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1.
Mymensingh Med J ; 29(1): 136-141, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915349

RESUMO

This study was designed to observe the haemodynamic changes, recovery status and cost effectiveness during anaesthesia in laparoscopic cholecystectomy with medical air in comparison to anaesthesia with nitrous oxide associated with maintain of adequate analgesia and was conducted in the department of Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2017 to June 2017. Nitrous oxide is popularly using as an analgesic in current balanced general anesthesia in addition carrier agent for anesthetic. Intraoperative pain intensity depends on many variables including, type of surgery, surgical stimulation and surgical incision. It is difficult to measure intraoperative pain properly under general anesthesia therefore anesthetist depends on the surrogate marker of inadequate analgesia like raised heart rate, blood pressure, sweating and lacrimation. However, unfortunately, these parameters may changes in same direction with light plane of anesthesia, hypercarbia and ongoing procedural status of the patient.


Assuntos
Analgésicos/administração & dosagem , Anestesia/métodos , Colecistectomia Laparoscópica/métodos , Óxido Nitroso/administração & dosagem , Analgésicos/economia , Período de Recuperação da Anestesia , Anestesia Geral/economia , Bangladesh , Colelitíase/cirurgia , Análise Custo-Benefício , Hemodinâmica/efeitos dos fármacos , Humanos , Monitorização Intraoperatória , Óxido Nitroso/economia , Período Pós-Operatório
2.
World Neurosurg ; 133: 1-7, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31541759

RESUMO

BACKGROUND: Recent studies have confirmed the effectiveness of minimally invasive endoscopic surgery for intracerebral hematoma (ICH). However, improvements are needed because incomplete hematoma removal may offset the surgical benefits of the technique. We describe a technique of neuroendoscopic surgery using an image detectable sheath, intraoperative computed tomography (iCT) scan, and a navigation system. METHODS: This is a retrospective study of 15 consecutive patients with spontaneous ICH who received neuroendoscopic surgery. During the surgery, a transparent sheath was fastened tightly to the scalp with 3.0 nylon. The patient's head was covered with a sterilized vinyl sheet and subsequent iCT scan visualized the orientation of the endoscopic sheath and the extent of residual hematoma, allowing the surgeon to decide to continue to remove the hematoma or to finish the treatment. RESULTS: The median hematoma evacuation rate was 93% (interquartile range, 82.2%-95.9%). The Glasgow Coma Scale score of all patients significantly improved at 1 week after the operation (P < 0.05). No complications associated with the procedure were observed. CONCLUSIONS: The combination of our techniques improves accuracy and safety of minimally invasive surgical evacuation of hematoma. Performing surgery with iCT scan also improves the spatial recognition of surgeons and therefore may be of educational value.


Assuntos
Hemorragias Intracranianas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Monitorização Intraoperatória/métodos , Neuroendoscopia/métodos , Neuronavegação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neuroendoscópios , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
4.
Enferm. intensiva (Ed. impr.) ; 30(4): 154-162, oct.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184479

RESUMO

Objetivo: Analizar el manejo intraquirúrgico y los resultados posquirúrgicos asociados a la extubación temprana en los pacientes sometidos a cirugía reparadora de tetralogía de Fallot en un hospital público argentino. Métodos: Se realizó una revisión retrospectiva de los expedientes clínicos de los pacientes a quienes se les practicó cirugía para corrección de tetralogía de Fallot. Se incluyeron en el análisis un total de 38 expedientes que cumplieron con los criterios de inclusión establecidos en el protocolo para la revisión retrospectiva. Resultados: El 16% fue extubado de manera temprana. Milrinona fue la única droga que mostró diferencias en los pacientes a quienes se extubó de manera temprana (p = 0,01). El tiempo de circulación extracorpórea, el de clampaje aórtico, la transfusión con crioprecipitados, la saturación de la presión de oxígeno, y el hematocrito al finalizar el procedimiento quirúrgico no evidenciaron diferencias (p > 0,05). En el período posquirúrgico, la estadía en UTI fue más corta en los pacientes que fueron extubados de manera temprana (p = 0,0007), pero no hubo diferencias en la estadía hospitalaria total (p = 0,26). Conclusiones: La extubación temprana en la institución si bien resultó de baja frecuencia ha demostrado ser una alternativa segura y eficaz para disminuir la estancia en UTI de estos pacientes


