Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 364
Filtrar
1.
BMJ Case Rep ; 14(3)2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33766961

RESUMO

COVID-19 affects a wide spectrum of organ systems. We report a 52-year-old man with hypertension and newly diagnosed diabetes mellitus who presented with hypoxic respiratory failure due to COVID-19 and developed severe brachial plexopathy. He was not treated with prone positioning respiratory therapy. Associated with the flaccid, painfully numb left upper extremity was a livedoid, purpuric rash on his left hand and forearm consistent with COVID-19-induced microangiopathy. Neuroimaging and electrophysiological data were consistent with near diffuse left brachial plexitis with selective sparing of axillary, suprascapular and pectoral fascicles. Given his microangiopathic rash, elevated D-dimers and paucifascicular plexopathy, we postulate a patchy microvascular thrombotic plexopathy. Providers should be aware of this significant and potentially under-recognised neurologic complication of COVID-19.


Assuntos
Neuropatias do Plexo Braquial/etiologia , /complicações , Braço/patologia , Neuropatias do Plexo Braquial/diagnóstico , Diabetes Mellitus , Exantema/complicações , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Hipertensão/complicações , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuralgia/complicações , Posicionamento do Paciente/efeitos adversos , Insuficiência Respiratória/etiologia , /isolamento & purificação
2.
Medicine (Baltimore) ; 100(11): e24241, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725929

RESUMO

RATIONALE: Intraoperative neurophysiological monitoring (IONM) is widely used in spinal surgeries to prevent iatrogenic spinal cord injury (SCI). Most surgeons focus on avoiding neurological compromise intraoperatively, while ignoring the possibility of nerve damage preoperatively, such as neck positioning. Thus, this study aims to report a case with transient neurological deterioration due to improper neck position detected by IONM during cervical surgery. PATIENT CONCERNS: A 63-year-old male patient had been suffering from hypoesthesia of the upper and lower extremities for three years. DIAGNOSES: Severe cervical stenosis (C5-C7) and cervical ossification of a posterior longitudinal ligament. INTERVENTIONS: The cervical stenosis patient underwent an anterior cervical corpectomy decompression and fusion (ACDF) surgery with the assistance of IONM. When the lesion segment was exposed, the SSEP and MEP suddenly elicited difficulty indicating that the patient may have developed SCI. All the technical causes of IONM events were eliminated, and the surgeon suspended operation immediately and suspected that the IONM alerts were caused by cervical SCI due to the improper position of the neck. Subsequently, the surgeon repositioned the neck of the patient by using a thinner shoulders pad. OUTCOMES: At the end of the operation, the MEP and SSEP signals gradually returned to 75% and 80% of the baseline, respectively. Postoperatively, the muscle strength of bilateral biceps decreased from grade IV to grade III. Besides, the sensory disturbance of both upper extremities aggravated. However, the muscle power and hypoesthesia were significantly improved after three months of neurotrophic therapy and rehabilitation training, and no complications of nerve injury were found at the last follow-up visit. LESSONS: IONM, consisting of SSEP and MEP, should be applied throughout ACDF surgery from the neck positioning to suture incisions. Besides, in the ward 1to 2 days before operation, it is necessary for conscious patients with severe cervical stenosis to simulate the intraoperative neck position. If the conscious patients present signs of nerve damage, they can adjust the neck position immediately until the neurological symptoms relieve. Therefore, intraoperatively, the unconscious patient can be placed in a neck position that was confirmed preoperatively to prevent SCI.


Assuntos
Monitorização Neurofisiológica Intraoperatória , Lesões do Pescoço/diagnóstico , Pescoço/inervação , Posicionamento do Paciente/efeitos adversos , Traumatismos da Medula Espinal/diagnóstico , Vértebras Cervicais/cirurgia , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Pescoço/cirurgia , Lesões do Pescoço/etiologia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Traumatismos da Medula Espinal/etiologia , Estenose Espinal/cirurgia
3.
Medicine (Baltimore) ; 100(11): e25190, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33726011

