Asunto(s)

Atención Perioperativa , Columna Vertebral , Humanos , Atención Perioperativa/métodos , Columna Vertebral/cirugía

RESUMEN

INTRODUCTION: One of the topics that show differences of opinion in the scientific field of nutrition is the recommendation by clinical practice guidelines (CPGs) of an immunomodulatory diet with arginine, nucleotides and omega-3 for individuals diagnosed with cancer undergoing major surgery. The quality of the recommendations is directly related to credibility, transparency and rigour in their development, but also to the quality of the studies published and available for inclusion in the recommendation, such as systematic reviews (SRs) and randomised clinical trials. The aim of this study is to evaluate the methodological quality of the recommendation of perioperative immunomodulatory supplementation for individuals with gastrointestinal and head and neck cancer, the CPGs, and the studies that support the recommendations. METHODS AND ANALYSIS: We will conduct a systematic search for CPGs. Recommendations for nutritional supplementation with immunomodulatory substrates for individuals undergoing major oncological surgery will be analysed using the Appraisal of Guidelines Research and Evaluation-Recommendations Excellence tool. CPGs will be analysed using the Appraisal of Guidelines Research and Evaluation II tool. The SRs cited in the recommendations will be analysed using the A Measurement Tool to Assess Systematic Reviews II tool and additional questions regarding heterogeneity in reviews. The clinical trials cited in the SRs and in the guideline recommendations (when applicable) will be analysed according to questions regarding heterogeneity in trials. The results will be presented in tables or charts using descriptive analyses. ETHICS AND DISSEMINATION: The results of this study will be disseminated through relevant conferences and peer-reviewed journals. PROTOCOL REGISTRATION NUMBER: 10.17605/OSF.IO/X2GYT.

Asunto(s)

Suplementos Dietéticos , Neoplasias Gastrointestinales , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Humanos , Neoplasias Gastrointestinales/cirugía , Suplementos Dietéticos/normas , Proyectos de Investigación/normas , Guías de Práctica Clínica como Asunto , Metaanálisis como Asunto , Atención Perioperativa/normas , Atención Perioperativa/métodos , Ácidos Grasos Omega-3/uso terapéutico , Ácidos Grasos Omega-3/administración & dosificación , Arginina/uso terapéutico , Procedimientos Quirúrgicos del Sistema Digestivo/normas

RESUMEN

BACKGROUND: Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist with sedative and analgesic effects, has been suggested in recent studies to possess renoprotective properties. Dexmedetomidine may reduce the incidence of delayed graft function and contribute to effective pain control post-renal transplantation. The primary objective of this systematic review was to assess whether dexmedetomidine decreases the occurrence of delayed graft function in renal transplant patients. METHODS: Databases including MEDLINE, EMBASE, and CENTRAL were comprehensively searched from their inception until March 2023. The inclusion criteria covered all Randomized Clinical Trials (RCTs) and observational studies comparing dexmedetomidine to control in adult patients undergoing renal transplant surgery. Exclusions comprised case series and case reports. RESULTS: Ten RCTs involving a total of 1358 patients met the eligibility criteria for data synthesis. Compared to the control group, the dexmedetomidine group demonstrated a significantly lower incidence of delayed graft function (OR = 0.71, 95% CI 0.52-0.97, p = 0.03, GRADE: Very low, I2 = 0%). Dexmedetomidine also significantly prolonged time to initiation of rescue analgesia (MD = 6.73, 95% CI 2.32-11.14, p = 0.003, GRADE: Very low, I2 = 93%) and reduced overall morphine consumption after renal transplant (MD = -5.43, 95% CI -7.95 to -2.91, p < 0.0001, GRADE: Very low, I2 = 0%). The dexmedetomidine group exhibited a significant decrease in heart rate (MD = -8.15, 95% CI -11.45 to -4.86, p < 0.00001, GRADE: Very low, I2 = 84%) and mean arterial pressure compared to the control group (MD = -6.66, 95% CI -11.27 to -2.04, p = 0.005, GRADE: Very low, I2 = 87%). CONCLUSIONS: This meta-analysis suggests that dexmedetomidine may potentially reduce the incidence of delayed graft function and offers a superior analgesia profile as compared to control in adults undergoing renal transplants. However, the high degree of heterogeneity and inadequate sample size underscore the need for future adequately powered trials to confirm these findings.