Objective: To assess surgical management and postoperative results associated with early extubation in patients undergoing tetralogy of Fallot corrective surgery at a public hospital in Argentina. Methods: A retrospective review was made from clinical records from patients who underwent corrective surgery for tetralogy of Fallot. A total of 38 clinical records that met the inclusion criteria for the retrospective review were included in the analysis. Results: 16% were extubated early. Milrinone was the only drug that showed differences in patients who were extubated early (p = 0.01). Extracorporeal circulation time, aortic clamping time, transfusion with cryoprecipitates, saturation of oxygen pressure, and haematocrit at the end of the surgical procedure showed no differences (p > .05). In the postoperative period, the ICU stay was shorter for the patients who were extubated early (p = 0.0007), but there were no differences in the total hospital stay (p = 0.26). Conclusions: Early extubation in the institution, although found to be low frequency, has proved as a safe and effective alternative to shorten these patients’ stay in ICU


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Extubação/instrumentação , Extubação/tendências , Tetralogia de Fallot/cirurgia , Cuidados Pós-Operatórios/enfermagem , Monitorização Intraoperatória/enfermagem , Hospitais Públicos , Argentina , Estudos Retrospectivos , Circulação Extracorpórea/enfermagem , Tempo de Internação , Serviço Hospitalar de Anestesia/organização & administração , Anestesia Endotraqueal/enfermagem , Manuseio das Vias Aéreas/enfermagem , Transtornos de Deglutição/prevenção & controle
5.
Bone Joint J ; 101-B(11): 1438-1446, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31674243

RESUMO

AIMS: This study aimed to explore whether intraoperative nerve monitoring can identify risk factors and reduce the incidence of nerve injury in patients with high-riding developmental dysplasia. PATIENTS AND METHODS: We conducted a historical controlled study of patients with unilateral Crowe IV developmental dysplasia of the hip (DDH). Between October 2016 and October 2017, intraoperative nerve monitoring of the femoral and sciatic nerves was applied in total hip arthroplasty (THA). A neuromonitoring technician was employed to monitor nerve function and inform the surgeon of ongoing changes in a timely manner. Patients who did not have intraoperative nerve monitoring between September 2015 and October 2016 were selected as the control group. All the surgeries were performed by one surgeon. Demographics and clinical data were analyzed. A total of 35 patients in the monitoring group (ten male, 25 female; mean age 37.1 years (20 to 46)) and 56 patients in the control group (13 male, 43 female; mean age 37.9 years (23 to 52)) were enrolled. The mean follow-up of all patients was 13.1 months (10 to 15). RESULTS: The two groups had no significant differences in preoperative data. In the monitoring group, ten nerve alerts occurred intraoperatively, and no neural complications were detected postoperatively. In the control group, six patients had neural complications. The rate of nerve injury was lower in the monitoring group than in the control group, but this did not achieve statistical significance. The degree of leg lengthening was significantly greater in the monitoring group than in the control group. In further analyses, patients who had previous hip surgery were more likely to have intraoperative nerve alerts and postoperative nerve injury. CONCLUSION: Nerve injury usually occurred during the processes of exposure and reduction. The use of intraoperative nerve monitoring showed a trend towards reduced nerve injury in THA for Crowe IV DDH patients. Hence, we recommend its routine use in patients undergoing leg lengthening, especially in those with previous hip surgery. Cite this article: Bone Joint J 2019;101-B:1438-1446.


Assuntos
Artroplastia de Quadril/métodos , Nervo Femoral/fisiologia , Luxação Congênita de Quadril/cirurgia , Tratamentos com Preservação do Órgão/métodos , Nervo Isquiático/fisiologia , Adulto , Feminino , Nervo Femoral/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Nervo Isquiático/lesões , Traumatismos do Sistema Nervoso/prevenção & controle , Adulto Jovem
6.
Rev Port Cir Cardiotorac Vasc ; 26(3): 205-208, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734972

