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1.
Ther Umsch ; 77(9): 433-440, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33146098

RESUMO

Primary hyperparathyroidism Abstract. Primary hyperparathyroidism is a common endocrine disease that comes along with a disruption of the calcium homeostasis and is accompanied by a variety of downstream disorders. These are often overlooked as patients present with a multitude of unspecific symptoms or may even be asymptomatic. The diagnosis of primary hyperparathyroidism can be made with the determination of calcium and parathyroid hormone levels, including the measurement of calcium in the 24-hours urine. The operation is the only therapy to cure primary hyperparathyroidism. To successfully conduct focused parathyroidectomy an accompanying visual imaging methodology is of great value and improves the operation success rate. Furthermore, an intraoperative parathyroid hormone monitoring is applied. A bilateral neck exploration technique is applicable in selected cases. The endocrine surgical expertise is pivotal in particular for re-operations, hereditary primary hyperparathyroidism and carcinomas. If surgery is not possible, a medication-based therapy is applied. This medical therapy requests a continuous therapy progress monitoring. In conclusion, to treat primary hyperparathyroidism an interdisciplinary team approach with endocrinologists and endocrine surgeons shows the best results.


Assuntos
Hiperparatireoidismo Primário , Humanos , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/terapia , Monitorização Intraoperatória , Hormônio Paratireóideo , Paratireoidectomia , Reoperação
3.
Rev Neurol ; 71(9): 340-350, 2020 11 01.
Artigo em Espanhol | MEDLINE | ID: mdl-33085079

RESUMO

At the end of January, the current outbreak of COVID-19 coronavirus disease was declared an important international public health emergency. In Spain, since the government declared the state of alarm on 14 March 2020, doctors responsible for carrying out neurophysiological tests have been performing them without any consensus criterion or clear safety guidelines for doctors, technicians or patients. The following recommendations, based on current knowledge of the disease and therefore liable to change in the future, are proposed when the pandemic appears to have entered a process of decreasing virulence and, with it, the strict containment measures established to date. However, in view of the possibility of a second wave of the pandemic, it seems necessary to establish basic and minimum recommendations to respect the patient's right to appropriate care, similar to that provided prior to the pandemic, and to maintain minimum safety standards for the patients themselves and for the doctors, technicians and health personnel carrying out these tests. These recommendations concern the constitution of a priority based on the reason for consultation, the establishment of calls to check the patient's clinical situation before going to the outpatient department and the rules for carrying out neurophysiological tests, which are generally based on the preservation of hospital circuits, respect for and observation of the known barriers to contagion of this disease, and the use of disposable material. These recommendations are of particular interest, especially given the uncertainty of not knowing the evolution of the SARS-CoV-2 infection in the coming weeks or months.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Eletrofisiologia , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Assistência Ambulatorial , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Desinfecção , Eletrofisiologia/instrumentação , Eletrofisiologia/métodos , Eletrofisiologia/normas , Contaminação de Equipamentos , Humanos , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Pacientes Internados , Monitorização Intraoperatória , Exposição Ocupacional , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Utilização de Procedimentos e Técnicas , Espanha/epidemiologia , Avaliação de Sintomas , Telemedicina
4.
Artigo em Russo | MEDLINE | ID: mdl-33095531