Asunto(s)

Funcionamiento Retardado del Injerto , Dexmedetomidina , Trasplante de Riñón , Ensayos Clínicos Controlados Aleatorios como Asunto , Dexmedetomidina/administración & dosificación , Dexmedetomidina/farmacología , Humanos , Funcionamiento Retardado del Injerto/prevención & control , Agonistas de Receptores Adrenérgicos alfa 2/administración & dosificación , Hipnóticos y Sedantes/administración & dosificación , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Analgésicos no Narcóticos/administración & dosificación , Atención Perioperativa/métodos

RESUMEN

INTRODUCTION: Management of the patient with cirrhosis of the liver that requires surgical treatment has been relatively unexplored. In Mexico, there is currently no formal stance or expert recommendations to guide clinical decision-making in this context. AIMS: The present position paper reviews the existing evidence on risks, prognoses, precautions, special care, and specific management or procedures for patients with cirrhosis that require surgical interventions or invasive procedures. Our aim is to provide recommendations by an expert panel, based on the best published evidence, and consequently ensure timely, quality, efficient, and low-risk care for this specific group of patients. RESULTS: Twenty-seven recommendations were developed that address preoperative considerations, intraoperative settings, and postoperative follow-up and care. CONCLUSIONS: The assessment and care of patients with cirrhosis that require major surgical or invasive procedures should be overseen by a multidisciplinary team that includes the anesthesiologist, hepatologist, gastroenterologist, and clinical nutritionist. With respect to decompensated patients, a nephrology specialist may be required, given that kidney function is also a parameter involved in the prognosis of these patients.

Asunto(s)

Cirrosis Hepática , Atención Perioperativa , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Atención Perioperativa/métodos , Atención Perioperativa/normas , México , Complicaciones Posoperatorias/prevención & control

RESUMEN

OBJECTIVE: To analyze the evidence on the influence of Lean and/or Six Sigma for process optimization in the perioperative period. METHODS: Integrative review carried out in the MEDLINE (PubMed), Web of Science, EMBASE, CINAHL, Scopus and LILACS databases on the use of Lean and/or Six Sigma to optimize perioperative processes. The studies included were analyzed in three thematic categories: flow of surgical patients, work process and length of stay. RESULTS: The final sample consisted of ten studies, which covered all operative periods. Lean and/or Six Sigma make a significant contribution to optimizing perioperative processes. FINAL CONSIDERATIONS: Lean and/or Six Sigma optimize perioperative processes to maximize the achievement of system stability indicators, making it possible to identify potential problems in order to recognize them and propose solutions that can enable the institution of patient-centered care.

Asunto(s)

Gestión de la Calidad Total , Humanos , Eficiencia Organizacional/normas , Periodo Perioperatorio/métodos , Periodo Perioperatorio/normas , Atención Perioperativa/métodos , Atención Perioperativa/normas

RESUMEN

BACKGROUND: Prior research has established the effectiveness of magnesium in relieving postoperative pain. This article aims to evaluate magnesium sulfate for perioperative analgesia in adults undergoing general abdominal surgery under general anesthesia. OBJECTIVE: The primary aim was to assess pain scores at 6 and 24 hours postoperatively in patients receiving magnesium sulfate vs. the control group. Secondary outcomes were postoperative opioid consumption, perioperative complications, and time to rescue analgesia. METHODS: A comprehensive database search identified studies comparing magnesium sulfate with control in adults undergoing general anesthesia for general abdominal surgery. Using random-effects models, data were presented as mean ± Standard Deviation (SD) or Odds Ratios (OR) with corresponding 95% Confidence Intervals (95% CI). A two-sided p-value < 0.05 was considered statistically significant. RESULTS: In total, 31 studies involving 1762 participants met the inclusion criteria. The magnesium group showed significantly lower postoperative pain scores at both early (within six hours) and late (up to 24 hours) time points compared to the control group. The early mean score was 3.1 ± 1.4 vs. 4.2 ± 2.3, and the late mean score was 2.3 ± 1.1 vs. 2.7 ± 1.5, resulting in an overall Mean Difference (MD) of -0.72; 95% CI -0.99, -0.44; p < 0.00001. The magnesium group was associated with lower rates of postoperative opioid consumption and shivering and had a longer time to first analgesia administration compared to the saline control group. CONCLUSION: Magnesium sulfate administration was linked to reduced postoperative pain and opioid consumption following general abdominal surgery.