RESUMO

OBJECTIVE: To observe the impact of the use of capnography system adapted to cardiopulmonary bypass (CPB). To measure the concordance between values obtained from continuous monitoring of partial pressure of carbon dioxide in membrane oxygenator exhaustion (PeCO2) and the results observed on arterial blood gas test. METHODS: Participated in this study 40 patients submitted to elective cardiovascular surgery with CPB. They were divided into two groups: Group 1, with 20 patients submitted to the surgical procedure using blood gas analysis at intermittent intervals (20 - 30 minutes); Group 2, with 20 patients operated with a capnography system adapted applied to membrane oxygenator exhaustion and blood gas test. A test was used to compare arterial partial pressure of carbon dioxide (PaCO2) from group 1 and group 2. In group 2, the strength of the correlation between PeCO2 and PaCO2 was evaluated by a linear regression test. The Bland-Altman method was used to determine the degree of agreement between the two variables. RESULTS: Average and standard deviation of Group 1's PaCO2 (34.6 ± 7.44) and Group 2's PaCO2 / PeCO2 (36.5 ± 4.42) / (39.9 ± 3.98). There was no statistically significant difference in PaCO2 between the groups (P = 0.21). In group 2, PeCO2 and PaCO2 analyzed corrected for esophageal temperature obtained a positive linear correlation (r = 0.79, P < 0.001), the degree of agreement presented an average 3.47 ± 2.70 mmHg. CONCLUSION: The continuous PeCO2 monitoring from cardiopulmonary bypass circuit has a positive impact on the result of PaCO2. This instrument confirms and maintains the carbon dioxide (CO2) values into reference parameters.


Assuntos
Capnografia/métodos , Dióxido de Carbono/análise , Ponte Cardiopulmonar/instrumentação , Procedimentos Cirúrgicos Cardiovasculares/métodos , Gasometria , Humanos , Monitorização Intraoperatória , Oxigenadores de Membrana , Pressão Parcial
7.
Transplant Proc ; 51(9): 2943-2947, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31607621

RESUMO

INTRODUCTION: The aim of the present investigation was to retrospectively evaluate the utilization of Swan-Ganz catheter during orthotopic liver transplantation as opposed to FloTrac/Vigileo in selected cases, comparing a number of clinical outcomes across postoperative hospitalization. MATERIALS AND METHODS: Before 2015 all recipients received pulmonary artery catheter (Swan-Ganz group, n = 109). After 2015 Swan-Ganz was used only if coronary artery disease or high-grade portal hypertension or Child-Pugh C were present; the remaining recipients were assigned to FloTrac/Vigileo monitoring (Mini group, n =100). A number of clinical outcomes were considered. RESULTS: Donor's Risk Index was similar between groups (median value 1.7, P = .27). Anthropometric characteristics of the recipients were similar in the 2 groups. There were no significant differences in the proportion of patients with Child-Pugh C (P = .873), coronary artery disease (P = .18), and grade of portal hypertension (P = .733). The Model for End-Stage Liver Disease score was slightly higher in the Mini group: (9 [7-11] vs 9 [8-12], Swan-Ganz vs Mini, respectively, P < .035). Swan-Ganz utilization decreased over time (92% vs 26%, Swan-Ganz vs Mini, P < .001). Upon admission to the intensive care unit, patients of the Mini group presented a higher SAPS II score with similar values of Sequential Organ Failure Assessment score. Days on mechanical ventilation were similar between groups. The incidence of graft failure was similar between groups (2% vs 5%, Swan-Ganz and Mini group respectively, P = .376). Recipients' hospital length of stay was similar (13 days [11-19] vs 14 [11-20], P < .083). CONCLUSIONS: Our data suggest that the intraoperative utilization of FloTrac/Vigileo for oncologic patients with low grade end stage liver disease is reasonably safe.


Assuntos
Monitorização Hemodinâmica/métodos , Transplante de Fígado/métodos , Monitorização Intraoperatória/métodos , Cateterismo de Swan-Ganz , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Monitorização Intraoperatória/instrumentação , Estudos Retrospectivos
8.
Artigo em Russo | MEDLINE | ID: mdl-31577270