RESUMO

RATIONALE: The prone position is commonly used in spinal surgery. There have been many studies on hemodynamic changes in the prone position during general anesthesia. We report a rare case of transient left bundle branch block (LBBB) in a prone position. PATIENT CONCERN: Electrocardiogram (ECG) of a 64-year-old man scheduled for spinal surgery showed normal sinus rhythm change to LBBB after posture change to the prone position. DIAGNOSIS: Twelve lead ECG revealed LBBB. His coronary angio-computed tomography results showed right coronary artery with 30% to 40% stenosis and left circumflex artery with 40% to 50% stenosis. The patient was diagnosed with stable angina and second-degree atrioventricular block of Mobitz type II. INTERVENTION: Nitroglycerin was administered intravenously during surgery. Adequate oxygen was supplied to the patient. After surgery, the patient was prescribed clopidogrel, statins, angiotensin II receptor blocker, and a permanent pacemaker was inserted. OUTCOME: Surgery was completed without complications. After surgery, the transient LBBB changed to a normal sinus rhythm. The patient did not complain of chest pain or dyspnea. LESSON: The prone position causes significant hemodynamic changes. A high risk of cardiovascular disease may cause ischemic heart disease and ECG changes. Therefore, careful management is necessary.


Assuntos
Anestesia Geral/efeitos adversos , Bloqueio de Ramo/etiologia , Complicações Intraoperatórias/etiologia , Posicionamento do Paciente/efeitos adversos , Decúbito Ventral , Anestesia Geral/métodos , Humanos , Masculino , Pessoa de Meia-Idade
4.
JBJS Case Connect ; 11(1)2021 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-33739958

RESUMO

CASE: We describe a preliminary report of 3 cases of ulnar neuropathy after coronavirus disease 2019 (COVID-19) infection and treatment with intermittent prone positioning. CONCLUSION: Ulnar neuropathy may be associated with recent COVID-19 infection. The natural process of the disease and intermittent prone positioning are likely risk factors contributing to this finding. Conservative management seems to lead to improvement of symptoms.


Assuntos
/terapia , Intubação Intratraqueal/efeitos adversos , Posicionamento do Paciente/efeitos adversos , Decúbito Ventral , Neuropatias Ulnares/etiologia , /virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
Medicine (Baltimore) ; 100(2): e24088, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466170

RESUMO

RATIONALE: Takotsubo syndrome (TTS) is characterized by recovery of wall motion abnormalities and acute left ventricular dysfunction, which are often caused by acute physical or emotional stressors. It is rarely reported that TTS can be precipitated by change in position in the patient in the operating room. We report a case of a patient with a thoracic vertebral fracture who presented with TTS precipitated by changing from a supine to a prone position before percutaneous kyphoplasty (PKP) under local anesthesia. PATIENT CONCERNS: A 76-year-old man who was diagnosed with a fracture in a thoracic vertebra was sent to the operating room to undergo PKP under local anesthesia. Approximately 5 minutes after changing from a supine to a prone position, which is necessary for PKP, the patient experienced chest pain, headache, and sweating. DIAGNOSIS: A fracture in a thoracic vertebra; TTS. INTERVENTIONS: As a result of 12-lead electrocardiography, echocardiography, left ventriculogram, and cardiac catheterization, the diagnosis of TTS was retained, and supportive therapy was initiated. OUTCOMES: Two hours later, the patient's symptoms mitigated significantly and the ST segment returned to baseline. Four days later, echocardiography showed normal systolic function without wall motion abnormalities and the patient returned to the orthopedics ward for further treatment. LESSONS: It is necessary for anesthetists to recognize TTS which is life-threatening during monitored anesthetic care (MAC). We highlight the importance of being alerted to the possibility of TTS when managing patients with thoracic vertebral fractures undergoing surgery under local anesthesia.