RESUMO

OBJECTIVE: To compare monopolar and bipolar mapping in point-by-point fashion by using of threshold amperage, frequency of positive motor responses and the number of muscles involved in response. MATERIAL AND METHODS: A prospective non-randomized study included 14 patients with supratentorial tumors who underwent surgery in 2018-2019. All neoplasms were localized within 2 cm from the motor cortex and pyramidal tract. Age of patients ranged from 25 to 74 years. There were 9 women and 5 men. Eight patients had malignant glioma (grade III - 4, grade IV - 4), 6 patients - meningioma. Motor functions were assessed in all patients before and after surgery (1, 7 days and 3 months later) by using of a 5-point scale. In addition to routine neurophysiological monitoring, comparative mono- and bipolar mapping of the pyramidal tract within the bed of excised tumor was carried out at the end of surgery. The points of motor responses were marked. Comparative analysis of mono- and bipolar stimulation at identical points included threshold amperage, frequency of positive motor responses and the number of muscles involved in response (leg, forearm, hand, facial muscles). Brain MRI was performed in early postoperative period for assessment of resection quality. RESULTS: There were 64 points of motor responses in 14 patients. The number of these points ranged from 2 to 8 per a patient (mean 5 points). Motor responses were recorded in 57 points during monopolar and bipolar stimulation, in other 7 points - only during monopolar stimulation. Amperage of monopolar stimulation was 3-15 mA, bipolar stimulation - 2.5-25 mA. Threshold amperage (7.37 mA for monopolar stimulation and 8.88 mA for bipolar stimulation; p=0.12), frequency of positive motor responses and the number of muscles involved in response (p=0.1 and p=0.73) were similar. Seven (50%) patients had neurological deterioration in early postoperative period (4 patients with glial tumors and 3 patients with meningiomas). At the same time, only 2 patients (14.3%) had persistent neurological deficit (both patients with infiltrative meningioma). According to postoperative MRI in T1+C mode, resection volume was 100% in 1 patient with contrast-enhanced glioma and 94% in another one. According to FLAIR MRI data, resection volume exceeded 70% in 2 patients with non-enhancing glioma and less than 70% in 2 patients. Meningioma resection volume was estimated according to postoperative T1+C MRI data and made up over 90% in 4 patients. CONCLUSION: Monopolar stimulation is a reliable method of pyramidal tract identification in supratentorial brain tumor surgery.


Assuntos
Transtorno Bipolar , Neoplasias Encefálicas , Neoplasias Meníngeas , Córtex Motor , Neoplasias Supratentoriais , Mapeamento Encefálico , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Potencial Evocado Motor , Feminino , Humanos , Masculino , Monitorização Intraoperatória , Córtex Motor/diagnóstico por imagem , Estudos Prospectivos , Tratos Piramidais/diagnóstico por imagem , Neoplasias Supratentoriais/diagnóstico por imagem , Neoplasias Supratentoriais/cirurgia
5.
Cochrane Database Syst Rev ; 10: CD010787, 2020 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-33085088