RESUMO

OBJECTIVE: Development of a quantitative indicator for the risk level of intraoperative iatrogenic motor disorders in the process of surgical correction of spinal deformity based on current neurophysiological monitoring data. MATERIAL AND METHODS: 288 patients 12.6±0.35 y.o. underwent surgical correction of spinal deformities under the control of intraoperative neuromonitoring. The nature of changes in motor evoked potentials was assessed according to the earlier proposed ranking scale. The incidence of different variants of changes in the rank values of the state of the pyramidal system during the operation and the resulting postoperative motor disturbances was calculated. RESULTS: By comparing probabilities of various changes in the conduction properties of pyramidal tracts during surgery with the incidence of the observed motor deficiencies we quantitatively assessed the possible correlation between these phenomena. We propose a method for calculating the risk index for postoperative motor disorders depending on the maximum rank of the pyramidal system's response to surgical aggression. CONCLUSION: The developed system of ranking evaluation of changes in motor evoked potentials during surgical correction of spinal deformity makes it possible to quantify the risk of postoperative motor disorders and, accordingly, to monitor the level of anxiety for a neurosurgeon during individual stages of surgical intervention.


Assuntos
Potenciais Somatossensoriais Evocados , Doença Iatrogênica , Tratos Piramidais , Coluna Vertebral , Potencial Evocado Motor , Humanos , Monitorização Intraoperatória , Tratos Piramidais/lesões , Coluna Vertebral/anormalidades , Coluna Vertebral/cirurgia
9.
Cochrane Database Syst Rev ; 9: CD003843, 2019 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-31557307

RESUMO

BACKGROUND: The use of clinical signs, or end-tidal anaesthetic gas (ETAG), may not be reliable in measuring the hypnotic component of anaesthesia and may lead to either overdosage or underdosage resulting in adverse effects because of too deep or too light anaesthesia. Intraoperative awareness, whilst uncommon, may lead to serious psychological disturbance, and alternative methods to monitor the depth of anaesthesia may reduce the incidence of serious events. Bispectral index (BIS) is a numerical scale based on electrical activity in the brain. Using a BIS monitor to guide the dose of anaesthetic may have advantages over clinical signs or ETAG. This is an update of a review last published in 2014. OBJECTIVES: To assess the effectiveness of BIS to reduce the risk of intraoperative awareness and early recovery times from general anaesthesia in adults undergoing surgery. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and Web of Science on 26 March 2019. We searched clinical trial registers and grey literature, and handsearched reference lists of included studies and related reviews. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and quasi-RCTs in which BIS was used to guide anaesthesia compared with standard practice which was either clinical signs or end-tidal anaesthetic gas (ETAG) to guide the anaesthetic dose. We included adult participants undergoing any type of surgery under general anaesthesia regardless of whether included participants had a high risk of intraoperative awareness. We included only studies in which investigators aimed to evaluate the effectiveness of BIS for its role in monitoring intraoperative depth of anaesthesia or potential improvements in early recovery times from anaesthesia. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion, extracted data, and assessed risk of bias. We assessed the certainty of evidence with GRADE. MAIN RESULTS: We included 52 studies with 41,331 participants; two studies were quasi-randomized and the remaining studies were RCTs. All studies included participants undergoing surgery under general anaesthesia. Three studies recruited only participants who were at high risk of intraoperative awareness, whilst two studies specifically recruited an unselected participant group. We analysed the data according to two comparison groups: BIS versus clinical signs; and BIS versus ETAG. Forty-eight studies used clinical signs as a comparison method, which included titration of anaesthesia according to criteria such as blood pressure or heart rate and, six studies used ETAG to guide anaesthesia. Whilst BIS target values differed between studies, all were within a range of values between 40 to 60.BIS versus clinical signsWe found low-certainty evidence that BIS-guided anaesthesia may reduce the risk of intraoperative awareness in a surgical population that were unselected or at high risk of awareness (Peto odds ratio (OR) 0.36, 95% CI 0.21 to 0.60; I2 = 61%; 27 studies; 9765 participants). However, events were rare with only five of 27 studies with reported incidences; we found that incidences of intraoperative awareness when BIS was used were three per 1000 (95% CI 2 to 6 per 1000) compared to nine per 1000 when anaesthesia was guided by clinical signs. Of the five studies with event data, one included participants at high risk of awareness and one included unselected participants, four used a structured questionnaire for assessment, and two used an adjudication process to identify confirmed or definite awareness.Early recovery times were also improved when BIS was used. We found low-certainty evidence that BIS may reduce the time to eye opening by mean difference (MD) 1.78 minutes (95% CI -2.53 to -1.03 minutes; 22 studies; 1494 participants), the time to orientation by MD 3.18 minutes (95% CI -4.03 to -2.33 minutes; 6 studies; 273 participants), and the time to discharge from the postanaesthesia care unit (PACU) by MD 6.86 minutes (95% CI -11.72 to -2 minutes; 13 studies; 930 participants).BIS versus ETAGAgain, events of intraoperative awareness were extremely rare, and we found no evidence of a difference in incidences of intraoperative awareness according to whether anaesthesia was guided by BIS or by ETAG in a surgical population at unselected or at high risk of awareness (Peto OR 1.13, 95% CI 0.56 to 2.26; I2 = 37%; 5 studies; 26,572 participants; low-certainty evidence). Incidences of intraoperative awareness were one per 1000 in both groups. Only three of five studies reported events, two included participants at high risk of awareness and one included unselected participants, all used a structured questionnaire for assessment and an adjudication process to identify confirmed or definite awareness.One large study (9376 participants) reported a reduced time to discharge from the PACU by a median of three minutes less, and we judged the certainty of this evidence to be low. No studies measured or reported the time to eye opening and the time to orientation.Certainty of the evidenceWe used GRADE to downgrade the evidence for all outcomes to low certainty. The incidence of intraoperative awareness is so infrequent such that, despite the inclusion of some large multi-centre studies in analyses, we believed that the effect estimates were imprecise. In addition, analyses included studies that we judged to have limitations owing to some assessments of high or unclear bias and in all studies, it was not possible to blind anaesthetists to the different methods of monitoring depth of anaesthesia.Studies often did not report a clear definition of intraoperative awareness. Time points of measurement differed, and methods used to identify intraoperative awareness also differed and we expected that some assessment tools were more comprehensive than others. AUTHORS' CONCLUSIONS: Intraoperative awareness is infrequent and, despite identifying a large number of eligible studies, evidence for the effectiveness of using BIS to guide anaesthetic depth is imprecise. We found that BIS-guided anaesthesia compared to clinical signs may reduce the risk of intraoperative awareness and improve early recovery times in people undergoing surgery under general anaesthesia but we found no evidence of a difference between BIS-guided anaesthesia and ETAG-guided anaesthesia. We found six studies awaiting classification and two ongoing studies; inclusion of these studies in future updates may increase the certainty of the evidence.