Assuntos
Posicionamento do Paciente/efeitos adversos , Fraturas da Coluna Vertebral/complicações , Cardiomiopatia de Takotsubo/etiologia , Vértebras Torácicas/lesões , Idoso , Humanos , Cifoplastia , Masculino , Fraturas da Coluna Vertebral/fisiopatologia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/fisiopatologia
6.
PLoS One ; 15(8): e0237136, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790771

RESUMO

BACKGROUND: There is increasing focus on earlier rehabilitation in patients with traumatic or hypoxic brain injury or stroke. This systematic review evaluates the benefits and harms of early head-up mobilisation versus standard care in patients with severe acquired brain injury. METHODS: We searched Medline, CENTRAL, EMBASE, four other databases and 13 selected clinical trial registries until April 2020. Eligible randomised clinical trials compared early head-up mobilisation versus standard care in patients with severe acquired brain injury and were analysed conducting random- and fixed-effects meta-analyses and Trial Sequential Analysis (TSA). Certainty of evidence was assessed by GRADE. MAIN RESULTS: We identified four randomised clinical trials (total n = 385 patients) with severe acquired brain injury (stroke 86% and traumatic brain injury 13%). Two trials were at low risk and two at high risk of bias. We found no evidence of a difference between early mobilisation vs. standard care on mortality or poor functional outcome at end of the intervention (relative risk (RR) 1.19, 95% CI 0.93 to 1.53; I2 0%; very low certainty) or at maximal follow-up (RR 1.03, 95% CI 0.89 to 1.21; I2 0%; very low certainty). We found evidence against an effect on quality of life at maximal follow-up. The proportion of patients with at least one serious adverse event did not differ at end of intervention or at maximal follow-up. For most comparisons, TSA suggested that further trials are needed. CONCLUSIONS: We found no evidence of a difference between early mobilisation versus standard care for patients with severe acquired brain injury. Early mobilisation appeared not to exert a major impact on quality of life. This systematic review highlights the insufficient evidence in patients with severe brain injury, and no firm conclusions can be drawn from these data. TRIAL REGISTRATION: Protocol uploaded to PROSPERO: April 2018 (revised October 2018, CRD42018088790).


Assuntos
Lesões Encefálicas/reabilitação , Posicionamento do Paciente/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/terapia , Humanos , Pessoa de Meia-Idade , Posicionamento do Paciente/efeitos adversos , Posicionamento do Paciente/normas , Ensaios Clínicos Controlados Aleatórios como Assunto , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Reabilitação do Acidente Vascular Cerebral/normas
7.
Artigo em Chinês | MEDLINE | ID: mdl-32791773

RESUMO

Objective: To explore the possible pathogenesis of central paroxysmal positional vertigo (CPPV) by analyzing its clinical manifestations and characteristics. Methods: The clinical data of 3 patients with CPPV, including 1 male and 2 females, aged 36, 14 and 70 years old respectively, were collected from the Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from June 2014 to June 2018. The clinical symptoms, nystagmus, other central ocular motor abnormalities, MRI, PET-CT, and laboratory findings were analyzed retrospectively. Results: All patients showed transient vertigo and nystagmus induced by head changes relative to gravity, but the characteristics of nystagmus did not conform to the typical characteristics of nystagmus in benign paroxysmal positional vertigo. None of patients response to repositioning maneuvers, and all patients presented with the signs of abnormal visual oculomotor system or other symptoms of central system. MRI, PET-CT and blood biochemical tests confirmed that the causes of CPPV in the patients were chronic hemorrhage, inflammation and paraneoplastic cerebellar degeneration. Although the etiology of the three cases is different, the lesion site is involved in the central velocity storage mechanism. Conclusion: The damage of central velocity storage mechanism may lead to the damage of feedback rotation signal correction pathway, and CPPV appears when the head position changes relative to gravity.


Assuntos
Nistagmo Patológico/diagnóstico , Nistagmo Patológico/etiologia , Vertigem/diagnóstico , Vertigem/etiologia , Adolescente , Adulto , Idoso , Encefalopatias/sangue , Encefalopatias/complicações , Encefalopatias/diagnóstico , Encefalopatias/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Nistagmo Patológico/sangue , Nistagmo Patológico/diagnóstico por imagem , Posicionamento do Paciente/efeitos adversos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Estudos Retrospectivos , Vertigem/sangue , Vertigem/diagnóstico por imagem
9.
Am J Phys Med Rehabil ; 99(10): 870-872, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32657818

RESUMO

The coronavirus 2019 pandemic has resulted in a surge of patients with acute respiratory distress syndrome. Prone positioning may be used in such patients to optimize oxygenation. Severe infections may leave survivors with significant functional impairment necessitating rehabilitation. Those who have experienced prolonged prone positioning are at increased risk for complications not typically associated with critical illness. This case report describes the course and clinical findings of a survivor of acute respiratory distress syndrome due to coronavirus 2019 who was prone positioned while in intensive care and subsequently admitted to an inpatient rehabilitation facility. Her related complications, as well as those described in the literature, are reviewed. Critical elements of a comprehensive rehabilitation treatment plan for those who have been prone positioned, including implementation of preventive strategies, as well as early recognition and treatment of related injuries, will be described.