RESUMO

BACKGROUND: Bilateral neck exploration (BNE) is the traditional approach to sporadic primary hyperparathyroidism. With the availability of the preoperative imaging techniques and intraoperative parathyroid hormone assays, minimally invasive parathyroidectomy (MIP) is fast becoming the favoured surgical approach. OBJECTIVES: To assess the effects of minimally invasive parathyroidectomy (MIP) guided by preoperative imaging and intraoperative parathyroid hormone monitoring versus bilateral neck exploration (BNE) for the surgical management of primary hyperparathyroidism. SEARCH METHODS: We searched CENTRAL, MEDLINE, WHO ICTRP and ClinicalTrials.gov. The date of the last search of all databases was 21 October 2019. There were no language restrictions applied. SELECTION CRITERIA: We included randomised controlled trials comparing MIP to BNE for the treatment of sporadic primary hyperparathyroidism in persons undergoing surgery for the first time. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts for relevance. Two review authors independently screened for inclusion, extracted data and carried out risk of bias assessment. The content expert senior author resolved conflicts. We assessed studies for overall certainty of the evidence using the GRADE instrument. We conducted meta-analyses using a random-effects model and performed statistical analyses according to the guidelines in the latest version of the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS: We identified five eligible studies, all conducted in European university hospitals. They included 266 adults, 136 participants were randomised to MIP and 130 participants to BNE. Data were available for all participants post-surgery up to one year, with the exception of missing data for two participants in the MIP group and for one participant in the BNE group at one year. Nine participants in the MIP group and 11 participants in the BNE group had missing data at five years. No study had a low risk of bias in all risk of bias domains. The risk ratio (RR) for success rate (eucalcaemia) at six months in the MIP group compared to the BNE group was 0.98 (95% confidence interval (CI) 0.94 to 1.03; P = 0.43; 5 studies, 266 participants; very low-certainty evidence). A total of 132/136 (97.1%) participants in the MIP group compared with 129/130 (99.2%) participants in the BNE group were judged as operative success. At five years, the RR was 0.94 (95% CI 0.83 to 1.08; P = 0.38; 1 study, 77 participants; very low-certainty evidence). A total of 34/38 (89.5%) participants in the MIP group compared with 37/39 (94.9%) participants in the BNE group were judged as operative success. The RR for the total incidence of perioperative adverse events was 0.50, in favour of MIP (95% CI 0.33 to 0.76; P = 0.001; 5 studies, 236 participants; low-certainty evidence). Perioperative adverse events occurred in 23/136 (16.9%) participants in the MIP group compared with 44/130 (33.9%) participants in the BNE group. The 95% prediction interval ranged between 0.25 and 0.99. These adverse events included symptomatic hypocalcaemia, vocal cord palsy, bleeding, fever and infection. Fifteen of 104 (14.4%) participants experienced symptomatic hypocalcaemia in the MIP group compared with 26/98 (26.5%) participants in the BNE group. The RR for this event comparing MIP with BNE at two days was 0.54 (95% CI 0.32 to 0.92; P = 0.02; 4 studies, 202 participants). Statistical significance was lost in sensitivity analyses, with a 95% prediction interval ranging between 0.17 and 1.74. Five out of 133 (3.8%) participants in the MIP group experienced vocal cord paralysis compared with 2/128 (1.6%) participants in the BNE group. The RR for this event was 1.87 (95% CI 0.47 to 7.51; P = 0.38; 5 studies, 261 participants). The 95% prediction interval ranged between 0.20 and 17.87. The effect on all-cause mortality was not explicitly reported and could not be adequately assessed (very low-certainty evidence). There was no clear difference for health-related quality of life between the treatment groups in two studies, but studies did not report numerical data (very low-certainty evidence). There was a possible treatment benefit for MIP compared to BNE in terms of cosmetic satisfaction (very low-certainty evidence). The mean difference (MD) for duration of surgery comparing BNE with MIP was in favour of the MIP group (-18 minutes, 95% CI -31 to -6; P = 0.004; 3 studies, 171 participants; very low-certainty evidence). The 95% prediction interval ranged between -162 minutes and 126 minutes. The studies did not report length of hospital stay. Four studies reported intraoperative conversion rate from MIP to open procedure information. Out of 115 included participants, there were 24 incidences of conversion, amounting to a conversion rate of 20.8%. AUTHORS' CONCLUSIONS: The success rates of MIP and BNE at six months were comparable. There were similar results at five years, but these were only based on one study. The incidence of perioperative symptomatic hypocalcaemia was lower in the MIP compared to the BNE group, whereas the incidence of vocal cord paralysis tended to be higher. Our systematic review did not provide clear evidence for the superiority of MIP over BNE. However, it was limited by low-certainty to very low-certainty evidence.


Assuntos
Hiperparatireoidismo Primário/diagnóstico por imagem , Hiperparatireoidismo Primário/cirurgia , Monitorização Intraoperatória/métodos , Hormônio Paratireóideo/sangue , Paratireoidectomia/métodos , Adulto , Viés , Humanos , Hiperparatireoidismo Primário/sangue , Hipocalcemia/epidemiologia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pescoço/cirurgia , Esvaziamento Cervical/métodos , Duração da Cirurgia , Paratireoidectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Paralisia das Pregas Vocais/epidemiologia
6.
Medicine (Baltimore) ; 99(43): e22712, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120766

