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1.
Arq Bras Cir Dig ; 32(1): e1423, 2019 Feb 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30758471

RESUMO

BACKGROUND: The aeronautical industry is one of the disciplines that most use control systems. Its purpose is to avoid accidents and return safer flights. The flight of an airplane, from its takeoff to its landing is a process divided into stages under strict control. A surgical procedure has the same characteristics. We try to identify and develop the stages of the surgical process using the experience of the aviation industry in order to optimize the results and reduce surgical complications. AIM: To identify and develop the stages of the surgical process so that they could be applied to surgery departments. METHODS: A search, review and bibliographic analysis of the application of aeronautical control and safety to medical practice in general and to surgery, in particular, were carried out. RESULTS: Surgical process comprises the perioperative period. It is composed of Preoperative Stage (it is divided into 2 "sub-steps": hospital admission and control of preoperative studies) Operative Stage (it is divided into 3 "sub-steps": anesthetic induction, surgery, and anesthetic recovery) and Postoperative Stage (it is divided into 2 "sub-steps": control during hospitalization and ambulatory control). Two checkpoints must be developed. Checkpoint #1 would be located between the preoperative and operative stages, and checkpoint #2 would be located between the operative and postoperative stages. Surgical factors are surgeons, instrumental and technology, anesthesiology and operating room environment. CONCLUSION: It is possible and necessary to develop a systematic surgical procedure. Its application in the department of surgery could optimize the results and reduce the complications and errors related to daily practice.


Assuntos
Lista de Checagem , Período Perioperatório/normas , Segurança , Procedimentos Cirúrgicos Operatórios/normas , Humanos , Período Perioperatório/métodos
2.
Medicine (Baltimore) ; 97(43): e12893, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30412087

RESUMO

The purpose of this study is to explore perioperative factors predicting symptomatic adjacent segment disease (ASD) after anterior cervical discectomy and fusion (ACDF) for patients with cervical spondylotic myelopathy (CSM) at 5-year follow-up.This study included 356 patients who underwent ACDF for CSM from Jan.2011 to Jan.2013. Up to Jan. 2018, 39 patients suffered from ASD and 317 did not. Assessments include: age, sex, body mass index (BMI), diabetes, smoking, alcohol, duration of symptoms, preoperative Cobb angle of C2 to 7, T1 slope, C2 to 7 range of motion (C2-7 range of motion [ROM]), C2 to 7 sagittal vertical axis (C2-7 SVA), fusion level involved, superior fusion segment, high signal intensity on T2-WI of magnetic resonance imaging (MRI), preoperative visual analogue scale (VAS)-neck, VAS-Arm, Neck Disability Index (NDI) and Japanese Orthopaedic Association (JOA). Factors were processed by univariate analysis and multivariate linear regression.Data analyzed by univariate and multivariate analysis shows that age (68.9 years old), duration of symptoms (18.8 months), superior fusion segment, more fusion level involved (2.7), high signal intensity on T2-WI (17 of 39 patients), Cobb angle of C2 to C7 (18.7°), C2 to C7 SVA (31.0 mm), T1 slope (28.4°), preoperative VAS-neck (5.2), VAS-Arm (5.6) and NDI (36.7) in ASD group are significantly higher than those in non-ASD group, however, preoperative JOA (8.2 vs 11.2, P < .001) has an opposite trend in 2 groups.The rate of ASD after ACDF is 10.9% in 5-year follow up. Patients with cervical sagittal imbalance, advanced age and sever state of CSM, which have a positive relation with ASD before surgery should be paid attention for surgeons.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Degeneração do Disco Intervertebral/etiologia , Deslocamento do Disco Intervertebral/etiologia , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Idoso , Vértebras Cervicais/anatomia & histologia , Vértebras Cervicais/diagnóstico por imagem , Discotomia/métodos , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/epidemiologia , Deslocamento do Disco Intervertebral/epidemiologia , Imagem por Ressonância Magnética/normas , Masculino , Pessoa de Meia-Idade , Período Perioperatório/normas , Estudos Retrospectivos , Doenças da Medula Espinal/etiologia , Fusão Vertebral/métodos , Escala Visual Analógica
3.
BMJ Case Rep ; 20182018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30389739

RESUMO

Anterior mediastinal masses present a significant challenge in the perioperative period. Standard anaesthetic induction and airway management are often not feasible due to the risk of complete respiratory and/or cardiovascular collapse. Invasive manoeuvres, such as extracorporeal membrane oxygenation, cardiac bypass, or tracheal or bronchial stenting, are sometimes not applicable due to significant anatomic aberration. We present a case of anterior mediastinal mass in a 5-month-old infant where typical management techniques in the treatment algorithm were not possible.