Assuntos
Infecções por Coronavirus/fisiopatologia , Cuidados Críticos/métodos , Posicionamento do Paciente/efeitos adversos , Pneumonia Viral/fisiopatologia , Decúbito Ventral , Terapia Respiratória/métodos , Adulto , Betacoronavirus , Infecções por Coronavirus/reabilitação , Infecções por Coronavirus/virologia , Feminino , Humanos , Pandemias , Pneumonia Viral/reabilitação , Pneumonia Viral/virologia
10.
Medicine (Baltimore) ; 99(28): e20946, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664094

RESUMO

BACKGROUND: The beach chair position (BCP), used during shoulder surgery, is associated with hypotension, bradycardia, and risk of cerebral hypoperfusion. Phenylephrine is commonly used as a first treatment of choice of intraoperative hypotension during surgery. We evaluated the hemodynamic effects of 2 doses of intravenous phenylephrine infusion administered before being placed in BCP for arthroscopic shoulder surgery. The primary endpoint was the incidence of hypotension after positional change. METHODS: Sixty-six patients were randomized to receive either intravenous normal saline (group NS) or intravenous phenylephrine infusion (0.5 µg/kg/min, group LP or 1.0 µg/kg/min, group HP) for 5 minutes before being placed in the BCP. Mean arterial pressure(MAP), heart rate, stroke volume variation, and cardiac index were measured before and after positional change. RESULTS: The total incidence of hypotension after the BCP was 93.65%, but was not significantly different among the 3 groups. However, there was a significant difference in trends between the groups for MAP for 5 minutes after BCP (P = .028). Comparison of changes in MAP at 1 minute compared to post-induction MAP was significantly different between group HP and group NS (P = .014). CONCLUSION: Infusion of 0.5 and 1.0 µg/kg/min of phenylephrine for 5 minutes before the BCP has no preventive effect for incidence of hypotension. However, this study showed that 1.0 µg/kg/min of phenylephrine infusion for 5 minutes can attenuate the severity of hypotension.


Assuntos
Hipotensão/etiologia , Hipotensão/prevenção & controle , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Posicionamento do Paciente/efeitos adversos , Fenilefrina/administração & dosagem , Idoso , Feminino , Humanos , Hipotensão/epidemiologia , Incidência , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego
11.
J Card Surg ; 35(8): 2050-2052, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652608

RESUMO

Acute pulmonary embolism (APE) is a well-described complication following surgical procedures. The incidence of such a complication can be related to the presence of a peculiar patient's condition. Cryoglobulinemia, which consists in the presence of one or more immunoglobulins in the serum that precipitate at temperatures below 37°C and redissolve on warming, seems to increase the risk of thrombotic events. Treatment options of APE, according to clinical severity, include systemic thrombolysis, surgical embolectomy, and systemic anticoagulation. Thrombolysis is considered the first-line treatment, whereas surgery is reserved in case of extremely-compromised hemodynamic conditions related to massive central embolism, and in case of contraindication to thrombolysis. Here, we report a case of acute massive pulmonary embolism occurring at the end of a surgical procedure for a thymic carcinoma resection, in a patient with cryoglobulinemia, which required an emergent surgical pulmonary embolectomy.


Assuntos
Crioglobulinemia/complicações , Embolectomia/métodos , Posicionamento do Paciente/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Doença Aguda , Ecocardiografia Transesofagiana , Emergências , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Índice de Gravidade de Doença , Toracotomia , Tomografia Computadorizada por Raios X
12.
BMJ Case Rep ; 13(7)2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32675133

RESUMO

We describe a 40-year-old woman with severe, persistent macroglossia following prone positioning as part of treatment for COVID-19. We used the treatment method of lingual compression with satisfactory results.


