protect: 0% air with all commercial devices for all flow rates greater than 1 SLPM. A flow rate of 1 SLPM does not create an inert atmosphere with any device. CONCLUSIONS: The optically observed carbon dioxide atmosphere is unstable and influenced by many factors. The device used for diffusion and the flow rate are important determinants of the maximum gas concentration that can be achieved, as is the location where this is measured.


Assuntos
Dióxido de Carbono/administração & dosagem , Procedimentos Cirúrgicos Cardíacos , Embolia Aérea/prevenção & controle , Insuflação , Gravação em Vídeo , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Difusão , Embolia Aérea/etiologia , Desenho de Equipamento , Insuflação/efeitos adversos , Insuflação/instrumentação , Fatores de Tempo
14.
J Minim Invasive Gynecol ; 27(1): 225-234, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31125720

RESUMO

STUDY OBJECTIVE: The primary objective was to compare carbon dioxide (CO2) absorption rates in patients undergoing gynecologic laparoscopy with a standard versus valveless insufflation system (AirSeal; ConMed, Utica, NY) at intra-abdominal pressures (IAPs) of 10 and 15 mm Hg. Secondary objectives were assessment of surgeons' visualization of the operative field, anesthesiologists' ability to maintain adequate end-tidal CO2 (etCO2), and patients' report of postoperative shoulder pain. DESIGN: A randomized controlled trial using an equal allocation ratio into 4 arms: standard insufflation/IAP 10 mm Hg, standard insufflation/IAP 15 mm Hg, valveless insufflation/IAP 10 mm Hg, and valveless insufflation/IAP 15 mm Hg. SETTING: Single tertiary care academic institution. PATIENTS: Women ≥ 18 years old undergoing nonemergent conventional or robotic gynecologic laparoscopic surgery. INTERVENTIONS: A standard or valveless insufflation system at IAPs of 10 or 15 mm Hg. MEASUREMENTS AND MAIN RESULTS: One hundred thirty-two patients were enrolled and randomized with 33 patients per group. There were 84 robotic cases and 47 conventional laparoscopic cases. CO2 absorption rates (mL/kg*min) did not differ across groups with mean rates of 4.00 ± 1.3 in the valveless insufflation groups and 4.00 ± 1.1 in the standard insufflation groups. The surgeons' rating of overall visualization of the operative field on a 10-point Likert scale favored the valveless insufflation system (median visualization, 9.0 ± 2.0 cm and 9.5 ± 1.8 cm at 10 and 15 mm Hg, respectively) over standard insufflation (7.0 ± 3.0 cm and 7.0 ± 2.0 cm at 10 and 15 mm Hg, respectively; p <.001). The anesthesiologists' ability to maintain adequate etCO2 was similar across groups (p = .417). Postoperative shoulder pain scores were low overall with no significant difference across groups (p >.05). CONCLUSION: CO2 absorption rates, anesthesiologists' ability to maintain adequate etCO2, and postoperative shoulder pain did not differ based on insufflation system type or IAP. Surgeons' rating of visualization of the operative field was significantly improved when using the valveless over the standard insufflation system.


Assuntos
Dióxido de Carbono/farmacocinética , Procedimentos Cirúrgicos em Ginecologia , Insuflação , Laparoscopia/métodos , Adulto , Dióxido de Carbono/efeitos adversos , Feminino , Absorção Gastrointestinal , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/normas , Humanos , Insuflação/efeitos adversos , Insuflação/instrumentação , Insuflação/métodos , Insuflação/normas , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/etiologia , Pressão , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/normas , Dor de Ombro/etiologia , Instrumentos Cirúrgicos/normas , Resultado do Tratamento
15.
Ther Adv Respir Dis ; 13: 1753466619875928, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31544581