RESUMO

BACKGROUND: Although dexmedetomidine has been used as either the anesthetic agent for light sedation or as an adjunct to other sedatives, no study has investigated the usefulness of dexmedetomidine as the main sedative agent for invasive and painful procedures. The purpose of this study was to compare the safety of dexmedetomidine-remifentanil and propofol-remifentanil during monitored anesthesia care (MAC) for hysteroscopy. METHODS: Female patients undergoing hysteroscopy were randomly assigned to either the dexmedetomidine (group D) or the propofol group (group P). The study drug (0.6 ml/kg; dexmedetomidine 2 µg/ml or propofol 4 mg/ml) was loaded for 10 minutes followed by 0.1 to 0.5 ml/kg/hour to maintain a bispectral index of 60 to 80 during the procedure. In both groups, remifentanil was infused using a target-controlled-infusion system with a target concentration of 2 ng/ml and titrated during the procedure. The incidence rates of intraoperative respiratory depression in both groups were compared. Postoperative pain and patients satisfaction were also compared. RESULTS: A total of 69 female patients were included in this study. Dexmedetomidine significantly decrease the incidence of respiratory depression compared with propofol (15/34 [44.1%] vs 5/35 [14.3%], P = .006, group P and D, respectively). Postoperative pain and patients satisfaction score did not differ between the groups. CONCLUSION: The combination of dexmedetomidine-remifentanil can reduce the incidence of respiratory depression without increasing hemodynamic complications compared with propofol-remifentanil for MAC during hysteroscopy.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Dexmedetomidina/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Histeroscopia , Monitorização Intraoperatória , Propofol/administração & dosagem , Remifentanil/administração & dosagem , Adulto , Combinação de Medicamentos , Feminino , Humanos , Pessoa de Meia-Idade , Método Simples-Cego
8.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(4): 184-194, jul.-ago. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193899

RESUMO

INTRODUCCIÓN: La cirugía de los tumores cerebrales se ha implementado en los últimos años con nuevas técnicas de imagen intraoperatoria, que tratan de mejorar la resección tumoral, aunque conllevan un aumento de recursos. Con el fin de hacer una actualización de este tema, se ha elaborado este manuscrito desde el grupo de tumores de la Sociedad Española de Neurocirugía. MATERIAL Y MÉTODOS: Se ha propuesto a expertos en el uso de cada una de las técnicas intraoperatorias más empleadas en la cirugía de los tumores cerebrales, la descripción de la técnica y una breve revisión de la literatura. Se describirán indicaciones de uso, sus ventajas e inconvenientes basados en la experiencia clínica y en lo publicado en la literatura. RESULTADOS: La técnica de imagen intraoperatoria más consistente sería la resonancia de bajo y alto campo, pero a su vez es la que supone un mayor gasto de recursos. La ecografía intraoperatoria navegada es portátil y tiene un menor coste, aunque discrimina peor los tumores de alto grado y es observador-dependiente. Las técnicas de fluorescencia más empleadas son el 5-aminolevulínico para gliomas de alto grado y la fluoresceína, de utilidad en lesiones que rompen la barrera hematoencefálica. Por último, la TAC intraoperatoria es la más versátil en el quirófano de neurocirugía, pero tiene menos indicaciones en la cirugía neurooncológica. CONCLUSIONES: Las técnicas de imagen intraoperatoria se emplean cada vez con más frecuencia en la cirugía de los tumores cerebrales, y el neurocirujano debe valorar su posible uso en función de sus recursos y las necesidades de cada paciente


INTRODUCTION: New intraoperative imaging techniques, which aim to improve tumour resection, have been implemented in recent years in brain tumour surgery, although they lead to an increase in resources. In order to carry out an update on this topic, this manuscript has been drafted by a group from the Sociedad Española de Neurocirugía (Spanish Society of Neurosurgery). MATERIAL AND METHODS: Experts in the use of each one of the most-used intraoperative techniques in brain tumour surgery were presented with a description of the technique and a brief review of the literature. Indications for use, their advantages and disadvantages based on clinical experience and on what is published in the literature will be described. RESULTS: The most robust intraoperative imaging technique appears to be low- and high-field magnetic resonance imaging, but this is the technique which results in the greatest expenditure. Intraoperative ultrasound navigation is portable and less expensive, but it provides poorer differentiation of high-grade tumours and is observer-dependent. The most-used fluorescence techniques are 5-aminolevulinic acid for high-grade gliomas and fluorescein, useful in lesions which rupture the blood-brain barrier. Last of all, intraoperative CT is more versatile in the neurosurgery operating theatre, but it has fewer indications in neuro-oncology surgery. CONCLUSIONS: Intraoperative imaging techniques are used with increasingly greater frequency in brain tumour surgery, and the neurosurgeon should assess their possible use depending on their resources and the needs of each patient