Assuntos
Betacoronavirus , Bandagens Compressivas , Infecções por Coronavirus/complicações , Macroglossia/complicações , Macroglossia/terapia , Posicionamento do Paciente/métodos , Pneumonia Viral/complicações , Doença Aguda , Adulto , Feminino , Humanos , Macroglossia/etiologia , Pandemias , Posicionamento do Paciente/efeitos adversos , Solução Salina/uso terapêutico , Língua
14.
Clin Med (Lond) ; 20(4): e97-e103, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32503800

RESUMO

Medical teams continue to treat many patients with COVID-19 infection. This disease can result in profound hypoxaemia that may necessitate intubation and invasive mechanical ventilation in those who are critically ill. This intervention carries risk to both patients and healthcare workers and utilises significant hospital resource for prolonged periods. Simple, safe interventions that can be used before critical deterioration are highly desirable. The prone position in conscious non-ventilated patients with COVID-19 infection may improve oxygenation in the short term and defer or prevent the need for intubation in some. However, clinicians must be aware that there is a small evidence base for this intervention currently. This review sets out evidence regarding the use of this technique to aid the decision making of frontline staff.


Assuntos
Infecções por Coronavirus/terapia , Posicionamento do Paciente , Pneumonia Viral/terapia , Decúbito Ventral , Estado de Consciência , Humanos , Oxigenoterapia/métodos , Pandemias , Posicionamento do Paciente/efeitos adversos , Decúbito Ventral/fisiologia , Respiração Artificial
15.
Rev Lat Am Enfermagem ; 28: e3261, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32401901

RESUMO

OBJECTIVE: to validate the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning in the stratification of risk for injury development in perioperative patients at a rehabilitation hospital. METHOD: analytical, longitudinal and quantitative study. An instrument and the scale were used in the three perioperative phases in 106 patients. The data were analyzed using descriptive and inferential statistics. RESULTS: most patients showed high risk for perioperative injuries, both in the scale score with estimated time and in the real-time score, with a mean of 19.97 (±3.02) and 19.96 (±3.12), respectively. Most participants did not show skin lesions (87.8%) or pain (92.5%). Inferential analysis enabled us to assert that the scale scores are associated with the appearance of injuries resulting from positioning, therefore, it can adequately predict that low-risk patients are unlikely to have injuries and those at high risk are more likely to develop injuries. CONCLUSION: the scale validation is shown by the association of scores with the appearance of injuries, therefore, it is a valid and useful tool, and it can guide the clinical practice of perioperative nurses in rehabilitation hospitals in order to reduce risk for injuries due to surgical positioning.


Assuntos
Hospitais de Reabilitação/normas , Complicações Intraoperatórias/prevenção & controle , Posicionamento do Paciente/métodos , Medição de Risco/normas , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Posicionamento do Paciente/efeitos adversos , Enfermagem Perioperatória/normas , Fatores de Risco , Ferimentos e Lesões/etiologia
16.
Spine Deform ; 8(5): 1139-1142, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32314179

RESUMO

BACKGROUND: To our knowledge, this is the first documented report of an operative cranial epidural hematoma secondary to skull fracture due to placement of Gardner-Wells Tongs (GWT) in the setting of a spinal deformity reconstruction. PURPOSE: The objective is to illustrate the possibility of cranial pathology secondary to GWT placement and the need to properly correlate intraoperative neuromonitoring findings. STUDY DESIGN: Case report. METHODS: A 14-year-old male with Marfan's Syndrome presented for three-column osteotomy spinal reconstruction for a large and stiff thoracic kyphoscoliosis. Gardner-Wells Tongs (GWT) was placed prior to prone positioning to provide neck stability without issue. During the lumbar posterior column osteotomies the patient began to lose upper and lower extremity motor data. This indicated a cranial pathology. A temporary rod was placed on the concavity and an emergent flip without closure was performed. Upon flip, the patient was fixed and dilated with only right corneal reflex. The patient was rushed to the CT scanner where a large right-sided epidural hematoma was noted with a temporal bone fracture at the pin site, with the patient's right temporal bone noted to be only 1.3 mm in thickness. RESULTS: The patient underwent emergent epidural hematoma evacuation by the Neurosurgical team. The patient was discharged to rehabilitation 1 week after his cranial epidural hematoma surgery with a complete recovery including with full strength examination of all extremities. He subsequently underwent a definitive posterior spinal fusion with posterior column osteotomies 8 weeks later. CONCLUSION: Cranial pin fixation has the rare possibility to produce cranial pathology and has a specific complication protocol. Proper utilization and interpretation of neuromonitoring is essential to aid in intraoperative decision-making.