Asunto(s)

Abdomen , Analgésicos , Sulfato de Magnesio , Dolor Postoperatorio , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Sulfato de Magnesio/administración & dosificación , Abdomen/cirugía , Analgésicos/administración & dosificación , Anestesia General/métodos , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Atención Perioperativa/métodos

RESUMEN

BACKGROUND: The concept introduced by protocols of enhanced recovery after surgery modifies perioperative traditional care in digestive surgery. The integration of these modern recommendations components during the perioperative period is of great importance to ensure fewer postoperative complications, reduced length of hospital stay, and decreased surgical costs. AIMS: To emphasize the most important points of a multimodal perioperative care protocol. METHODS: Careful analysis of each recommendation of both ERAS and ACERTO protocols, justifying their inclusion in the multimodal care recommended for digestive surgery patients. RESULTS: Enhanced recovery programs (ERPs) such as ERAS and ACERTO protocols are a cornerstone in modern perioperative care. Nutritional therapy is fundamental in digestive surgery, and thus, both preoperative and postoperative nutrition care are key to ensuring fewer postoperative complications and reducing the length of hospital stay. The concept of prehabilitation is another key element in ERPs. The handling of crystalloid fluids in a perfect balance is vital. Fluid overload can delay the recovery of patients and increase postoperative complications. Abbreviation of preoperative fasting for two hours before anesthesia is now accepted by various guidelines of both surgical and anesthesiology societies. Combined with early postoperative refeeding, these prescriptions are not only safe but can also enhance the recovery of patients undergoing digestive procedures. CONCLUSIONS: This position paper from the Brazilian College of Digestive Surgery strongly emphasizes that the implementation of ERPs in digestive surgery represents a paradigm shift in perioperative care, transcending traditional practices and embracing an intelligent approach to patient well-being.

Asunto(s)

Procedimientos Quirúrgicos del Sistema Digestivo , Atención Perioperativa , Humanos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Atención Perioperativa/métodos , Atención Perioperativa/normas , Brasil , Recuperación Mejorada Después de la Cirugía/normas , Protocolos Clínicos

Asunto(s)

Anestesia , Dengue , Atención Perioperativa , Humanos , Atención Perioperativa/métodos , Anestesia/métodos

RESUMEN

PURPOSE: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of perioperative or postoperative probiotics as a therapeutic approach for managing colorectal cancer treatment-related complications in patients undergoing surgery, with or without adjuvant therapy. METHODS: MEDLINE, Embase, and Scopus databases were searched. RESULTS: Ten RCTs with 1276 patients were included. There was a significant decrease in the incidence of diarrhea (odds ratio (OR) 0.42; 95% CI 0.31 to 0.55; p < 0.001), surgical site infection (OR 0.44; 95% CI 0.22 to 0.89; p = 0.023), urinary infection (OR 0.43; 95% CI 0.20 to 0.91; p = 0.028), pulmonary infection (OR 0.30; 95% CI 0.15 to 0.60; p < 0.001), abdominal distention (OR 0.43; 95% CI 0.25 to 0.76; p = 0.004), length of ATB therapy (mean difference (MD) - 1.66 days; 95% CI - 2.13 to - 1.19 days; p < 0.001), and duration of postoperative pyrexia (MD - 0.80 days; 95% CI - 1.38 to - 0.22 days; p = 0.007) in the probiotic group. Nevertheless, length of hospital stay, time to first defecation, and time to first solid diet were not different between groups. CONCLUSION: Our findings suggest that perioperative or postoperative probiotics is effective for reducing treatment-related complications in patients with colorectal cancer undergoing surgery, with a lower rate of adverse events.