Assuntos
Humanos , Neoplasias Encefálicas/cirurgia , Procedimentos Neurocirúrgicos , Processamento de Imagem Assistida por Computador , Monitorização Intraoperatória/instrumentação , Imagem por Ressonância Magnética/instrumentação , Monitorização Intraoperatória/normas , Imagem por Ressonância Magnética/normas
10.
Medicine (Baltimore) ; 99(34): e21914, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846858

RESUMO

We aimed to evaluate the accuracy and interchangeability of stroke volume and cardiac output measured by electrical velocimetry and transthoracic echocardiography during cesarean delivery.We enrolled 20 parturients in this prospective observational study. We recorded the stroke volume and cardiac output using both methods and compared the values at seven specific time points. We analyzed the data using linear regression analysis for Pearson's correlation coefficients and Bland-Altman analysis to determine percentage errors. We conducted a trending ability analysis based on the four-quadrant plot with the concordance rate and correlation coefficient.We recorded 124 paired datasets during cesarean delivery. The correlation coefficients of the measured cardiac output and stroke volume between the two methods were 0.397 (P < .001) and 0.357 (P < .001). The 95% limits of agreement were -1.0 to 8.1 L min for cardiac output and -10.4 to 90.4 ml for stroke volume. Moreover, the corresponding percentage errors were 62% and 60%. The concordance correlation coefficients were 0.447 (95% CI: 0.313-0.564) for stroke volume and 0.562 (95% CI: 0.442-0.662) for cardiac output. Both methods showed a moderate trending ability for stroke volume (concordance rate: 82% (95% CI: 72-90%)) and cardiac output (concordance rate: 85% (95% CI: 78-93%)).Our findings indicated that electrical velocimetry monitoring has limited accuracy, precision, and interchangeability with transthoracic echocardiography; however, it had a moderate trending ability for stroke volume and cardiac output measurements during cesarean delivery.


Assuntos
Débito Cardíaco , Cesárea/métodos , Ecocardiografia/métodos , Reologia/métodos , Adulto , Algoritmos , China/epidemiologia , Confiabilidade dos Dados , Ecocardiografia/estatística & dados numéricos , Feminino , Hemodinâmica , Humanos , Monitorização Intraoperatória/instrumentação , Gravidez , Estudos Prospectivos , Reologia/estatística & dados numéricos , Volume Sistólico
11.
Curr Opin Anaesthesiol ; 33(5): 626-632, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32769746

RESUMO

PURPOSE OF REVIEW: Major adverse cardiovascular and cerebrovascular events (MACCE) significantly affect the surgical outcomes. Electrocardiogram (ECG) has been a standard intraoperative monitor for 30 years. Electroencephalogram (EEG) can provide valuable information about the anesthetized state and guide anesthesia management during surgery. Whether EEG should be a standard intraoperative monitor is discussed in this review. RECENT FINDINGS: Deep anesthesia has been associated with postoperative delirium, especially in elderly patients. Intraoperative EEG monitoring has been demonstrated to reduce total anesthesia drug use during general anesthesia and postoperative delirium. SUMMARY: Unlike ECG monitoring, the EEG under general anesthesia has not been designated as a standard monitor by anesthesiologist societies around the world. The processed EEG technology has been commercially available for more than 25 years and EEG technology has significantly facilitated its intraoperative use. It is time to consider EEG as a standard anesthesia monitor during surgery.


Assuntos
Delírio , Eletrocardiografia , Eletroencefalografia , Idoso , Anestesia Geral , Humanos , Monitorização Intraoperatória
12.
PLoS One ; 15(8): e0238249, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32845935