Assuntos
Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/cirurgia , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/cirurgia , Cifose/cirurgia , Síndrome de Marfan/cirurgia , Osteotomia/métodos , Posicionamento do Paciente/efeitos adversos , Posicionamento do Paciente/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Escoliose/cirurgia , Vértebras Torácicas/cirurgia , Adolescente , Pinos Ortopédicos/efeitos adversos , Extremidades/fisiologia , Fraturas Ósseas/etiologia , Hematoma Epidural Craniano/diagnóstico por imagem , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Monitorização Neurofisiológica Intraoperatória , Masculino , Osteotomia/efeitos adversos , Osteotomia/instrumentação , Fusão Vertebral , Osso Temporal , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Br J Anaesth ; 124(5): 648-655, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32169254

RESUMO

BACKGROUND: Desaturation frequently occurs in infants after general anaesthesia in the prone position. We aimed to evaluate the effect of regular alveolar recruitment in preventing atelectasis in infants and children after general anaesthesia in the prone position. METHODS: Children (<3 yr) undergoing general anaesthesia (>2 h) in the prone position were randomised to either receive regular alveolar recruitment or standardised care without recruitment. Ultrasound-guided alveolar recruitment was performed for both groups, and mechanical ventilation was started with a tidal volume of 6 ml kg-1 and PEEP of 7 cm H2O. During mechanical ventilation, the intervention (regular recruitment) group received alveolar recruitment once per hour. Lung ultrasound was performed after inducing anaesthesia and each position change. The primary outcome was the incidence of significant atelectasis (defined by consolidation score ≥2 in any region) before extubation, as evaluated by lung ultrasound undertaken by an investigator masked to trial allocation. RESULTS: Seventy-three children (regular recruitment: 37; standardised care: 36) were included in the analysis. Before the hourly intervention, atelectasis was similar between children randomised to regular alveolar recruitment or standardised care in both supine (83.3%, both groups; P>0.99) and prone positions (88.9% vs 91.9%; P=0.970). The incidence of atelectasis before extubation was lower in children receiving regular alveolar recruitment (8.1%), compared with 47.2% in children randomised to standardised care (absolute risk reduction: 39.1% [95% confidence interval: 20.6-57.6%); P<0.001). CONCLUSIONS: Regular alveolar recruitment reduced the incidence of atelectasis at the end of surgery in infants and children <3 yr undergoing general anaesthesia in the prone position. CLINICAL TRIAL REGISTRATION: NCT03486847.


Assuntos
Anestesia Geral/efeitos adversos , Complicações Intraoperatórias/prevenção & controle , Respiração com Pressão Positiva/métodos , Atelectasia Pulmonar/prevenção & controle , Pré-Escolar , Feminino , Humanos , Lactente , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Masculino , Oxigênio/sangue , Posicionamento do Paciente/efeitos adversos , Posicionamento do Paciente/métodos , Decúbito Ventral , Estudos Prospectivos , Atelectasia Pulmonar/diagnóstico por imagem , Atelectasia Pulmonar/etiologia , Ultrassonografia
18.
Cancer Radiother ; 24(2): 138-142, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-32061532

RESUMO

The decision to irradiate during pregnancy is based on a risk benefit compromise of two kinds: maternal risk and fetal risk. The aim of this work is to determine the foetal risk, and uterine dose measurement in proton therapy. Foetal exposure during treatment is linked to two sources: the treatment phase, and the repositioning phase. An Alderson-Rando anthropomorphic ghost (170cm, 74kg) was positioned on the table in the treatment position. A tissue-equivalent proportional counter (TEPC), adapted to the analysis of complex radiation fields (neutron and photonics), was used to determine the irradiation related to the treatment phase. An AT1123 radiation survey meter was used to measure photons generated by X-ray radiation. I dosimetry was proposed using radio-photoluminescent dosimeters, allowing for a daily check of the dose received in the uterus. The treatment phase produces higher uterine doses than the positioning phase, but these remain very low. The equivalent dose received in the uterus for the entire treatment is estimated at 840 µSv. Using a methodology for measuring the out-of-field dose with pencil beam scanning proton therapy, the foetal dose in the first trimester was well below the acceptance dose of 100 mGy determined by the International Commission on Radiological Protection.