Assuntos
Neoplasias do Mediastino/cirurgia , Período Perioperatório/normas , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Teratoma/cirurgia , Ecocardiografia/métodos , Humanos , Lactente , Comunicação Interdisciplinar , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Mediastino/diagnóstico por imagem , Mediastino/patologia , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Teratoma/diagnóstico por imagem , Teratoma/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 97(39): e12471, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30278531

RESUMO

Literature about postoperative relapse of Pott's disease is rare. Accordingly, the risk factors and clinical treatments for postoperative relapse of Pott's disease remain controversial. In order to evaluate the clinical outcomes of surgical treatment of postoperative Pott's disease relapse, and to investigate its optimal therapeutic procedures with respect to focal characteristics, we performed a retrospective review of clinical and radiographic data that were prospectively collected between July 2008 and May 2014 from 753 consecutive spinal tubercular patients including 67 patients who were diagnosed and treated as postoperative relapse of Pott's disease in our hospital. Apart from 9 patients being treated conservatively, the remaining 58 cases received surgery in our series. Specifically, 12 cases underwent anterior debridement, interbody fusion with instrumentation; 15 cases received posterior instrumentation anterior debridement, and bone grafting; 10 cases underwent posterior decompression, bone grafting, and instrumentation; 7 cases with debridement, 5 with debridement and sinus resection. Nine cases received percutaneous drainage and low-dose local continuous chemotherapy. Clinical outcomes before and after treatment were evaluated with statistical analysis based on hematologic and radiographic examinations, bone fusion, and neurologic status. Patients were followed-up for a mean of 39.2 ±â€Š8.2 months (range, 24-60 months). Postoperatively, the erythrocyte sedimentation rate (ESR) became normal within 4-6 months in all patients, and solid bone fusion was achieved within 8 months. Patients exhibited significant improvements in neurological deficits postoperatively, while the visual analog scale for pain showed significant improvements in all patients at final follow-up. The outcomes of follow-up showed that the reasons for postoperative relapse of Pott's disease were multiple. Individualized therapeutic methods should be chosen in accordance with the patient's general condition, recurrence focal characteristic, surgeon's experience, but above all is administration of appropriate chemotherapy.


Assuntos
Descompressão Cirúrgica/instrumentação , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/instrumentação , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Sedimentação Sanguínea/efeitos dos fármacos , Transplante Ósseo/métodos , Desbridamento/métodos , Descompressão Cirúrgica/métodos , Drenagem/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/efeitos dos fármacos , Período Perioperatório/normas , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fusão Vertebral/métodos , Resultado do Tratamento , Tuberculose da Coluna Vertebral/tratamento farmacológico
5.
Medicine (Baltimore) ; 97(21): e10830, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29794773

RESUMO

Aortic arch surgery in patients with acute aortic dissection is frequently complicated by neurological complications and coagulopathy. However, the relationship between the coagulation system and neurological complications in patients with acute aortic dissection has not been clarified. Thus, the aim of this study was to investigate the relationship between the coagulation system and neurological complications in patients with acute aortic dissection.From September 2014 to January 2016, a total of 126 patients with acute type A aortic dissection were enrolled. Perioperative characteristics and standard laboratory tests upon admission were analyzed using univariate and multivariate logistic regression analysis in this study. The primary outcome was the correlation between the coagulation system and neurological complications.Univariate logistic regression analysis showed that the neurological complications (+) group underwent more serious and complicated postoperative outcomes. Multivariable logistic regression analysis revealed serum creatinine level (OR, 1.049; 95% CI, 1.011-1.089; P = .01), white blood cell counts (OR, 1.581; 95% CI, 1.216-2.057; P = .001) and fibrinogen concentration upon admission (OR, 0.189; 95% CI, 0.060-0.596; P = .004) as predictors of neurological complications. However, we found that there was no association between the coagulation system and in-hospital mortality.Low preoperative fibrinogen level is the preferred marker for predicting clinical neurological complications in patients with acute type A aortic dissection treated with surgical repair.