Assuntos
Anestesia Geral , Anestésicos/administração & dosagem , Consciência no Peroperatório , Monitorização Intraoperatória/métodos , Período de Recuperação da Anestesia , Eletroencefalografia , Humanos , Consciência no Peroperatório/prevenção & controle , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Oral Maxillofac Surg Clin North Am ; 31(4): 611-619, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31427193

RESUMO

During surgery, one of the primary functions of the anesthesiologist is to monitor the patient and ensure safe and effective conduct of anesthesia to provide the optimum operating conditions. Standard guidelines for perioperative monitoring have been firmly established by the American Society of Anesthesiologists. However, in recent years, new advances in technology has led to the development of many new monitoring modalities, especially involving the neurologic and cardiovascular systems. This article presents a targeted review to discuss the functions and limitations of these new monitors and how they are applied in the modern operating room setting.


Assuntos
Anestesia Dentária/métodos , Anestesiologia/normas , Monitorização Fisiológica/métodos , Período de Recuperação da Anestesia , Humanos , Monitorização Intraoperatória , Salas Cirúrgicas , Assistência Perioperatória
12.
World Neurosurg ; 131: e425-e432, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376552

RESUMO

BACKGROUND: Near-infrared spectroscopy (NIRS) is an alternative monitoring method during carotid artery stenting (CAS). NIRS has been reported to be effective in emergency care; however, it is unknown whether it can predict intraoperative ischemic intolerance and cerebral hyperperfusion during CAS. Perioperative ischemic intolerance and cerebral hyperperfusion are potential events during CAS for carotid artery stenosis. We evaluated whether perioperative monitoring of the tissue oxygenation index (TOI) using NIRS with the NIRO system can predict the occurrence of ischemic intolerance and cerebral hyperperfusion. METHODS: The TOI of 27 patients was measured during CAS. The relationship between the TOI and ischemic intolerance or cerebral hyperperfusion was analyzed, and the cutoff TOI was calculated to predict their occurrence. RESULTS: Ischemic intolerance occurred in 5 patients during balloon protection. The TOI in the presence of ischemic intolerance was significantly lower than that without ischemic intolerance. The cutoff TOI to detect ischemic intolerance was 50% and that of the TOI change rate before and after balloon protection was 80%. The ischemic symptoms in all patients had resolved immediately after balloon deflation. The cerebral hyperperfusion phenomenon was detected using single-photon emission computed tomography in 4 patients. These patients showed a transient increase in the TOI immediately after CAS; however, none of these patients showed symptomatic cerebral hyperperfusion phenomenon. The cutoff TOI to detect cerebral hyperperfusion was 109% compared with the TOI before CAS. CONCLUSION: Monitoring of the TOI using the NIRO system could be useful for the detection of ischemic intolerance and cerebral hyperperfusion during CAS and to prevent perioperative adverse events.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Estenose das Carótidas/terapia , Complicações Intraoperatórias/diagnóstico por imagem , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/métodos , Circulação Cerebrovascular , Feminino , Humanos , Hipotensão/epidemiologia , Complicações Intraoperatórias/epidemiologia , Masculino , Complicações Pós-Operatórias/epidemiologia , Stents , Tomografia Computadorizada de Emissão de Fóton Único
13.
Foot Ankle Int ; 40(1_suppl): 32S-33S, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31322944

RESUMO

RECOMMENDATION: The optimal number of samples for culture in patients undergoing surgery for foot and ankle infections is unknown. We recommend that multiple tissue samples be taken. LEVEL OF EVIDENCE: Consensus. DELEGATE VOTE: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).


Assuntos
Artroplastia de Substituição do Tornozelo/efeitos adversos , Monitorização Intraoperatória , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Humanos , Técnicas Microbiológicas
14.
Foot Ankle Int ; 40(1_suppl): 31S-32S, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31322962

RESUMO

RECOMMENDATION: We recommend that intraoperative cultures be taken during revision total ankle arthroplasty (TAA). The result of intraoperative cultures should be interpreted together with clinical suspicion for infection and the results of the laboratory and imaging investigations. We also recommend that multiple tissue specimens be collected. Given a lack of evidence for routine intraoperative cultures for revision TAA literature, this recommendation is based on analogous evidence in the total hip and knee replacement literature. LEVEL OF EVIDENCE: Consensus. DELEGATE VOTE: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).


Assuntos
Artroplastia de Substituição do Tornozelo/efeitos adversos , Monitorização Intraoperatória , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Humanos
15.
J Orthop Surg Res ; 14(1): 236, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340818

RESUMO

INTRODUCTION: The aim of this study was to evaluate the intraoperative revision rate and reasons for revision following 3D imaging in the management of dislocated articular tibial plateau fractures based on a large patient sample. METHODS: This retrospective cohort study included all patients who underwent open reduction and internal fixation due type B or C tibial plateau fracture according to the AO/OTA classification between August 2001 and December 2017 using intraoperative cone beam CT (3D imaging) for the analysis of fracture reduction and implant placement. The findings of the 3D scan were categorized regarding the amount and type of revision. Furthermore, demographic data was examined. RESULTS: Five hundred and fifty-nine consecutive fractures were included in the study. Evaluation of the image data records revealed an intraoperative revision due to the usage of 3D imaging in 148 out of 559 cases (26.5%). The most common reasons for an intraoperative revision were insufficient fracture reduction (114 cases) and screw length (21 cases). CONCLUSION: This study reveals indications for a limited analysis of fracture reduction and implant placement during the operative treatment of dislocated articular tibial plateau fractures using conventional fluoroscopy. In view of the high revision rate during open reduction and internal fixation of tibial plateau fractures due to 3D imaging the usage of intraoperative cone beam, CT may be considered. If this is not possible, a postoperative computed tomography may therefore be reasonable.