Assuntos
Feto/efeitos da radiação , Posicionamento do Paciente/efeitos adversos , Complicações Neoplásicas na Gravidez/radioterapia , Exposição à Radiação , Útero/efeitos da radiação , Adulto , Feminino , Cabeça/efeitos da radiação , Humanos , Nêutrons , Posicionamento do Paciente/métodos , Imagens de Fantasmas , Fótons , Gravidez , Primeiro Trimestre da Gravidez
19.
J Robot Surg ; 14(5): 733-738, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31997148

RESUMO

Risk of intraoperative neuropathic injury in minimally invasive surgery has been established as a leading complication. Continuous intraoperative neuromonitoring (IONM), such as upper extremity somatosensory evoked potentials (ueSSEPs), to decrease peripheral nerve injury due to positional stress has been described. Robotic-assisted laparoscopic prostatectomy (RALP) requires steep Trendelenberg, which may predispose patients to upper extremity neuropraxia. Subdermal stimulating electrodes were placed on the patients' bilateral wrists over the ulnar nerve and the nerve was stimulated. Realtime waveforms were compared to baseline data to prevent and detect injury to the ulnar nerve. Established intervention criteria, indicating risk for neuropathic damage necessitating intraoperative patient repositioning, was a 50% loss in amplitude or a 10% increase in latency. One hundred and forty three patients received RALP with IONM. 17 of 143 patients (11.8%) met ueSSEP intervention criteria. Only weight was significantly different between the two groups (p = 0.04). Mean reduction in amplitude was 79.9% (SE 4.1). Average amplitude loss duration was 22 min (SE 4.0). Weight and BMI were correlated to the degree of amplitude reduction (p = 0.03 and < 0.01), while operative time and DM approached significance (p = 0.09 and p = 0.14). This is the first study to use IONM to reduce the risk of nerve injury during genitourinary surgery. Realtime nerve monitoring using ueSSEP allowed for upper extremity intraoperative monitoring and repositioning. This may decrease the risk of upper extremity neuropraxia due to malpositioning during RALP. Weight and BMI were identified as risk factors for possible nerve injury. Further data collection and analysis to preoperatively stratify patients for application of IONM during RALP is currently ongoing.


Assuntos
Laparoscopia/efeitos adversos , Laparoscopia/métodos , Monitorização Intraoperatória/métodos , Posicionamento do Paciente/efeitos adversos , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Extremidade Superior/inervação , Idoso , Índice de Massa Corporal , Potenciais Somatossensoriais Evocados , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
20.
Spine Deform ; 8(2): 345-348, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31925762

RESUMO

We report the case of a 12-year-old female, otherwise healthy patient, who underwent surgery for scoliosis correction in prone position under total intravenous general anesthesia, with CardioQ and sensory-motor-evoked potentials for hemodynamic and neurological monitoring. The patient showed severe intraoperative hypotension, lactic acidosis, and complete abolition of motor-evoked potentials during the positioning of posterior corrective bars. During the postoperative period, the increase in muscle and liver enzymes indicated an abdominal organ damage and confirmed hypoperfusion of the lower limbs. Both side effects were caused by the malposition of the patient on the operating table. The case resolved within the first postoperative week without sequelae.


Assuntos
Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Fígado/lesões , Músculo Esquelético/lesões , Posicionamento do Paciente/efeitos adversos , Decúbito Ventral , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Acidose/diagnóstico , Acidose/etiologia , Criança , Potencial Evocado Motor , Feminino , Humanos , Hipotensão/diagnóstico , Hipotensão/etiologia , Doença Iatrogênica , Monitorização Neurofisiológica Intraoperatória , Ácido Láctico , Fusão Vertebral/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...