Assuntos
Afibrinogenemia/complicações , Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Aorta Torácica/patologia , Aneurisma Aórtico/patologia , Fibrinogênio/metabolismo , Doença Aguda , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/patologia , Aorta Torácica/cirurgia , Aneurisma Aórtico/cirurgia , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/metabolismo , Transtornos da Coagulação Sanguínea/mortalidade , Feminino , Fibrinogênio/uso terapêutico , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/metabolismo , Doenças do Sistema Nervoso/mortalidade , Período Perioperatório/normas , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Tomógrafos Computadorizados
6.
Paediatr Anaesth ; 28(5): 382-391, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29700892

RESUMO

The Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) Guidelines Working Group on Thromboprophylaxis in Children has reviewed the literature and where possible provided advice on the care of children in the perioperative period. Areas reviewed include the incidence of perioperative venous thromboembolism (VTE), risk factors, evidence for mechanical and chemical prophylaxis, and complications. Safe practice of regional anesthesia with anticoagulant prophylaxis is detailed. In summary, there are few areas of strong evidence. Routine prophylaxis cannot be recommended for young children. Postpubertal adolescents (approximately 13 years and over) are at a slightly increased risk of VTE and should be assessed for prophylaxis and may warrant intervention if other risk factors are present. However, the incidence of VTE is significantly lower than in the adult population. This special interest review presents a summary and discussion of the key recommendations, a decision-making algorithm and a risk assessment chart. For the full guideline, go to www.apagbi.org.uk/publications/apa-guidelines.


Assuntos
Anestesia/normas , Anticoagulantes/administração & dosagem , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/normas , Tromboembolia Venosa/prevenção & controle , Adolescente , Adulto , Anestesia/métodos , Anticoagulantes/normas , Criança , Humanos , Irlanda , Período Perioperatório/métodos , Período Perioperatório/normas , Medição de Risco/métodos , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Reino Unido , Tromboembolia Venosa/etiologia
7.
Eur Heart J ; 39(15): 1246-1254, 2018 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-28329105

RESUMO

Advanced percutaneous and surgical procedures in structural and congenital heart disease require precise pre-procedural planning and continuous quality control. Although current imaging modalities and post-processing software assists with peri-procedural guidance, their capabilities for spatial conceptualization remain limited in two- and three-dimensional representations. In contrast, 3D printing offers not only improved visualization for procedural planning, but provides substantial information on the accuracy of surgical reconstruction and device implantations. Peri-procedural 3D printing has the potential to set standards of quality assurance and individualized healthcare in cardiovascular medicine and surgery. Nowadays, a variety of clinical applications are available showing how accurate 3D computer reformatting and physical 3D printouts of native anatomy, embedded pathology, and implants are and how they may assist in the development of innovative therapies. Accurate imaging of pathology including target region for intervention, its anatomic features and spatial relation to the surrounding structures is critical for selecting optimal approach and evaluation of procedural results. This review describes clinical applications of 3D printing, outlines current limitations, and highlights future implications for quality control, advanced medical education and training.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiologia/normas , Cardiopatias Congênitas/diagnóstico por imagem , Impressão Tridimensional/instrumentação , Procedimentos Cirúrgicos Cardíacos/normas , Cardiopatias Congênitas/cirurgia , Humanos , Modelos Anatômicos , Período Perioperatório/normas , Próteses e Implantes/normas , Garantia da Qualidade dos Cuidados de Saúde , Software
8.
Monaldi Arch Chest Dis ; 87(2): 851, 2017 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-28967727

RESUMO

In the literature, the term "inoperable" mainly refers to two specific clinical aspects: cancer staging and technical difficulty/impossibility in performing. In light of this clarification, the statement "the patient cannot be anesthetized" has no medical foundation. On the contrary, the physicians have to carefully stratify the perioperative risk and optimize the patients' preoperative clinical status. In order to perform a precise risk stratification, the European Society of Cardiology and the European Society of Anaesthesiology have joined and published the guidelines for the perioperative cardiovascular management of patients scheduled to undergo non-cardiac surgery. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) represents the most complete and accurate prediction tool so far. It includes 21 preoperative factors relating to demographics, comorbidities and procedures able to predict outcomes based on preoperative risk factors such as death, cardiac complications, pneumonia, and acute kidney injury. The present article will address aspects related to common aspects concerning modifiable and non-modifiable that should be addressed in every patient to whom elective surgery has been scheduled.


