RESUMEN
With the ineffectiveness of conservative therapy of chronic rhinosinusitis in all age groups of patients, functional rhinosinusosurgical endoscopic interventions are now often used to do. The minimal bleeding is a necessary condition for their realization. There are reports of the use of beta-blockers for reducing surgical bleeding, but the possibility of their intravenous use in older patients has not been sufficiently studied. The aim of the work was to evaluate the effectiveness of intravenous metoprolol to reduce the bleeding intensity (BI) during rhinosinusosurgical interventions under general anesthesia in elderly and senile patients. The BI was assessed on the Fromme-Boezaart Score scale at different stages of the operation from the 10th to the 60th minute in two groups of patients: without (WM) and using metoprolol (M). It was shown that at the 30th minute of the operation BI was significantly lower in M group. Multivariate analysis of hemodynamic parameters demonstrated a direct relationship between heart rate (HR) and the development of bleeding. In the WM group, the probability of significant bleeding was 8,6 times higher. It has been shown that intraoperative intravenous use of metoprolol reduces the intensity of local bleeding during endoscopic rhinosinusosurgical operations.
Asunto(s)
Metoprolol , Sinusitis , Humanos , Anciano , Sinusitis/cirugía , Pérdida de Sangre Quirúrgica , Endoscopía/efectos adversos , HemodinámicaRESUMEN
A case of successful endoscopic correction of grade II laryngeal stenosis under general anesthesia and respiratory support is reported. High-frequency jet ventilation of the lungs was accomplished through a transtracheally introduced catheter.
Asunto(s)
Ventilación con Chorro de Alta Frecuencia , Laringoestenosis , Anestesia General , Endoscopía , HumanosRESUMEN
STUDY OBJECTIVE: To describe the clinical experience with high-frequency jet ventilation (HFJV) of the lungs during endolaryngeal surgery and its effect on acid-base balance and capillary PO2 (PcO2), PCO2, central hemodynamics, and tracheobronchial mucous membrane. DESIGN: Evaluation of different modalities of HFJV. SETTING: Operating rooms and otolaryngology intensive care unit in a medical institute. PATIENTS: 218 patients undergoing elective endolaryngeal surgery. INTERVENTIONS: Patients receive HFJV through catheters with an inner diameter of 1.4 to 1.8 mm. Catheters were introduced orotracheally, nasotracheally, percutaneously, or through a fenestrated tracheostomy tube. Minute volume was based on body weight times 0.2, corrected for acid-base balance. MEASUREMENTS AND MAIN RESULTS: Intraoperative cardiac output, airway pressure, changes in tracheobronchial mucosa, and acid-base balance were monitored. HFJV changed central hemodynamics slightly and preserved gas exchange: PcCO2 remained within normal limits, while PcO2 increased. Use of thin catheters enhanced largyneal exposure and surgical manipulation. Percutaneous catheterization permitted resumption of HFJV in the event of laryngeal edema and inadequate spontaneous respiration after surgery. CONCLUSION: HFJV leads to optimal conditions for endolaryngeal surgery, reverses constant outflow of the respiratory gas mixture, prevents aspiration of tissue products and blood, and removes smoke from the operative site when using laser surgery.
Asunto(s)
Ventilación con Chorro de Alta Frecuencia , Laringe/cirugía , Equilibrio Ácido-Base , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bronquios/fisiología , Capilares , Dióxido de Carbono/sangre , Gasto Cardíaco/fisiología , Cateterismo/instrumentación , Procedimientos Quirúrgicos Electivos , Ventilación con Chorro de Alta Frecuencia/instrumentación , Ventilación con Chorro de Alta Frecuencia/métodos , Humanos , Intubación Intratraqueal/instrumentación , Persona de Mediana Edad , Monitoreo Intraoperatorio , Membrana Mucosa/fisiología , Oxígeno/sangre , Intercambio Gaseoso Pulmonar/fisiología , Ventilación Pulmonar/fisiología , Tráquea/fisiología , Traqueostomía/instrumentaciónRESUMEN
To ensure controlled lung ventilation in endolaryngeal surgical interventions, using a high-energy laser, use was made of normal frequency jet ventilation (NFJV) and high frequency jet ventilation (HFJV) through a non-inflammable fluoroplast catheter supplied at a distal end with a device fixing it in a central position. HFJV seems preferable, as endolaryngeal manipulations become more convenient. The study was performed in 118 patients. Venturi effect was observed only during ventilation through a tracheostomic canule. It has been established that, unlike NFJV, in HFJV gas exchange parameters are much better, though oxygenation in NFJV is satisfactory in all the patients.