Asunto(s)

Neoplasias Colorrectales , Complicaciones Posoperatorias , Probióticos , Humanos , Probióticos/uso terapéutico , Probióticos/administración & dosificación , Neoplasias Colorrectales/cirugía , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Atención Perioperativa/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Adulto

Asunto(s)

Humanos , Disfunción Ventricular Izquierda/cirugía , Atención Perioperativa/métodos , Simendán/administración & dosificación , Revascularización Miocárdica/métodos , Evaluación en Salud/economía , Eficacia

RESUMEN

OBJECTIVE: Hospital costs in surgery constitute a burden for the health system in all over the world. Multimodal protocols such as the ACERTO project enhance postoperative recovery. The aim of this study was to analyze the hospital costs in patients undergoing major digestive surgical procedures with or without the perioperative care strategies proposed by the ACERTO project. METHODS: Retrospective data from elective patients undergoing major digestive surgical procedures in a university hospital between January 2002 and December 2011 were collected. The investigation involved two phases: between January 2002 and December 2005, covering cases admitted before the implementation of the ACERTO protocol (pre-ACERTO period), and cases operated between January 2006 and December 2011, after implementation (ACERTO period). The primary outcome was the comparison of hospital costs between the two periods. As secondary end point, we compared length of stay (LOS), postoperative complications, surgical-site infection (SSI) rate, and mortality. RESULTS: We analyzed 381 patients (239 of the pre-ACERTO period and 142 of the ACERTO period) who underwent major procedures on the gastrointestinal tract. Patients operated after within the ACERTO protocol postoperative LOS had a median of 3 days shorter (p=0.001) when compared with pre-ACERTO period [median (IQR): 10 (12) days vs. 13 (12) days]. Mortality was similar between the two periods. Postoperative complications risk, however, was 29% greater (RR: 1.29; 95%CI 1.11-1.50) in the pre-ACERTO period (p=0.002). SSI risk was also greater in pre-ACERTO period (RR: 1.33; 95%CI 1.14-1.50). Costs (mean and SE) per patients were R$24,562.84 (1,349.33) before the implementation and R$19,912.81 (1,459.89) after the ACERTO protocol (p=0.02). CONCLUSION: The implementation of the ACERTO project in this University Hospital reduced the hospital costs in major digestive procedures. Moreover, the implementation of this modern perioperative care strategy also reduced postoperative complications, SSI risks, and LOS.

Asunto(s)

Procedimientos Quirúrgicos del Sistema Digestivo , Análisis Costo-Beneficio , Procedimientos Quirúrgicos Electivos , Humanos , Tiempo de Internación , Atención Perioperativa/métodos , Complicaciones Posoperatorias , Estudios Retrospectivos , Infección de la Herida Quirúrgica

RESUMEN

Introducción: Los cuidados perioperatorios estandarizados ayudan a asegurar que todos los pacientes reciban un tratamiento óptimo. Objetivo: Aplicar un método de cuidados perioperatorios multimodales sistemáticos, en pacientes sometidos a cirugía pulmonar mayor. Métodos: Se realizó una revisión narrativa de la literatura relevante, publicada sobre el tema en las bases de datos MEDLINE, Cochrane, además de Medigraph, en idiomas inglés, español y francés. Se hizo énfasis en los artículos de los últimos 5 años, sobre todo estudios aleatorizados, bases de datos institucionales y nacionales, revisiones sistemáticas, metanálisis y programas y protocolos ERAS/ERATS, además de artículos de revisión. Desarrollo: Los estudios obtenidos fueron evaluados por los autores por separado y, más tarde, en conjunto para definir cuáles se ajustaban a los objetivos. El protocolo se dividió en 5 fases: preoperatoria, ingreso hospitalario, preoperatoria inmediata, intraoperatoria, posoperatoria. Para cada una de ellas se definieron las acciones a realizar, según la evidencia disponible. Conclusiones: La implantación del protocolo permitirá pasar de una fase empírica a una investigativa, de manera que se podrán obtener resultados superiores en el tratamiento quirúrgico de los pacientes enrolados en las investigaciones que se realicen(AU)

