RESUMO
BACKGROUND: Little information exists regarding factors influencing perioperative cardiac arrests and their outcome. This survey evaluated the incidence, causes and outcome of perioperative cardiac arrests in a Brazilian tertiary general teaching hospital between April 1996 and March 2005. METHODS: The incidence of cardiac arrest during anaesthesia was prospectively identified from an anaesthesia database. There were 53,718 anaesthetics during the study period. Data collected included patient characteristics, surgical procedures (elective, urgent or emergency), ASA physical status classification, anaesthesia provider information, type of surgery, surgical areas and outcome. All cardiac arrests were retrospectively reviewed and grouped by cause of arrest and death into one of four groups: totally anaesthesia related, partially anaesthesia related, totally surgery related or totally patient disease or condition related. RESULTS: One hundred and eighty-six cardiac arrests (34.6:10,000) and 118 deaths (21.97:10,000) were found. Major risk factors for cardiac arrest were neonates, children under 1 yr and the elderly (P<0.05), male patients with ASA III or poorer physical status (P<0.05), in emergency surgery (P<0.05) and under general anaesthesia (P<0.05). Patient disease/condition was the major cause of cardiac arrest or death (P<0.05). There were 18 anaesthesia-related cardiac arrests (3.35:10,000) -- 10 totally attributed (1.86:10,000) and 8 partially related to anaesthesia (1.49:10,000). There were 6 anaesthesia-related deaths (1.12:10,000) -- 3 totally attributable and 3 partially related to anaesthesia (0.56:10,000 in both cases). The main causes of anaesthesia-related cardiac arrest were respiratory events (55.5%) and medication-related events (44.5%). CONCLUSIONS: Perioperative cardiac arrests were relatively higher in neonates, infants, the elderly and in males with severe underlying disease and under emergency surgery. All anaesthesia-related cardiac arrests were related to airway management and medication administration which is important for prevention strategies.
Assuntos
Anestesia/efeitos adversos , Parada Cardíaca/etiologia , Complicações Intraoperatórias , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/efeitos adversos , Brasil/epidemiologia , Causas de Morte , Criança , Pré-Escolar , Emergências , Métodos Epidemiológicos , Feminino , Indicadores Básicos de Saúde , Parada Cardíaca/epidemiologia , Hospitais de Ensino , Humanos , Lactente , Recém-Nascido , Complicações Intraoperatórias/epidemiologia , Masculino , Pessoa de Meia-Idade , Distribuição por SexoRESUMO
INTRODUCTION: To study the functional and histological alterations in dog kidneys submitted to total ischemia for thirty minutes and the possible metoprolol protective action. MATERIAL AND METHODS: Sixteen dogs anesthetized with sodium pentobarbital (SP) were studied and divided into two groups: G1-8 dogs submitted to left nephrectomy and right renal artery clamping for thirty minutes, and G2-8 dogs submitted to the same procedures of G1 and to the administration of 0.5 mg x kg(-1) metoprolol before ischemia. Attributes of renal function were studied. RESULTS: There was acute tubular necrosis and a decrease of renal blood flow and glomerular filtration, and a increase of renal vascular resistance in both groups. CONCLUSION: The thirty minute renal ischemia appears to have determined the alterations found in the renal function and histology in both groups. Metoprolol, used in G2, as to the time and dose applied didn't protect the kidney from the ischemic episode.
Assuntos
Antagonistas Adrenérgicos beta/farmacologia , Necrose Tubular Aguda/tratamento farmacológico , Rim/irrigação sanguínea , Metoprolol/farmacologia , Traumatismo por Reperfusão/prevenção & controle , Animais , Cães , Rim/patologia , Rim/fisiopatologia , Circulação Renal , Renina/metabolismo , Fatores de TempoRESUMO
BACKGROUND AND OBJECTIVES: The study investigated possible neurotoxic effects of increasing concentrations and doses of bupivacaine administered into the subarachnoid space in dogs. METHODS: Fifty animals were allocated to five experimental groups: G1, control; G2, 5 mg 0.5 bupivacaine in 10% glucose solution; G3, 10 mg of 1% bupivacaine in 10% glucose solution; G4, 20 mg 2% bupivacaine in 10% glucose solution, and G5, 20 mg 2% bupivacaine in water. After 72 hours of observation, the animals were killed and the spinal cords removed for histologic examination by light microscopy. RESULTS: None of the animals showed any neurologic clinical disturbance following recovery from spinal anesthesia. One case of necrosis of nerve tissue was observed in G3 and four in G4. CONCLUSIONS: Increasing concentrations and doses of hyperbaric bupivacaine solutions increased the incidence of nerve tissue damage, which did not occur with hypobaric solutions. These results should contribute to the further understanding of neurologic complications following spinal anesthesia when large doses of local anesthetics in hyperbaric solutions are used.
Assuntos
Anestésicos Locais/toxicidade , Bupivacaína/toxicidade , Medula Espinal/efeitos dos fármacos , Animais , Cães , Relação Dose-Resposta a Droga , Feminino , Masculino , Medula Espinal/patologia , Espaço SubaracnóideoRESUMO
Em 633 anestesias do tipo geral inalatória com respiraçäo assistida e controlada, geral venosa, raquianestesia, peridural lombar e epidural sacra, foi avaliado o custo médio/hora de anestesia. A peridural lombar e a raquianestesia evidenciaram-se como as técnicas anestésicas mais econômicas, seguidas pela epidural sacra, e pelas gerais inalatórias. A anestesia geral venosa foi a de maior custo
Assuntos
Anestesia/economia , Custos e Análise de Custo , Hospitais UniversitáriosRESUMO
Os autores descrevem dois casos de hipertermia maligna ocorridos, um em pacientes de 8 anos de idade, feminina, branca, hígida, submetida a broncoscopia e exploraçäo cirúrgica do maxilar, e outro em paciente de 25 anos de idade, masculino, branco, submetido a síntese de fratura cominutiva exposta de nariz e disjunçäo maxilofacial. Ambos os pacientes haviam sido anestesiados com halotano e apresentaram taquicardia moderada durante o ato anestésico-cirúrgico. Na sala de recuperaçäo, apresentaram hipertemia, hiperventilaçäo, acidose metabólica e elevados níveis séricos de CPK. Hiperventilaçäo com oxigênio a 100% e manobras de resfriamento corpóreo com compressas de álcool-éter, lavagem gástrica com soro gelado e bloqueadores alfa-adrenérgicos foram introduzidos, bem como diuréticos e procaína. Ambos pacientes tiveram boa evoluçäo, sem seqüelas