RESUMO

BACKGROUND: To determine the effectiveness of combined noninvasive ventilation (NIV) and mechanical insufflator-exsufflator (MI-E) for acute respiratory failure (ARF) in patients with neuromuscular disease (NMD), and outcome predictors. METHODS: A prospectively observational study of patients with ARF was conducted in a pediatric intensive care unit (PICU). All received combined NIV/MI-E during PICU stays between 2007 and 2017. Pertinent clinical variables of heart rate (HR), respiratory rate (RR), pH, PaCO2, and PaO2/FiO2 ratio were collected at baseline and at 2 h, 4-8 h, and 12-24 h after initiating use of NIV/MI-E. Treatment success was defined as avoiding intubation. RESULTS: A total of 62 ARF episodes in 56 patients with NMD (median age, 13 years) were enrolled. The most frequent underlying NMD was spinal muscular atrophy (32/62, 52%). ARF was primarily due to pneumonia (65%). The treatment success rate was 86%. PICU stay and hospitalization were shorter in the success group (9.4 ± 6.1 vs. 21.9 ± 13.9 days and 16.3 ± 7.8 vs. 33.6 ± 17.9 days, respectively; both p < 0.05). HR, RR, pH, and PaCO2 showed a progressive improvement, particularly after 4 h following successful NIV/MI-E treatment. RR decrease at 4 h, and pH increase and PaCO2 decrease at 4-8 h might predict success of NIV/MI-E treatment. The multivariate analysis identified PaCO2 at 4-8 h of 58.0 mmHg as an outcome predictor of NIV/MI-E treatment. CONCLUSIONS: Applying combined NIV/MI-E in the acute care setting is an efficient means of averting intubation in NMD patients with ARF. Clinical features within 8 h of the institution may predict treatment outcome. The reviews of this paper are available via the supplemental material section.


Assuntos
Insuflação , Pulmão/fisiopatologia , Doenças Neuromusculares/complicações , Ventilação não Invasiva , Insuficiência Respiratória/terapia , Doença Aguda , Adolescente , Adulto , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Lactente , Insuflação/efeitos adversos , Unidades de Terapia Intensiva Pediátrica , Tempo de Internação , Masculino , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/fisiopatologia , Ventilação não Invasiva/efeitos adversos , Estudos Prospectivos , Recuperação de Função Fisiológica , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
16.
Gen Thorac Cardiovasc Surg ; 67(10): 823-834, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31290000

RESUMO

Since the beginning of cardiac surgery, retained intracardiac air has been an important problem. While transesophageal echocardiography enabled to visualize the air and de-airing procedures have been routinely done, they appear to vary much among institutions not necessarily based on firm scientific evidence. Thus, "de-airing" was chosen as the theme of 2016 CVSAP (cardiovascular surgery and anesthesia and perfusion) symposium and a nation-wide questionnaire survey was carried out prior to it. This paper reports on its results and illustrate "the best of de-airing" based on literature review. The collection rate of the questionnaire survey was 77.9% (278/357) and 83.3% (85/102) from the major institutions of surgeons and anesthesiologists, respectively. More than 90% of both consider de-airing as important, since adverse events of air embolism were actually encountered including critical ones. Most routinely performed de-airing procedures are posture change, lung inflation and aspiration through the vent cannulae. Direct aspiration is performed in one-third of institutions. Carbon dioxide insufflation is performed in 82.5% of institutions (mostly 2-3 L/min). However, not a few surgeons are skeptical for its significance. While many surgeons are grateful for collaboration by anesthesiologists, some expect more information sharing between them. They also expect that clinical engineers understand "de-airing" better and operate the extracorporeal circulation system appropriately to avoid an occurrence of undesirable event. Some surgeons anticipated a convenient device for de-airing. Furthermore, some questions to be solved in the future were raised, including how meticulously the bubbles should be removed or how efficient carbon dioxide insufflation is.


Assuntos
Dióxido de Carbono/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Embolia Aérea/prevenção & controle , Insuflação/efeitos adversos , Embolia Aérea/etiologia , Humanos
17.
J Obstet Gynaecol ; 39(7): 1000-1005, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31210067

RESUMO

The aim of this study was to determine whether direct trocar entry without prior pneumoperitoneum at umbilical level (DTI) can be a safe alternative to access the abdominal cavity in gynaecological laparoscopic surgery. We present a prospective observational analytical study of cohorts, comparing DTI with umbilical entry with trocar after previous insufflation with a Veress needle at umbilical level (V). The study period was performed from June 2013 to April 2016; data was collected on 600 patients who underwent gynaecological laparoscopic surgery. There were no significant differences in the risk of suffering a complication during the access manoeuvres between DTI (6.49%) and V (7.39%), OR 0.89 (95% CI: 0.42-1.81). The duration of the access manoeuvres was 69 s in DTI and 193 s in V (p < .001). The percentage of patients in whom two or more access attempts were performed was lower in DTI (7.8%) than in V (12.3%) (p > .05). We concluded that DTI is at least as safe as V, regarding the risk of suffering complications arising from access into the abdominal cavity. DTI has advantages with regard to V, such as: the shorter duration of access manoeuvres or the lesser number of unsuccessful entry or insufflation attempts. Impact statement What is already known on this subject? There are few international publications comparing DTI and V. When we conducted a search in PubMed for the terms 'Veress needle and direct trocar insertion', 51 publications were obtained. When we increased the restriction and added the terms 'laparoscopic entry and laparoscopy complications', 27 publications were obtained; thus, the uniqueness of our study. What do the results of this study add? We present a 3-year observational prospective study of cohorts that included 600 patients. The aim of this study was to determine that in laparoscopic gynaecological surgery, DTI is an access method to the abdominal cavity at least as safe as V, with respect to the risk of complications. On the other hand, DTI has some advantages such as the shorter duration of access manoeuvres or the lower number of failed entry attempts. What are the implications of these findings for clinical practice and/or further research? Given the limited number of publications that compared both techniques, our study indicates that DTI can be a safe alternative for access to abdominal cavity in gynaecological surgery, compared to the traditional V.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Insuflação/estatística & dados numéricos , Laparoscopia/métodos , Pneumoperitônio Artificial/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Insuflação/efeitos adversos , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Pneumoperitônio Artificial/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Espanha/epidemiologia , Adulto Jovem
18.
J Surg Res ; 243: 274-280, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31254900