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Introduction: Standardized perioperative care helps ensure that all patients receive optimal treatment. Objective: To apply a method of systematic multimodal perioperative care in patients undergoing major pulmonary surgery. Methods: A narrative review was performed of the relevant literature published on the subject in MEDLINE, Cochrane, and Medigraph databases in English, Spanish, and French. Emphasis was made on articles from the last 5 years, especially randomized studies, institutional and national databases, systematic reviews, meta-analyses, and ERAS/ERATS programs and protocols, as well as review articles. Discussion: The studies retrieved were evaluated by the authors separately and, later, together to define which ones met the objectives. The protocol was divided into 5 phases: preoperative, hospital admission, immediate preoperative, intraoperative, and postoperative. For each of them, the actions to be carried out were defined, according to the available evidence. Conclusions: The implementation of the protocol will allow to go from an empirical phase to an investigative one, so that better results can be obtained in the surgical treatment of patients enrolled in the investigations(AU)

Asunto(s)

Humanos , Cirugía Torácica/métodos , Atención Perioperativa/métodos , Neoplasias Pulmonares/cirugía , Literatura de Revisión como Asunto , Bases de Datos Bibliográficas , Guías como Asunto

RESUMEN

Fluid therapy in pediatric patients plays a fundamental role in perioperative anesthetic management. Planning of all surgical procedures must take into account the fluid therapy necessary to maintain both the basal metabolic needs and the losses de- rived from surgery. Generally, maintenance fluid therapy is performed with balanced hydro electrolytic solutions plus glucose (although the latter may not be necessary in most pediatric surgeries), and replacement fluid therapy with glucose-free solutions, with crystalloids being the most frequently used. Surgeries that present significant losses require a replacement fluid plan that allows maintaining an adequate intravascular volume, allowing an appropriate return and ventricular filling, as well as adequate tissue transport of oxygen. When necessary, transfusion of blood products should be aimed at reestablishing the necessary con- ditions to maintain homeostasis during the perioperative period.

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La terapia de aporte de fluidos en pediatría es una parte fundamental del manejo anestésico perioperatorio. La planificación de todo procedimiento quirúrgico debe considerar el aporte necesario para mantener tanto las necesidades metabólicas basales como las pérdidas derivadas de la cirugía. En general, la terapia de mantención se efectúa con soluciones hidroelectrolíticas balanceadas más glucosa (aunque en la mayoría de las cirugías pediátricas pudiese no ser necesario esto último), y la terapia de reposición con soluciones libres de glucosa, siendo los cristaloides los más frecuentemente utilizados. Cirugías que presentan pérdidas importantes requieren tener un plan de aporte que permita mantener un espacio intravascular adecuado y permita a su vez un adecuado retorno y llenado ventricular, así como un adecuado transporte de oxígeno tisular. Cuando sea necesario, la transfusión de hemoderivados debe estar dirigida a reestablecer las condiciones necesarias para mantener dicho balance y homeostasis durante todo el período perioperatorio.

Asunto(s)

Humanos , Niño , Atención Perioperativa/métodos , Fluidoterapia/métodos , Anestesia

RESUMEN

INTRODUCTION: Timely and appropriate preoperative information is beneficial for the child, parents, and the health team. Few preoperative information delivery programs exist based on the information needs of children. OBJECTIVE: To review the available evidence on the children's perspective about the characteristics of the desired preoperative information. METHOD: In the PubMed, Embase, and Web of Science databases a search was performed, using the descriptors: "anesthesia"; "pediatric anesthesia"; "pediatric surgery"; "child"; "pediatry"; "information needs"; "perioperative information"; "preoperative information"; "questionnaires"; "surveys". Articles in English and Spanish that met the inclusion criteria were selected. RESULTS: Articles founded were 3,438, and nine were selected. Most children would like more preoperative information, especially about pain, accompaniment, food, surgery, and anesthesia (content). Using brochures that include images or photos would be the preferred way of receiving the information (format). There was no consensus on when they would like to receive the information (opportunity). CONCLUSIONS: Pediatric patients would like more detailed preoperative information on their procedures; through brochures with images, but there is no clarity on when to receive the information.