Assuntos
Cardiologia/organização & administração , Cardiopatias/cirurgia , Neoplasias/cirurgia , Período Perioperatório/métodos , Lesão Renal Aguda , Idoso , Comorbidade , Morte , Europa (Continente)/epidemiologia , Cardiopatias/complicações , Cardiopatias/epidemiologia , Humanos , Estadiamento de Neoplasias , Período Perioperatório/normas , Pneumonia/epidemiologia , Pneumonia/etiologia , Complicações Pós-Operatórias , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Melhoria de Qualidade , Medição de Risco/métodos , Fatores de Risco
9.
Arq Bras Cardiol ; 109(3 Supl 1): 1-104, 2017.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29044300
10.
ANZ J Surg ; 87(9): 677-681, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28733996

RESUMO

BACKGROUND: Smoking is associated with adverse effects in the perioperative period, including elevated risk of death. The perioperative period provides an opportunity to engage with patients who are smokers to encourage smoking cessation, often referred to as a 'teachable moment'. We developed a smoking intervention model for the pre-admission clinic (PAC) at Western Health, Victoria, Australia. This case series aimed to assess the impact of the smoking intervention model, which is standard of care, on the participant's smoking habits over four time points. METHODS: We enrolled 50 consecutive participants for elective surgery who were smokers and had attended PAC at Western Health, Footscray. All smokers were offered a standard intervention package to address their smoking. Participants underwent a brief interview to elicit their current smoking behaviour on their day of surgery, 3 and 12 months post-operatively. RESULTS: We found a reduction at each time point post-intervention in the average number of cigarettes smoked per day by all participants with a 43% reduction at 12 months compared with PAC. We found that the number of participants who had quit increased at each time point, with 29% abstinent at 12 months post-operatively. At 12 months, we found 71% of participants had either quit or reduced the number of cigarettes smoked compared with the amount reported at PAC. CONCLUSION: This study adds to the evidence that a simple intervention preoperatively can contribute to long-term changes in smoking behaviour.


Assuntos
Período Perioperatório/normas , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/normas , Fumar/efeitos adversos , Tempo , Adulto , Idoso , Austrália/epidemiologia , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Abandono do Hábito de Fumar/estatística & dados numéricos , Prevenção do Hábito de Fumar/métodos , Vitória/epidemiologia
11.
BMJ Open ; 7(6): e016743, 2017 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-28667227

RESUMO

INTRODUCTION: 'Standardised Endpoints for Perioperative Medicine' (StEP) is an international collaboration undertaking development of consensus-based consistent definitions for endpoints in perioperative clinical trials. Inconsistency in endpoint definitions can make interpretation of trial results more difficult, especially if conflicting evidence is present. Furthermore, this inconsistency impedes evidence synthesis and meta-analyses. The goals of StEP are to harmonise definitions for clinically meaningful endpoints and specify standards for endpoint reporting in clinical trials. To help inform this endeavour, we aim to conduct a scoping review to systematically characterise the definitions of clinically important endpoints in the existing published literature on perioperative blood loss and transfusion. METHODS AND ANALYSIS: The scoping review will be conducted using the widely adopted framework developed by Arksey and O'Malley, with modifications from Levac. We refined our methods with guidance from research librarians as well as researchers and clinicians with content expertise. The electronic literature search will involve several databases including Medline, PubMed-not-Medline and Embase. Our review has three objectives, namely to (1) identify definitions of significant blood loss and transfusion used in previously published large perioperative randomised trials; (2) identify previously developed consensus-based definitions for significant blood loss and transfusion in perioperative medicine and related fields; and (3) describe the association between different magnitudes of blood loss and transfusion with postoperative outcomes. The multistage review process for each question will involve two reviewers screening abstracts, reading full-text articles and performing data extraction. The abstracted data will be organised and subsequently analysed in an iterative process. ETHICS AND DISSEMINATION: This scoping review of the previously published literature does not require research ethics approval. The results will be used to inform a consensus-based process to develop definitions of clinically important perioperative blood loss and transfusion. The results of the scoping review will be published in a peer-reviewed scientific journal.