Assuntos
Fixação Interna de Fraturas/métodos , Imagem Tridimensional/métodos , Monitorização Intraoperatória/métodos , Reoperação/métodos , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Gerenciamento Clínico , Feminino , Fluoroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
16.
Plast Reconstr Surg ; 144(2): 252e-263e, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348359

RESUMO

BACKGROUND: Facial paralysis and postparalysis facial synkinesis both cause severe functional and aesthetic deficits. Functioning free muscle transplantation is the authors' preferred method for reconstructing both deformities. METHODS: From 1985 to 2017, a total of 392 patients underwent 403 gracilis functioning free muscle transplantations for facial reanimation. Different motor neurotizers were used: cross-face nerve graft (74 percent), spinal accessory nerve (17 percent), and masseter nerve (8 percent). Smile excursion score, cortical adaptation stage, patient questionnaire, Hadlock lip excursion, and the Terzis evaluation systems were used to assess outcomes. RESULTS: For smile excursion score, the spinal accessory and masseter nerve groups showed higher scores than the cross-face nerve graft group in the first 2 years, but no difference by 3-year follow-up. For cortical adaptation stage, nearly all cross-face nerve graft patients achieved stage IV or V spontaneity, the spinal accessory nerve group achieved at least stage III (independent) movement, but individuals in the masseter nerve group achieved only stage III or less. The cross-face nerve graft group also achieved higher scores according to the Hadlock system and the Terzis evaluation system compared with the other two groups. CONCLUSIONS: The concept of "sugarcane chewing" where the sweetness is the least at the tail but the most at the head can be simply applied for surgeons and patients in weighing the benefits and drawbacks during the motor neurotizer selection. Cross-face nerve graft-innervated gracilis is analogous to chewing sugarcane from tail to head; despite lower outcome measures earlier, it yields the highest scores at 3 years postoperatively. Masseter-innervated gracilis is akin to chewing sugarcane from head to tail, with greater outcome scores initially but little improvement at longer follow-up. Spinal accessory-innervated gracilis results fall in between these two groups. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Paralisia Facial/cirurgia , Músculo Grácil/inervação , Monitorização Intraoperatória/métodos , Transferência de Nervo/métodos , Procedimentos Neurocirúrgicos/métodos , Adulto , Estudos de Coortes , Expressão Facial , Paralisia Facial/diagnóstico , Feminino , Seguimentos , Músculo Grácil/transplante , Humanos , Masculino , Músculo Masseter/inervação , Mastigação/fisiologia , Pessoa de Meia-Idade , Qualidade de Vida , Recuperação de Função Fisiológica , Estudos Retrospectivos , Saccharum , Índice de Gravidade de Doença , Sorriso/fisiologia , Taiwan
17.
Am J Case Rep ; 20: 998-1001, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31292431

RESUMO

BACKGROUND It is very challenging for anesthesiologists to manage patients with pulmonary hypertension undergoing general anesthesia for elective or emergent surgeries. CASE REPORT We present a patient with severe pulmonary hypertension going through a major robotic thoracic surgery. CONCLUSIONS A goal-directed anesthesia management algorithm based on serial stroke volume (SV) values obtained from FloTrac (Edwards Lifesciences, LLC.) minimally invasive arterial pressure sensor was utilized in an attempt to reduce the anesthetic and surgical risk associated with severe pulmonary hypertension.


Assuntos
Anestesia Geral , Terapia Precoce Guiada por Metas , Hipertensão Pulmonar/complicações , Neoplasias Pulmonares/cirurgia , Monitorização Intraoperatória , Idoso , Feminino , Humanos , Procedimentos Cirúrgicos Torácicos
18.
Handb Clin Neurol ; 160: 313-327, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277857

RESUMO

Brain mapping is often critical to the success of epilepsy and brain tumor surgeries. Mapping the cerebral cortex can be performed either extraoperatively or intraoperatively. When considering the optimal venue for a particular patient, a number of important considerations need to be considered including: the intended goals for the mapping, patient factors, anesthetic effects, stimulation parameters, cortical functions of interest, as well as the mapping modalities being considered. In this chapter, we will cover electrocorticography, cortical somatosensory evoked potentials, and the various neurophysiologic techniques used to map sensorimotor and cognitive functions, including language. One of the main uses of electrocorticography in epilepsy surgery is to map the cortical regions associated with epileptiform activity. This information is used to plan resection boundaries. Electrocorticography can also be used to monitor for afterdischarges (ADs) during direct cortical stimulation as well as for mapping high-frequency activity during various cognitive tasks. Cortical somatosensory evoked potentials can identify the central sulcus by mapping the dipolar activation of the primary somatosensory cortex that results from stimulation of the large fiber somatosensory pathway by peripheral nerve stimulation. Motor, sensory, and language cortex can also be identified by direct electrical cortical stimulation.