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INTRODUCCIÓN: La información preoperatoria oportuna y apropiada tiene beneficios para el niño, los padres y el equipo de salud. Existen pocos programas de entrega de información preoperatoria basadas en las necesidades de información de los niños. OBJETIVO: Revisar la evidencia disponible sobre la perspectiva de los niños en relación a las caraterísticas de la información preoperatoria deseada. MÉTODO: Se realizó una búsqueda en las bases de datos PubMed, Embase y Web of Science, utilizando los descriptores: "anesthesia", "pediatric anaesthesia", "paediatric surgery", "child", "pediatry", "information needs", "perioperative information", "preoperative information", "questionnaires", "surveys". Se seleccionaron artículos en inglés y español que cumplieran con los criterios de inclusión. RESULTADOS: Se encontraron 3.438 artículos, 9 fueron seleccionados. La mayoría de los niños desearía más información preoperatoria, especialmente en relación al dolor, acompañamiento, comida, cirugía y anestesia (contenido). Utilizar folletos que incluyan imágenes o fotos sería la forma preferida de recibir la información (formato). No hubo concenso sobre cuando desearían recibir la información (oportunidad). CONCLUSIONES: Los pacientes pediátricos desearían información preoperatoria más detallada sobre sus procedimientos, a través de folletos con imágenes; pero no hay claridad sobre cuando recibir la información.

Asunto(s)

Humanos , Niño , Cuidados Preoperatorios/métodos , Educación del Paciente como Asunto , Evaluación de Necesidades , Anestesia Pediátrica/métodos , Atención Perioperativa/métodos

RESUMEN

OBJECTIVES: To evaluate the nutritional status and early nutritional intake of infants with univentricular congenital heart disease. STUDY DESIGN: The included infants underwent a Norwood procedure or hybrid intervention (stage 1) within the first 6 weeks of life, between January 2014 and January 2019, at Children's Health Ireland at Crumlin. Demographic, anthropometric, nutritional intake, and morbidity data were collected. RESULTS: Data were collected on 90 infants and 1886 neonatal admission days. There was a significant drop in mean weight-for-age z-score (WAZ) between measurements at birth, -0.01 and on discharge post stage 1 surgery -1.45 (P < .01). On hospital discharge (median hospital stay, 25 days) 32% of infants had a WAZ <-2 and 11% had a WAZ <-3. Pre-stage 1, 26% received trophic feeds and 39% received parenteral nutrition. Basal metabolic requirements and target caloric intake (120 kcal/kg) were met on 56% and 13% of admission days, respectively. Infants referred to a dietitian had a shorter time to any form of nutrition support, enteral feeds, and target caloric intake (P < .001, P = .016, and P = .048, respectively). At stage 3 (Fontan) surgery, 15% of infants were classified as stunted (length-for-age z-score [LAZ] <-2). CONCLUSIONS: The greatest decline in nutritional status occurs in the neonatal period, followed by significant growth stunting by the time of the Fontan procedure. Early involvement of dietitians is critical in the care of this nutritionally fragile group. With the currently low rate of preoperative nutritional support, there may be opportunities to improve intake at this critical stage.

Asunto(s)

Ingestión de Alimentos , Ingestión de Energía , Trastornos del Crecimiento/etiología , Cardiopatías Congénitas/fisiopatología , Ventrículos Cardíacos/anomalías , Desnutrición/etiología , Aumento de Peso , Preescolar , Conducta Alimentaria , Femenino , Procedimiento de Fontan , Trastornos del Crecimiento/diagnóstico , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/prevención & control , Cardiopatías Congénitas/cirugía , Cardiopatías Congénitas/terapia , Ventrículos Cardíacos/cirugía , Humanos , Lactante , Recién Nacido , Masculino , Desnutrición/diagnóstico , Desnutrición/epidemiología , Desnutrición/terapia , Apoyo Nutricional/métodos , Apoyo Nutricional/estadística & datos numéricos , Atención Perioperativa/métodos , Atención Perioperativa/estadística & datos numéricos , Estudios Retrospectivos

RESUMEN

RESUMEN Antecedentes: los avances en cuidados perioperatorios e inmunosupresión permitieron que la su pervivencia de los pacientes trasplantados aumente significativamente, así observamos que la litiasis vesicular es más frecuente en este grupo de pacientes. Objetivo: el objetivo de este trabajo es analizar y describir los resultados obtenidos en colecistecto mías en pacientes trasplantados cardíacos. Material y métodos: seleccionamos los pacientes mediante una búsqueda cruzada entre las bases de datos de Trasplante Cardíaco y Cirugía Biliar. Recopilamos información sobre sus antecedentes médi cos, parámetros clínicos y de laboratorio, entre otros. Resultados: entre enero 1994-diciembre 2017 se realizaron 154 trasplantes cardíacos con una edad media de 40 años; 16 pacientes fueron incluidos en este estudio y en los cuales fue realizada la cole cistectomía laparoscópica posterior al trasplante. No se registraron morbilidad, readmisiones ni mor talidad. Conclusión: la colecistectomía laparoscópica es segura y es el método de elección en pacientes tras plantados cardíacos. Se debe realizar colangiografía intraoperatoria, ya que los predictores de litiasis coledociana suelen estar alterados.