RESUMO

Spontaneous electroencephalogram (EEG) and auditory evoked potentials (AEP) have been suggested to monitor the level of consciousness during anesthesia. As both signals reflect different neuronal pathways, a combination of parameters from both signals may provide broader information about the brain status during anesthesia. Appropriate parameter selection and combination to a single index is crucial to take advantage of this potential. The field of machine learning offers algorithms for both parameter selection and combination. In this study, several established machine learning approaches including a method for the selection of suitable signal parameters and classification algorithms are applied to construct an index which predicts responsiveness in anesthetized patients. The present analysis considers several classification algorithms, among those support vector machines, artificial neural networks and Bayesian learning algorithms. On the basis of data from the transition between consciousness and unconsciousness, a combination of EEG and AEP signal parameters developed with automated methods provides a maximum prediction probability of 0.935, which is higher than 0.916 (for EEG parameters) and 0.880 (for AEP parameters) using a cross-validation approach. This suggests that machine learning techniques can successfully be applied to develop an improved combined EEG and AEP parameter to separate consciousness from unconsciousness.


Assuntos
Monitores de Consciência , Estado de Consciência/fisiologia , Eletroencefalografia/métodos , Aprendizado de Máquina , Monitorização Intraoperatória/métodos , Algoritmos , Anestesia Geral/métodos , Anestésicos Intravenosos/uso terapêutico , Estado de Consciência/efeitos dos fármacos , Potenciais Evocados Auditivos/fisiologia , Humanos , Monitorização Fisiológica/métodos , Redes Neurais de Computação , Máquina de Vetores de Suporte
13.
Stud Health Technol Inform ; 272: 318-321, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32604666

RESUMO

In neurosurgery, intraoperative neurophysiological monitoring (IOM) with continuous measurements of neural electrical activity may reduce the risk of postoperative deficits. During an IOM, surgical information as well as neurophysiological, surgical and anesthesia events have to be recorded. So far, there is no common standard for this task available. In this paper, such a standardization with the aim of facilitating the data input and making the protocols data available for different sorts of analyses is described. We developed a protocol entry catalog with 200 standard expressions, which were divided into four categories: IOM, surgical procedure, anesthesia and others. An empirical assessment of the catalog by the IOM team showed the need for subcategories. In the final version of the catalog, the standard terms were grouped into 25 subcategories. The catalog is a first step to support systematic research into the occurrence of clinical events during the IOM and their association with postoperative neurological deficits that could enable improved surgical procedures in the future.


Assuntos
Anestesia , Neurocirurgia , Monitorização Intraoperatória , Neurofisiologia , Procedimentos Neurocirúrgicos
14.
Ann Surg ; 272(2): 220-226, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675485

RESUMO

OBJECTIVE: To develop and evaluate a novel instrument to measure SEVERE processes using video data. BACKGROUND: Surgical video data can serve an important role in understanding the relationship between intraoperative events and postoperative outcomes. However, a standard tool to measure severity of intraoperative events is not yet available. METHODS: Items to be included in the instrument were identified through literature and video reviews. A committee of experts guided item reduction, including pilot tests and revisions, and determined weighted scores. Content validity was evaluated using a validated sensibility questionnaire. Inter-rater reliability was assessed by calculating intraclass correlation coefficient. Construct validity was evaluated on a sample of 120 patients who underwent laparoscopic Roux-en-Y gastric bypass procedure, in which comprehensive video data was obtained. RESULTS: SEVERE index measures severity of 5 event types using ordinal scales. Each intraoperative event is given a weighted score out of 10. Inter-rater reliability was excellent [0.87 (95%-confidence interval, 0.77-0.92)]. In a sample of consecutive 120 patients undergoing gastric bypass procedures, a median of 12 events [interquartile range (IQR) 9-18] occurred per patient and bleeding was the most frequent type (median 10, IQR 7-14). The median SEVERE score per case was 11.3 (IQR 8.3-16.9). In risk-adjusted multivariable regression models, history of previous abdominal surgery (P = 0.02) and body mass index (P = 0.005) were associated with SEVERE scores, demonstrating construct validity evidence. CONCLUSION: The SEVERE index may prove to be a useful instrument in identifying patients with high risk of developing postoperative complications.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Endoscopia Gastrointestinal/métodos , Complicações Intraoperatórias/diagnóstico , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Gravação em Vídeo , Centros Médicos Acadêmicos , Adulto , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Estudos de Coortes , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Humanos , Complicações Intraoperatórias/prevenção & controle , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Variações Dependentes do Observador , Ontário , Projetos Piloto , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco , Resultado do Tratamento
16.
Br J Anaesth ; 125(4): 466-482, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32680607