RESUMO

The possibility that ventral hernia orifice size may increase with insufflation at the time of laparoscopic ventral hernia repair has a number of consequences, including mesh size used and trocar placement. We measured ventral hernia orifice defects intraoperatively at 8 mm Hg and 15 mm Hg for comparison. We also took measurements of the external abdominal wall at various points to determine the relationship between insufflation and the abdominal wall externally. Of 39 patients measured, we found a mean increase of 3.7 mm in the hernia defect transversely and 2.9 mm vertically. The external measurements showed correlation with insufflation pressure, as expected. The transverse measurements across the mid-abdomen showed a mean increase of 5 mm from 0 to 8 mm Hg insufflation and a full additional centimeter when insufflation was increased from 8 to 15 mm Hg. We were able to detect and quantify an increase in hernia defect size with insufflation, but the increase is so small it is unlikely to be clinically significant in the management of surgical patients.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/métodos , Insuflação/efeitos adversos , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
19.
Dis Colon Rectum ; 62(7): 794-801, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31188179

RESUMO

BACKGROUND: Carbon dioxide embolus has been reported as a rare but clinically important risk associated with transanal total mesorectal excision surgery. To date, there exists limited data describing the incidence, risk factors, and management of carbon dioxide embolus in transanal total mesorectal excision. OBJECTIVE: This study aimed to obtain data from the transanal total mesorectal excision registries to identify trends and potential risk factors for carbon dioxide embolus specific to this surgical technique. DESIGN: Contributors to both the LOREC and OSTRiCh transanal total mesorectal excision registries were invited to report their incidence of carbon dioxide embolus. Case report forms were collected detailing the patient-specific and technical factors of each event. SETTINGS: The study was conducted at the collaborating centers from the international transanal total mesorectal excision registries. MAIN OUTCOME MEASURES: Characteristics and outcomes of patients with carbon dioxide embolus associated with transanal mesorectal excision were measured. RESULTS: Twenty-five cases were reported. The incidence of carbon dioxide embolus during transanal total mesorectal excision is estimated to be ≈0.4% (25/6375 cases). A fall in end tidal carbon dioxide was noted as the initial feature in 22 cases, with 13 (52%) developing signs of hemodynamic compromise. All of the events occurred in the transanal component of dissection, with mean (range) insufflation pressures of 15 mm Hg (12-20 mm Hg). Patients were predominantly (68%) in a Trendelenburg position, between 30° and 45°. Venous bleeding was reported in 20 cases at the time of carbon dioxide embolus, with periprostatic veins documented as the most common site (40%). After carbon dioxide embolus, 84% of cases were completed after hemodynamic stabilization. Two patients required cardiopulmonary resuscitation because of cardiovascular collapse. There were no deaths. LIMITATIONS: This is a retrospective study surveying reported outcomes by surgeons and anesthetists. CONCLUSIONS: Surgeons undertaking transanal total mesorectal excision must be aware of the possibility of carbon dioxide embolus and its potential risk factors, including venous bleeding (wrong plane surgery), high insufflation pressures, and patient positioning. Prompt recognition and management can limit the clinical impact of such events. See Video Abstract at http://links.lww.com/DCR/A961.


Assuntos
Embolia Aérea/etiologia , Hemorragia/complicações , Insuflação/efeitos adversos , Complicações Intraoperatórias/etiologia , Reto/cirurgia , Cirurgia Endoscópica Transanal/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Dióxido de Carbono , Embolia Aérea/diagnóstico , Embolia Aérea/terapia , Feminino , Humanos , Insuflação/métodos , Internacionalidade , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/terapia , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Cuidados Pós-Operatórios , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Veias
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