Assuntos
Perda Sanguínea Cirúrgica , Transfusão de Sangue/normas , Período Perioperatório/normas , Padrões de Referência , Humanos , Projetos de Pesquisa
12.
Rev. esp. anestesiol. reanim ; 64(6): 313-322, jun.-jul. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-162581

RESUMO

Objetivo. Evaluar los resultados de la instauración de un programa de recuperación intensificada (ERAS) para cistectomía radical en abordaje abierto con respecto a la cohorte histórica de un mismo hospital. Material y métodos. Estudio de análisis retrospectivo de 138 pacientes sometidos a cistectomía radical con derivación ileal tipo Bricker o Studer de forma consecutiva (97 históricos vs. 41 ERAS). Se compararon tasa de complicaciones a 30 días, complicaciones estadio Clavien-Dindo>2, mortalidad, estancia y tasa de readmisión en el hospital y en cuidados críticos, reintervención y necesidad de sondaje nasogástrico, trasfusión o nutrición parenteral. Resultados. No se hallaron diferencias estadísticamente significativas en cuanto a la tasa de complicaciones globales tras 30 días de alta (73,171 vs. 77.32%; OR 1,25, IC 95% 0,54-2,981; p=0,601) ni en Clavien-Dindo>2 (41,463 vs. 42.268%; OR 1.033, IC 95% 0,492-2,167; p=0,93), así como en mortalidad, estancias o tasas de readmisión y reintervención. La necesidad de sondaje nasogástrico fue menor en el grupo ERAS (43,902 vs. 78,351%; OR 4,624, IC 95% 2,112-10,123; p<0,0001), así como la necesidad de nutrición parenteral total (26,829 vs. 34,021%; OR 12,234, IC 95% 5,165-28,92; p<0,0001) y el tiempo bajo intubación orotraqueal desde la inducción anestésica (mediana [RIC]=325 (285-355) vs. 540 (360-600) min; p<0,0001). Conclusión. Los programas de recuperación intensificada en cistectomía radical disminuyen el intervencionismo sobre el paciente sin aumentar la morbimortalidad (AU)


Objective. To evaluate the results of the implementation of an enhanced recovery program (ERAS) for open approach radical cystectomy compared to the historical cohort of the same hospital. Material and methods. A retrospective analysis of 138 consecutive patients who underwent radical cystectomy with Bricker or Studer ileal derivation (97 historical vs. 41 ERAS). Overall complication rate, Clavien-Dindo stage>2 complications, mortality, hospital and critical care length of stay and readmission rates, as well as need for reoperation, nasogastric intubation, transfusion or parenteral nutrition were compared. Results. No statistically significant differences in overall complication rate were found (73.171 vs. 77.32%; OR 1.25, 95% CI 0.54-2.981; P=.601) nor in Clavien-Dindo>2 complications (41.463 vs. 42.268%; OR 1.033, 95% CI 0.492-2.167; P=.93), mortality, lengths of stays readmission and reoperation rates. The need for nasogastric tube insertion was lower in the ERAS group (43.902 vs. 78.351%; OR 4.624, 95% CI 2.112-10.123; P<.0001), as well as the need for total parenteral nutrition (26.829 vs. 34.021%; OR 12.234, 95% CI 5.165-28.92; P<.0001), and time under endotracheal intubation since anaesthesia induction (median [IRQ]=325 (285-355) vs. 540 (360-600) min; P<.0001). Conclusion. Enhanced recovery programs in radical cystectomy decrease interventionism on the patient without increasing morbidity and mortality (AU)


Assuntos
Humanos , Masculino , Feminino , Cistectomia/métodos , Cistectomia/reabilitação , Terapia Combinada/métodos , Tempo de Internação/estatística & dados numéricos , Planos e Programas de Saúde/organização & administração , Analgesia/normas , Estudos Retrospectivos , Estatísticas não Paramétricas , Período Perioperatório/normas
13.
Mo Med ; 114(4): 268-271, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-30228609

RESUMO

Smoking remains a prevalent part of present day society, with over 42 million Americans who continue to use cigarettes. Smoking is strongly associated with a variety of conditions that result in increased morbidity and mortality. Research also indicates that smoking has an adverse effect on surgical outcomes. Its effect on the musculoskeletal system is evident and results in postoperative complications such as infection, nonunion, and malunion. These complications also come with a price, as there are severe economic implications of smoking. Patients who smoke may benefit from a period of perioperative cessation to help diminish some of these negative outcomes. It is the physician's duty to educate patients preoperatively about these outcomes and the potential benefit of smoking cessation.


