RESUMO
A 52-year-old patient, ASA physical status IV, undergoing a radical prostatectomy for cancer with a robotic system had a cardiac arrest 3 hours into the case. All attempts to resuscitate were unsuccessful, and several hours later he was pronounced dead. Underlying patient comorbidity and procedural issues contributed to the patient's death. The patient had a history of coronary artery disease that required the placement of drug-eluting stents 2 years before this surgical procedure. The preoperative cardiac evaluation and pharmacological management of patients with drug-eluting coronary stents are reviewed. There are a number of positional and technical considerations for patients undergoing robotic surgical procedures, especially in relation to the requirement of low-lithotomy and steep Trendelenburg positions. The cardiac and respiratory systems are especially vulnerable to the extreme and lengthy head-down position. The needed positioning, combined with the problems associated with insufflation, presents a unique challenge in anesthetic management. This course reviews the current literature on the surgical implications for patients with drug-eluting stents and the physiologic factors related to position and pneumoperitoneum and their associated stressors. By using a review of the contemporary literature, a best-evidence approach to anesthetic management is reviewed.
Assuntos
Stents Farmacológicos/efeitos adversos , Decúbito Inclinado com Rebaixamento da Cabeça/efeitos adversos , Infarto do Miocárdio/etiologia , Prostatectomia/efeitos adversos , Robótica , Angioplastia Coronária com Balão , Comorbidade , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/terapia , Prática Clínica Baseada em Evidências , Evolução Fatal , Parada Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiros Anestesistas , Avaliação em Enfermagem , Assistência Perioperatória/métodos , Assistência Perioperatória/enfermagem , Pneumoperitônio Artificial/efeitos adversos , Pneumoperitônio Artificial/enfermagem , Prostatectomia/instrumentação , Prostatectomia/métodos , Prostatectomia/enfermagem , Neoplasias da Próstata/complicações , Neoplasias da Próstata/cirurgia , Fatores de Risco , Robótica/instrumentação , Robótica/métodosRESUMO
Multiple patient and economic benefits have contributed to the widespread popularity of laparoscopic surgery. Although the laparoscopic approach is safe, it is not without potential complications. The following case study describes a patient undergoing a laparoscopic salpingo-oophorectomy who had a sudden rise in end-tidal carbon dioxide to 65 mm Hg and was found to have developed subcutaneous emphysema. Hyperventilation, close monitoring, and mechanical ventilation for 4 hours postoperatively resulted in a positive patient outcome. The mechanisms of carbon dioxide absorption, as well as risk factors, complications, treatment, and prevention of subcutaneous emphysema will be described.
Assuntos
Dióxido de Carbono/efeitos adversos , Hipercapnia/etiologia , Laparoscopia , Ovariectomia , Pneumoperitônio Artificial/efeitos adversos , Enfisema Subcutâneo/etiologia , Absorção , Idoso de 80 Anos ou mais , Gasometria , Dióxido de Carbono/administração & dosagem , Dióxido de Carbono/farmacocinética , Feminino , Humanos , Hipercapnia/sangue , Hipercapnia/diagnóstico , Hipercapnia/prevenção & controle , Insuflação , Monitorização Intraoperatória , Enfermeiros Anestesistas , Avaliação em Enfermagem , Cistos Ovarianos/cirurgia , Palpação , Pneumoperitônio Artificial/métodos , Pneumoperitônio Artificial/enfermagem , Respiração Artificial , Fatores de Risco , Gestão da Segurança , Enfisema Subcutâneo/diagnóstico , Enfisema Subcutâneo/prevenção & controleRESUMO
Gaseous insufflation of the abdomen (i.e., pneumoperitoneum) is used routinely during laparoscopic surgery to allow the surgical team members to view the patient's viscera and to perform indicated procedures. Pneumoperitoneum has varying effects on the patient. The initiation and maintenance of pneumoperitoneum causes most of the complications seen with laparoscopic surgery. The perioperative nurse must understand the physiological effects of pneumoperitoneum on the patient to plan appropriate nursing interventions that ensure safe patient care.