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ABSTRACT Background: The advances in perioperative care and immunosuppressive treatment resulted in a significant increase in survival of transplant patients; as a result, cholelithiasis is more common in transplant patients. Objective: The aim of this study is to analyze and describe the results obtained in cholecystectomies in heart transplant patients. Material and methods: We selected patients by cross-referencing the databases of heart transplantation and scheduled biliary surgeries, and collected information on their medical history, clinical parameters and laboratory tests, among other data. Results: Between January 1994 and December 2017, 154 heart transplant procedures were performed; mean age was 40 years; 16 underwent laparoscopic cholecystectomy after heart transplantation and were included in this study. There were no complications, readmissions or deaths. Conclusion: Laparoscopic cholecystectomy is safe and is the method of choice for heart transplant patients with cholelithiasis. Intraoperative cholangiography should be performed as the predictors of choledocholithiasis are usually abnormal.

Asunto(s)

Humanos , Masculino , Trasplante de Corazón , Colecistectomía Laparoscópica/métodos , Atención Perioperativa/métodos , Cistectomía , Terapia de Inmunosupresión , Trasplantes , Coledocolitiasis , Álcalis , Corazón

Asunto(s)

COVID-19/terapia , Apoyo Nutricional/métodos , Atención Perioperativa/métodos , COVID-19/inmunología , Humanos , Sistema Inmunológico/fisiología

RESUMEN

Resumen Introducción: Entre el 50% al 80% de los pacientes con un ictus, presentan lesión de la arteria carótida común o interna, de estos un 15% a 30% quedan con discapacidad severa, y el 20% requiere de institucionalización. Objetivo: Analizar las variables epidemiológicas involucradas en la estenosis carotídea y los resultados a mediano-largo plazo de la endarterectomía carotídea. Materiales y Método: Estudio observacional, descriptivo y retrospectivo, donde se analizan 103 endarterectomías carotídeas sucesivas, realizadas en 97 pacientes, en un período de 12 años (2007 a 2018), en el Servicio de Cirugía del Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Sexo masculino 64,9%, edad promedio 70,2 años, sintomáticos 65,9%, presentación clínica más frecuente el ataque isquémico transitorio (48,4%), morbilidad global inmediata del procedimiento 20,3%, AVE perioperarorio 3,9% (ninguno discapacitante), disfunción de nervios periféricos 5,8%, mortalidad operatoria 70% y cuando se efectúa en un plazo menor a 2 semanas del evento isquémico. Conclusión: La endarterectomía carotídea sigue siendo el procedimiento quirúrgico de elección para tratar la estenosis carotídea severa; realizada en centros con experiencia, es un procedimiento seguro y eficaz en la prevención del infarto cerebral.

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Introduction: Between 50 and 80% of patients with a stroke, have lesions of the common or internal carotid artery, of these 15 to 30% are severely disabled, and 20% require institutionalization. Aim: To analyze the epidemiological variables involved in carotid stenosis, and the medium to long-term results of carotid endarterectomy. Materials and Method: Observational, descriptive and retrospective study, analyzed 103 successive carotid endarterectomies procedures in 97 patients, in a period of 12 years (2007 to 2018), in the Surgery Department of the Dr. Eduardo Pereira Hospital, Valparaíso, Chile. Results: Male sex 64.9%, average age 70.2 years, symptomatic 65.9%, most frequent clinical presentation, transient ischemic attack (48.4%), immediate global morbidity of the procedure 20.3%, peri-operative AVE 3.9% (none disabling), peripheral nerve dysfunction 5.8%, operative mortality 70%, and when performed within a period less than 2 weeks of the ischemic event. Conclusion: Carotid endarterectomy remains the surgical procedure of choice, to treat severe carotid stenosis, performed in experienced centers, it is a safe and effective procedure in the prevention of cerebral ischemia.

