RESUMO
We report two cases of early-onset pressure pneumocephalus, one occurring during supratentorial brain surgery (craniopharyngioma) which was diagnosed at the end of the anesthetic period upon appearance of comatose status leading to the suspicion of surgical complication in the form of a hematoma. The second case of pneumocephalus was detected after posterior fossa surgery performed with the patient in the sitting position. We review the significance of our anesthetic management on the prevention of tension pneumocephalus, and discuss diagnostic and therapeutic measures available for use in the Postoperative Intensive Care Recovery Unit.
Assuntos
Anestesia Geral/efeitos adversos , Encéfalo/cirurgia , Pneumocefalia/fisiopatologia , Encéfalo/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Criança , Fossa Craniana Posterior/diagnóstico por imagem , Fossa Craniana Posterior/cirurgia , Craniofaringioma/diagnóstico por imagem , Craniofaringioma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Tomografia Computadorizada por Raios XRESUMO
We report the case of a 54-year-old woman with cephalea of five months duration caused by a chronic subdural hematoma that appeared after epidural anesthesia and accidental dural puncture for bilateral saphenectomy. Computed tomography of the brain revealed an intracranial hematoma. After surgical evacuation, the patient's headaches resolved and she recovered fully. The appearance of cephalea after dural puncture is a relatively frequent complication of spinal anesthesia, but its persistence over time, as well as changes in its initial characteristics, should lead to a suspicion of life-threatening subdural hematoma.
Assuntos
Anestesia Epidural/efeitos adversos , Dura-Máter/lesões , Cefaleia/etiologia , Hematoma Subdural/complicações , Ferimentos Penetrantes/complicações , Doença Crônica , Feminino , Hematoma Subdural/etiologia , Humanos , Pessoa de Meia-Idade , Ferimentos Penetrantes/etiologiaRESUMO
OBJECTIVE: To determine whether provision of an information sheet during the preanesthesia visit to the patient, and general recommendations for anesthesia, can change patients' image of the anesthesiologist. PATIENTS AND METHODS: Two groups of 100 patients each were studied before outpatient surgery. Group 1 (given no information) answered a questionnaire before an interview with the anesthesiologist. Group 2 (who were given information) answered the same questionnaire, which was accompanied by an information sheet explaining the nature of anesthesia, possible risks, operating room and postoperative procedures. RESULTS: In group 1,67% identified the anesthesiologist as a physician. In group 2, 99% (p < 0.05) were able to do so. In group 1, 48% believed that the anesthesiologist works under the surgeon's orders, while only 27% (p < 0.05) thought so in group 2. The chief of the postanesthesia intensive care unit was thought to be a member of the nursing staff by 48% in group 1, whereas 95% (p < 0.05) in group 2 identified the chief as an anesthesiologist. CONCLUSIONS: The image of anesthesiology and the anesthesiologist can be improved by systematically providing an information sheet to patients who are scheduled for presurgical study.