Assuntos
Mapeamento Encefálico/métodos , Eletrocorticografia/métodos , Monitorização Intraoperatória/métodos , Córtex Somatossensorial/fisiologia , Eletroencefalografia/métodos , Humanos , Monitorização Intraoperatória/instrumentação
19.
Handb Clin Neurol ; 160: 329-344, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277858

RESUMO

Spinal cord surgery carries the risk of spinal cord or nerve root injury. Neurophysiologic monitoring decreases risk of injury by continuous assessment of spinal cord and nerve root function throughout surgery. Techniques include somatosensory evoked potentials (SEPs), transcranial electrical motor evoked potentials (MEPs), and electromyography (EMG). Baseline neurophysiologic data are obtained prior to incision. Real-time signal changes are identified in time to correct compromised neural function. Such monitoring improves postoperative neurologic functional outcomes. Challenges in neurophysiologic intraoperative monitoring (NIOM) include effects of anesthetics, neuromuscular blockade, hypotension, hypothermia, and preexisting neurological conditions, e.g., neuropathy or myelopathy. Technical factors causing poor quality data must be overcome in the electrically noisy operating room environment. Experienced monitoring teams understand tactics to obtain quality recordings and consider confounding variables before raising alarms when change occurs. Once an alert is raised, surgeons and anesthesiologists respond with a variety of actions, such as raising blood pressure or adjusting retractors. In experienced hands, NIOM significantly reduces postoperative neurological deficits, e.g., 60% reduction in risk of paraplegia and paraparesis. A technologist in the operating room sets up the NIOM procedure. An experienced clinical neurophysiologist supervises the case, either in the operating room or remotely on-line continuously in real time.


Assuntos
Potencial Evocado Motor/fisiologia , Potenciais Somatossensoriais Evocados/fisiologia , Monitorização Intraoperatória/métodos , Medula Espinal/fisiologia , Medula Espinal/cirurgia , Humanos , Monitorização Intraoperatória/normas , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/normas
20.
Br J Anaesth ; 123(3): 288-297, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31279479

RESUMO

BACKGROUND: Minimum alveolar concentration (MAC) and MAC-awake decrease with age. We hypothesised that, in clinical practice, (i) end-tidal MAC fraction in older patients would decline by less than the predicted age-dependent MAC decrease (i.e. older patients would receive relatively excessive anaesthetic concentrations), and (ii) bispectral index (BIS) values would therefore be lower in older patients. METHODS: We examined the relationship between end-tidal MAC fraction, BIS values, and age in 4699 patients > 30 yr in age at a single centre using unadjusted local regression (locally estimated scatterplot smoothing), Spearman's correlation, stratification, and robust univariable and multivariable linear regression. RESULTS: The end-tidal MAC fraction in older patients declined by 3.01% per decade (95% confidence interval [CI]: 2.56-3.45; P<0.001), less than the 6.47% MAC decrease per decade that we found in a meta-regression analysis of published studies of age-dependent changes in MAC (P<0.001), and less than the age-dependent decrease in MAC-awake. The BIS values correlated positively with age (ρ=0.15; 95% CI: 0.12-0.17; P<0.001), and inversely with the age-adjusted end-tidal MAC (aaMAC) fraction (ρ= -0.13; 95% CI: -0.16, -0.11; P<0.001). CONCLUSIONS: The age-dependent decline in end-tidal MAC fraction delivered in clinical practice at our institution was less than the age-dependent percentage decrease in MAC and MAC-awake determined from published studies. Despite receiving higher aaMAC fractions, older patients paradoxically showed higher BIS values. This most likely suggests that the BIS algorithm is inaccurate in older adults.


Assuntos
Envelhecimento/fisiologia , Anestésicos Inalatórios/farmacologia , Eletroencefalografia/efeitos dos fármacos , Adulto , Fatores Etários , Idoso , Envelhecimento/metabolismo , Anestésicos Inalatórios/administração & dosagem , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Alvéolos Pulmonares/metabolismo , Estudos Retrospectivos
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