Assuntos
Consolidação da Fratura/fisiologia , Fraturas Mal-Unidas/etiologia , Sistema Musculoesquelético/fisiopatologia , Fumar/efeitos adversos , Osso e Ossos/metabolismo , Fraturas Mal-Unidas/epidemiologia , Humanos , Período Perioperatório/normas , Complicações Pós-Operatórias/epidemiologia , Prevalência , Fumar/economia , Fumar/epidemiologia , Fumar/mortalidade , Abandono do Hábito de Fumar/métodos
14.
Annu Rev Nurs Res ; 35(1): 241-256, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27935783

RESUMO

The field of pharmacogenomics seeks to identify the impact of genetic variants on drug dosing, response, metabolism, and safety outcomes. The narrow therapeutic indices for anesthesia drugs, variability of patient responses to anesthesia, and the risks associated with surgery make anesthetics and the perioperative period prime targets for pharmacogenetic research. Anesthesia providers strive to optimize anesthesia delivery and patient outcomes and to specifically reduce anesthesia-related risks and negative outcomes. Despite pharmacogenomics emerging from the field of anesthesia, the most significant advances to date in the understanding and application of genetics to pharmacology have occurred outside of anesthesiology. This chapter provides an overview of genetic concepts fundamental to understanding the pharmacogenetics of anesthesia practice and presents the current state of the science with respect to the genetic influence on the response to volatile and intravenous anesthetic agents and opioid receptor agonists commonly used in anesthesia practice. In addition, the chapter delineates U.S. Food and Drug Administration labeling tenets for pharmacogenetics, discusses clinical implications of pharmacogenomics for family members, and highlights the potential for future paradigm shifts in pharmacogenomics of anesthesia practice.


Assuntos
Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/normas , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/normas , Perfil Genético , Período Perioperatório/normas , Farmacogenética , Humanos , Estados Unidos
15.
Anesth Analg ; 122(6): 1880-4, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27195633

RESUMO

Extraction of data from the electronic medical record is becoming increasingly important for quality improvement initiatives such as the American Society of Anesthesiologists Perioperative Surgical Home. To meet this need, the authors have built a robust and scalable data mart based on their implementation of EPIC containing data from across the perioperative period. The data mart is structured in such a way so as to first simplify the overall EPIC reporting structure into a series of Base Tables and then create several Reporting Schemas each around a specific concept (operating room cases, obstetrics, hospital admission, etc.), which contain all of the data required for reporting on various metrics. This structure allows centralized definitions with simplified reporting by a large number of individuals who access only the Reporting Schemas. In creating the database, the authors were able to significantly reduce the number of required table identifiers from >10 to 3, as well as to correct errors in linkages affecting up to 18.4% of cases. In addition, the data mart greatly simplified the code required to extract data, making the data accessible to individuals who lacked a strong coding background. Overall, this infrastructure represents a scalable way to successfully report on perioperative EPIC data while standardizing the definitions and improving access for end users.


Assuntos
Mineração de Dados/métodos , Bases de Dados Factuais , Registros Eletrônicos de Saúde , Registro Médico Coordenado/métodos , Período Perioperatório , Mineração de Dados/normas , Bases de Dados Factuais/normas , Registros Eletrônicos de Saúde/normas , Humanos , Registro Médico Coordenado/normas , Período Perioperatório/normas , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde
17.
Rev. esp. anestesiol. reanim ; 62(8): 450-460, oct. 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-141284

RESUMO

Existe un amplio consenso sobre el manejo perioperatorio de los pacientes tratados con los nuevos anticoagulantes orales directos (dabigatrán, ribaroxabán y apixabán) en cirugía programada. Por el contrario, en la actualidad no existe este nivel de acuerdo en cirugía urgente, especialmente en el paciente sangrante. Por este motivo, se ha realizado una revisión bibliográfica a través del buscador PubMed en la base de datos MEDLINE de los artículos publicados entre 2000-2014 referidos a los términos «monitorización» y «reversión» de los fármacos mencionados. Guías de práctica clínica, revisiones sistemáticas, revisiones y artículos sobre la materia se incluyeron en la búsqueda. Se verifica un limitado papel de los test rutinarios de coagulación (tiempo de protrombina y tiempo parcial de tromboplastina activado) en el manejo perioperatorio de estos pacientes. Así mismo, muestran la ausencia de antídotos específicos, aunque plantean la posibilidad de usar concentrado de complejo protrombínico y factor vii activado recombinante en la reversión urgente de su efecto anticoagulante (AU)