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedades de las Arterias Carótidas/cirugía , Endarterectomía Carotidea/efectos adversos , Atención Perioperativa/métodos , Enfermedades de las Arterias Carótidas/epidemiología , Estudios de Seguimiento , Endarterectomía Carotidea/métodos , Endarterectomía Carotidea/tendencias

RESUMEN

OBJECTIVE: To evaluate the effect of a standardized feeding approach using a clinical nutrition pathway on weight-for-age Z score (WAZ) over hospital length of stay (HLOS) for infants with congenital heart disease (CHD). STUDY DESIGN: A 10-year retrospective cohort study examined eligible infants who underwent neonatal cardiac surgery between July 2009 and December 2018 (n = 987). Eligibility criteria included infants born at least 37 weeks of gestation and a minimum birth weight of 2 kg who underwent cardiac surgery for CHD within the first 30 days of life. Using the best linear unbiased predictions from a linear mixed effects model, WAZ change over HLOS was estimated before and after January 2013, when the standardized feeding approach was initiated. The best linear unbiased predictions model included adjustment for patient characteristics including sex, race, HLOS, and class of cardiac defect. RESULTS: The change in WAZ over HLOS was significantly higher from 2013 to 2018 than from 2009 to 2012 (ß = 0.16; SE = 0.02; P < .001), after controlling for sex, race, HLOS, and CHD category, indicating that infants experienced a decreased WAZ loss over HLOS after the standardized feeding approach was initiated. Additionally, differences were found in WAZ loss over HLOS between infants with single ventricle CHD (ß = 0.26; SE = 0.04; P < .001) and 2 ventricle CHD (ß = 0.04; SE = 0.02; P = .04). CONCLUSIONS: These data suggest that an organized, focused approach for nutrition therapy using a standardized pathway improves weight change outcomes before hospital discharge for infants with single and 2 ventricle CHD who require neonatal cardiac surgery.

Asunto(s)

Cardiopatías Congénitas/cirugía , Terapia Nutricional/normas , Atención Perioperativa/normas , Aumento de Peso , Pérdida de Peso , Vías Clínicas , Femenino , Cardiopatías Congénitas/fisiopatología , Hospitalización , Humanos , Lactante , Recién Nacido , Modelos Lineales , Modelos Logísticos , Masculino , Terapia Nutricional/métodos , Atención Perioperativa/métodos , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

The Haemostasis Traffic Light is a cognitive aid with a user-centred design to enhance and simplify situation awareness and decision-making during peri-operative bleeding. Its structure helps to prioritise therapeutic interventions according to the pathophysiology and the severity of the bleeding. This investigator-initiated, randomised, prospective, international, dual-centre study aimed to validate the Haemostasis Traffic Light by adapting it to the local coagulation protocols of two university hospitals. Between 9 January and 12 May 2020, we recruited 84 participants at the University Hospital Zurich, Switzerland, and the Italian Hospital of Buenos Aires, Argentina. Each centre included 21 resident and 21 staff anaesthetists. Participants were randomly allocated to either the text-based algorithm or the Haemostasis Traffic Light. All participants managed six bleeding scenarios using the same algorithm. In simulated bleeding scenarios, the design of the Haemostasis Traffic Light algorithm enabled more correctly solved cases, OR (95%CI) 7.23 (3.82-13.68), p < 0.001, and faster therapeutic decisions, HR (95%CI) 1.97 (1.18-3.29, p = 0.010). In addition, the tool improved therapeutic confidence, OR (95%CI) 4.31 (1.67-11.11, p = 0.003), and reduced perceived work-load coefficient (95%CI) -6.1 (-10.98 to -1.22), p = 0.020). This study provides empirical evidence for the importance of user-centred design in the development of haemostatic management protocols.

Asunto(s)

Recursos Audiovisuales , Coagulación Sanguínea , Toma de Decisiones Clínicas/métodos , Hemorragia/terapia , Atención Perioperativa/métodos , Entrenamiento Simulado/métodos , Enfermedad Aguda , Argentina , Femenino , Humanos , Masculino , Estudios Prospectivos , Suiza