RESUMO

BACKGROUND: The reported incidence of postoperative residual curarisation (PORC) is still unacceptably high. The capacity of intraoperative neuromuscular monitoring (NMM) to reduce the incidence of PORC has yet to be established from pooled clinical studies. We conducted a meta-analysis of data from 1979 to 2019 to reanalyse this relationship. METHODS: English language, peer-reviewed, and operation room adult anaesthesia setting articles published between 1979 and 2019 were searched for on PubMed, Cochrane Central Register of Controlled Trials, ISI-WoK, and Scopus. The primary outcome was PORC incidence as defined by an at- or post-extubation train-of-four ratio (TOFR) of lower than 0.7, 0.9, or 1.0. Additional collected variables included the duration of action of neuromuscular blocking agents (NMBAs) used, sugammadex or neostigmine use, and the technique of anaesthesia maintenance. RESULTS: Fifty-three studies (109 study arms, 12 664 patients) were included. The pooled PORC incidence associated with the use of intermediate duration NMBAs and quantitative NMM was 0.115 (95% confidence interval [CI], 0.057-0.188). This was significantly lower than the PORC rate for both qualitative NMM (0.306; 95% CI, 0.09-0.411) and no NMM (0.331; 95% CI, 0.234-0.435). Anaesthesia type did not significantly affect PORC incidence. Sugammadex use was associated with lower PORC rates. The GRADE global level of evidence was very low and the refined assessment of the network meta-analysis by means of a confidence in network meta-analysis raised concerns on within- and across-study bias. CONCLUSIONS: Quantitative NMM outperforms both subjective and no NMM monitoring in reducing PORC as defined by a TOFR of <0.9.


Assuntos
Monitorização Intraoperatória , Metanálise em Rede , Monitoração Neuromuscular , Fármacos Neuromusculares não Despolarizantes/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Humanos , Bloqueio Neuromuscular , Complicações Pós-Operatórias/induzido quimicamente
17.
Cerebrovasc Dis Extra ; 10(2): 66-75, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32726777

RESUMO

INTRODUCTION: Moyamoya disease (MMD) is a rare cerebrovascular disease associated with cerebral infarction or hemorrhage. Hyperperfusion is the most significant complication of direct bypass surgery. Previous research has shown that an increase in cerebral blood flow (CBF) is strongly related to symptomatic hyperperfusion and highlighted the importance of postoperative assessment of CBF. OBJECTIVE: The principal aims of this study were to quantitatively analyze the relationship between intraoperative graft flow and increase in CBF and to evaluate the effectiveness of intraoperative graft flow measurement during bypass surgery for patients with MMD. METHODS: This study included 91 surgeries in 67 consecutive adult patients with MMD who underwent direct revascularization surgery at our institution between November 2013 and September 2018. Intraoperative graft flow of the branches and main trunk was measured in all patients, after anastomosis had been established. Postoperative CBF measurements were performed under sedation, immediately after surgery. Radiological hyperperfusion was defined as focal high uptake, as determined by CBF imaging immediately after surgery. Patients were divided into two groups (radiological hyperperfusion and nonradiological hyperperfusion groups), and the relationship between intraoperative graft flow and radiological hyperperfusion was analyzed. RESULTS: Significant differences were observed between the radiological hyperperfusion and nonradiological hyperperfusion groups in terms of intraoperative graft flow of both the branch (median 72 vs. 42 mL/min, respectively; p < 0.01) and main trunk (median 113 vs. 68 mL/min, respectively; p < 0.01). A receiver-operating characteristic analysis was performed to test the utility of intraoperative flow as a quantitative measure. We set the cutoff values for the intraoperative branch and main trunk flow at 57 mL/min (sensitivity: 0.707, specificity: 0.702; area under the curve [AUC]: 0.773; 95% confidence interval [CI]: 0.675-0.871) and 84 mL/min (sensitivity: 0.667, specificity: 0.771; AUC: 0.78; 95% CI: 0.685-0.875), respectively. CONCLUSIONS: Measuring intraoperative graft flow during bypass surgery may be an effective means of predicting hyperperfusion and could serve to facilitate early therapeutic intervention such as strict blood pressure control.


