RESUMEN
A retrospective chart review was conducted on 241 oncology patients who received monitored anesthesia care for laparoscopy. A review of perioperative analgesic and sedative requirements, and perioperative complications is included. The authors conclude that laparoscopy for diagnostic and staging purposes can be accomplished successfully with monitored anesthesia care.
Asunto(s)
Anestesia Local/métodos , Laparoscopía/métodos , Neoplasias/diagnóstico , Adolescente , Adulto , Anciano , Anestesia Local/efectos adversos , Biopsia , Femenino , Humanos , Complicaciones Intraoperatorias , Laparoscopía/efectos adversos , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio , Estadificación de Neoplasias/métodos , Dolor/etiología , Dolor Postoperatorio , Complicaciones Posoperatorias , Medicación Preanestésica/métodos , Estudios RetrospectivosRESUMEN
To test the hypothesis that central haemodynamic monitoring is not necessary in all patients undergoing abdominal aortic surgery, a prospective randomised study in 40 consecutive patients undergoing elective abdominal aortic surgery was carried out. Patients with unstable angina, recent myocardial infarction (less than or equal to 6 months), and left ventricular ejection fraction (LVEF) less than 0.50 were excluded. Twenty-one patients had perioperative central haemodynamic monitoring while 19 patients had central venous pressure monitoring alone. Parameters studied included, perioperative haemodynamics and fluid balance, perioperative cardiac drug administration, operation time and clamp time, postoperative renal function, incidence of postoperative ventilation and line complications, duration of hospital and ICU stay, and 30 day postoperative outcome. Results obtained were compared with a high risk group of patients (LVEF less than 0.50) undergoing similar surgery. Statistical analysis failed to show any difference in outcome for any variable measured in either low risk group. All serious postoperative cardiac complications occurred in patients with LVEF less than 0.50 (P less than 0.0001). These data suggest that patients with LVEF greater than or equal to 0.50 are at low risk of developing postoperative cardiac complications and can be successfully managed perioperatively without the added potential risks and costs of central haemodynamic monitoring.
Asunto(s)
Enfermedades de la Aorta/cirugía , Cateterismo de Swan-Ganz , Monitoreo Intraoperatorio , Anciano , Aorta Abdominal/cirugía , Cateterismo Venoso Central , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Factores de Riesgo , Volumen Sistólico/fisiologíaRESUMEN
We studied the responses of plasma CRH, ACTH, cortisol, norepinephrine, epinephrine, and renin activity in 11 patients undergoing parathyroid or thyroid surgery after identical preoperative sedation and during isoflurane (Forane) anesthesia. During surgical exploration, plasma CRH levels [10 +/- 2 (+/- SEM) pg/mL] remained at basal (unstimulated) levels, and plasma ACTH (11.5 +/- 1.4 pg/mL), cortisol (24 +/- 4 micrograms/dL), and epinephrine (35 +/- 10 pg/mL) concentrations remained within their normal morning ranges. The majority of the patients had no evidence of pulsatile ACTH secretion during the operation, but, rather, secreted ACTH and cortisol continuously. There was a small elevation of plasma norepinephrine and PRA which was associated with a small increase in heart rate and decrease in blood pressure. Anesthesia reversal, endotrachial extubation, and the early recovery period were associated with marked mean peak increases in plasma ACTH (173 +/- 45 pg/mL), cortisol (35 +/- 6 micrograms/dL), and epinephrine (220 +/- 56 pg/mL) and the return of plasma norepinephrine and PRA to basal levels. All hormones returned to basal levels by the first post-operative day. The data suggest that with modern anesthetic techniques patients undergoing neck surgery had mildly elevated plasma ACTH, cortisol, and epinephrine levels. Glucocorticoid secretion during the operation was maintained primarily by continuous rather than pulsatile ACTH secretion. The immediate postoperative period was associated with profound elevations of plasma ACTH, cortisol, and epinephrine. The major determinant of ACTH, cortisol, and epinephrine secretion was anesthesia reversal and recovery and not surgical trauma.
Asunto(s)
Sistema Hipotálamo-Hipofisario/fisiopatología , Sistema Hipófiso-Suprarrenal/fisiopatología , Sistema Renina-Angiotensina , Procedimientos Quirúrgicos Operativos/efectos adversos , Sistema Nervioso Simpático/fisiopatología , Hormona Adrenocorticotrópica/sangre , Adulto , Anciano , Anestesia/efectos adversos , Hormona Liberadora de Corticotropina/sangre , Epinefrina/sangre , Femenino , Humanos , Hidrocortisona/sangre , Masculino , Persona de Mediana Edad , Norepinefrina/sangre , Glándulas Paratiroides/cirugía , Renina/sangre , Estrés Fisiológico/etiología , Estrés Fisiológico/fisiopatología , Glándula Tiroides/cirugíaRESUMEN
The majority of patients with pulmonary metastases from primary soft tissue sarcomas have peripheral lesions that can be removed by wedge excision. A subset of these patients, however, present with, or develop, clinically significant endobronchial metastases. These patients require a preoperative evaluation that includes pulmonary function testing and a detailed endoscopic evaluation of the bronchial tree. We described three of these patients from the National Cancer Institute and review the clinical histories of eight additional previously reported cases.