There is an almost unanimous consensus on the management of the direct new oral anticoagulants, dabigatran, rivaroxaban, and apixaban in elective surgery. However, this general consensus does not exist in relation with the direct new oral anticoagulants use in emergency surgery, especially in the bleeding patient. For this reason, a literature review was performed using the MEDLINE-PubMed. An analysis was made of the journal articles, reviews, systematic reviews, and practices guidelines published between 2000 and 2014 using the terms “monitoring” and “reversal”. From this review, it was shown that the routine tests of blood coagulation, such as the prothrombin time and activated partial thromboplastin time, have a limited efficacy in the perioperative control of blood coagulation in these patients. There is currently no antidote to reverse the effects of these drugs, although the possibility of using concentrated prothrombin complex and recombinant activated factor vii has been suggested for the urgent reversal of the anticoagulant effect (AU)


Assuntos
Feminino , Humanos , Masculino , Período Perioperatório/métodos , Período Perioperatório/normas , Período Perioperatório , Anticoagulantes/uso terapêutico , Monitoramento , Tromboplastina/uso terapêutico , Assistência Perioperatória/métodos , Assistência Perioperatória/instrumentação , Assistência Perioperatória , Testes de Coagulação Sanguínea/métodos
19.
Artigo em Alemão | MEDLINE | ID: mdl-26018067

RESUMO

Due to the demographic and medical development, the number of patients with heart failure needing anaesthesiological care will continue to grow in the upcoming years. For the optimal care of these patients close coordination between the surgically treating, the cardiology and the anesthesiological department is important. Cardiac function and structural characters, such as cardiac valve defects should be known preoperatively. Thus, the anaesthetic management, intraoperative monitoring, as well as necessary pharmacological interventions can be tailored. Especially in high-risk patients goal directed hemodynamic therapy is useful. For this, in addition to the established monitoring procedures, less invasive monitoring devices areincreasingly used. During an acutehaemodynamic instability, thetransoesophageal echocardiography is gaining importance due to its wide diagnostic evaluation.


Assuntos
Anestesia Geral/normas , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/prevenção & controle , Monitorização Intraoperatória/normas , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Alemanha , Humanos , Período Perioperatório/normas , Guias de Prática Clínica como Assunto
20.
Crit Care Nurse ; 34(6): 29-36, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25452407

RESUMO

BACKGROUND: Preoperative interventions improve outcomes for patients after coronary artery bypass surgery (CABG). OBJECTIVE: To reduce mortality for patients undergoing urgent CABG. METHODS: Eight centers implemented preoperative aspirin and statin, preinduction heart rate less than 80/min, hematocrit greater than 30%, blood sugar less than 150 mg/dL (8.3 mmol/L), and delayed surgery at least 3 days after a myocardial infarction. Data were collected on the last 150 isolated, urgent CABGs at each center (n=1200). A "bundle" score of 0 to 100 was calculated for each patient to represent the percentage of interventions used. RESULTS: Scores ranged from 33 to 100. About 56% of patients had a perfect score. Crude mortality and composite rates were lower in patients with higher scores, but once adjusted for patient and disease characteristics, the difference in scores was not significant. Higher scores were associated with shorter intubation: 6.0 hours (score 100), 8.0 hours (score 80-99), 8.4 hours (score<80) (log-rank P<.001). Median length of stay was shorter for patients with higher scores: 5 days (score 100), 6 days (scores 80-99), and 6 days (scores <80) (log-rank P<.001). CONCLUSION: Implementation of interventions to optimize patients' "readiness for surgery" is associated with shorter intubation times and shorter hospital stays after CABG.


Assuntos
Ponte de Artéria Coronária , Período Perioperatório/normas , Complicações Pós-Operatórias/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Ponte de Artéria Coronária/mortalidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio , Estudos de Casos Organizacionais , Complicações Pós-Operatórias/mortalidade , Fatores de Risco , Resultado do Tratamento
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