Assuntos
Angiografia Cerebral , Revascularização Cerebral/efeitos adversos , Circulação Cerebrovascular , Angiografia por Ressonância Magnética , Monitorização Intraoperatória , Doença de Moyamoya/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Adolescente , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/diagnóstico por imagem , Doença de Moyamoya/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
Medicine (Baltimore) ; 99(21): e20339, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481323

RESUMO

The aim of the present study was to investigate the role of intraoperative oxygen content on the development of early allograft dysfunction (EAD) in patients undergoing living donor liver transplantation (LDLT).This retrospective review included 452 adult patients who underwent elective LDLT. Our study population was classified into 2 groups: EAD and non-EAD. Arterial blood gas analysis was routinely performed 3 times during surgery: during the preanhepatic phase (ie, immediately after anesthetic induction); during the anhepatic phase (ie, at the onset of hepatic venous anastomosis); and during the neohepatic phase (ie, 1 hour after graft reperfusion). Arterial oxygen content (milliliters per deciliters) was derived using the following equation: (1.34 × hemoglobin [gram per deciliters] × SaO2 [%] × 0.01) + (0.0031 × PaO2 [mmHg]).The incidence of EAD occurrence was 13.1% (n = 59). Although oxygen contents at the preanhepatic phase were comparable between the 2 groups, the oxygen contents at the anhepatic and neohepatic phases were lower in the EAD group than in the non-EAD group. Patients with postoperative EAD had lower oxygen content immediately before and continuously after graft reperfusion, compared to patients without postoperative EAD. After the preanhepatic phase, oxygen content decreased in the EAD group but increased in the non-EAD group. The oxygen content and prevalence of normal oxygen content gradually increased during surgery in the non-EAD group, but not in the EAD group. Multivariable analysis revealed that oxygen content during the anhepatic phase and higher preoperative CRP levels were factors independently associated with the occurrence of EAD (area under the receiver-operating characteristic curve: 0.754; 95% confidence interval: 0.681-0.826; P < .001 in the model). Postoperatively, patients with EAD had a longer duration of hospitalization, higher incidences of acute kidney injury and infection, and experienced higher rates of patient mortality, compared to patients without EAD.Lower arterial oxygen concentration may negatively impact the functional recovery of the graft after LDLT, despite preserved hepatic vascular flow. Before graft reperfusion, the levels of oxygen content components, such as hemoglobin content, PaO2, and SaO2, should be regularly assessed and carefully maintained to ensure proper oxygen delivery into transplanted liver grafts.


Assuntos
Transplante de Fígado , Doadores Vivos , Monitorização Intraoperatória/métodos , Estudos Observacionais como Assunto , Oxigênio/metabolismo , Cooperação do Paciente , Disfunção Primária do Enxerto/metabolismo , Gasometria , Sobrevivência de Enxerto , Humanos
19.
J Card Surg ; 35(8): 2041-2043, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32557779

RESUMO

A 59-year-old male with a history of unstable angina was diagnosed with a myocardial bridge of the left anterior descending artery (LAD) and apical variant hypertrophic cardiomyopathy (AHCM). He underwent unroofing of the myocardial bridge and a left ventricular apical myectomy. Intraoperatively, epicardial ultrasound was used to identify the myocardial bridge with systolic compression of the LAD and confirm resolution of this compression postoperatively. Furthermore, epicardial ultrasound was used for guiding the degree of apical resection of the decompressed heart. This novel use of intraoperative epicardial ultrasound can help guide surgeons preoperatively and confirm results immediately after an operation.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/cirurgia , Monitorização Intraoperatória/métodos , Ponte Miocárdica/diagnóstico por imagem , Ponte Miocárdica/cirurgia , Cirurgia Assistida por Computador/métodos , Ultrassonografia de Intervenção/métodos , Angina Instável/etiologia , Cardiomiopatia Hipertrófica/complicações , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Ponte Miocárdica/complicações
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