RESUMO
Amniotic fluid embolism (AFE) represents a challenge for the medical team. Due to its low incidence and high mortality, it is one of the most complex conditions to manage during pregnancy and delivery. Our objective is to present the case of a 36-year- old high-risk obstetric patient, who was taken to the ward for emergency cesarean section, during which she presented acute hemodynamic collapse during fetal extraction maneuvers. Based on the clinic, echocardiographic evaluation, and hemodynamic monitoring, a diagnosis of amniotic embolism was made. In the critical care unit, the evolution was favorable with a good maternal outcome. Although the understanding of this pathology has improved in the last decade, it is still associated with a high rate of maternal and perinatal morbidity and mortality. In patients with suspected AFE, the routine use of echocardiography within the ward should be encouraged whenever available, while in the ICU the use of advanced hemodynamic monitoring is essential. Management should be early, with immediate recognition and the presence of a multidisciplinary team being key factors that reduce mortality. In this work, we review the literature with emphasis on the pathophysiology, diagnosis, obstetric, anesthetic, and intensive care management of this pathology.
La embolia de líquido amniótico (AFE) representa un desafío para el equipo médico. Debido a su baja incidencia y alta mortalidad es una de las condiciones más complejas de manejar durante el embarazo y el parto. Nuestro objetivo es presentar el caso de una paciente de 36 años de alto riesgo obstétrico, que es llevada a pabellón para cesárea de urgencia, quien durante las maniobras de extracción fetal presenta colapso hemodinámico agudo. Según clínica, evaluación ecocardiográfica y monitoreo hemodinámico, se plantea el diagnóstico de embolia amniótica. En la Unidad de cuidados críticos la evolución fue favorable con buen resultado materno. Si bien la comprensión de esta patología ha mejorado en la última década, sigue estando asociada a una alta tasa de morbimortalidad materna y perinatal. En pacientes con sospecha de AFE, se debe alentar el uso rutinario de la ecocardiografía dentro del pabellón siempre que se encuentre disponible, mientras que en UCI el uso de monitoreo hemodinámico avanzado es imprescindible. El manejo debe ser precoz, siendo el reconocimiento inmediato y la presencia de un equipo multidisciplinario factores claves que disminuyen la mortalidad. En este trabajo se hace una revisión bibliográfica con énfasis en la fisiopatología, diagnóstico, manejo obstétrico, anestésico y de cuidados intensivos de esta patología.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Choque/etiologia , Embolia Amniótica/diagnóstico por imagem , Choque/terapia , Ecocardiografia , Cesárea , Embolia Amniótica/terapia , Monitorização Hemodinâmica , AnestesiaRESUMO
Abstract According to the most recent guidelines, the use of intraoperative transesophageal echocardiography in valvular surgeries is well established, as well as its use in the diagnosis, management, and rescue of perioperative complications. The aim of this case report is to illustrate a condition in which its intraoperative use had a positive influence on the outcome.
Resumo O uso da ecocardiografia transesofágica no intraoperatório em cirurgias valvulares é bem estabelecido de acordo com os guidelines mais recentes, assim como o seu uso no diagnóstico, manuseio e resgate de complicações perioperatórias. O objetivo deste relato de caso é ilustrar uma situação em que o seu uso no intraoperatório influenciou de maneira positiva o seu desfecho.
Assuntos
Humanos , Masculino , Idoso , Ecocardiografia Transesofagiana/métodos , Implante de Prótese de Valva Cardíaca/métodos , Dissecção Aórtica/diagnóstico por imagem , Cuidados Intraoperatórios/métodos , Complicações Intraoperatórias/diagnóstico por imagem , Dissecção Aórtica/etiologia , Valva Mitral/cirurgiaRESUMO
According to the most recent guidelines, the use of intraoperative transesophageal echocardiography in valvular surgeries is well established, as well as its use in the diagnosis, management, and rescue of perioperative complications. The aim of this case report is to illustrate a condition in which its intraoperative use had a positive influence on the outcome.
Assuntos
Dissecção Aórtica/diagnóstico por imagem , Ecocardiografia Transesofagiana/métodos , Implante de Prótese de Valva Cardíaca/métodos , Idoso , Dissecção Aórtica/etiologia , Humanos , Cuidados Intraoperatórios/métodos , Complicações Intraoperatórias/diagnóstico por imagem , Masculino , Valva Mitral/cirurgiaRESUMO
Abstract Background and objectives: The Brazilian Society of Anesthesiology (SBA) has been promoting continuing education in intraoperative echocardiography in Brazil since 2011, with the implementation of an Intraoperative Echocardiography Course (ETI/SBA). Although echocardiography is a reality of anesthesiology practice in Brazil, we still do not have an established policy on the area of expertise, job training, and recognition by the other societies, such as the Brazilian Society of Cardiology (SBC). The aim of this paper is to contextualize the anesthesiology in the intraoperative echocardiography in Brazil and promote a discussion on the formation of a Task Force along with the SBC to begin drawing up the Brazilian Guidelines on Intraoperative Echocardiography. Case report: The first reports on the involvement of anesthesiology in Brazil with intraoperative echocardiography are from the 80s and 90s. However, this technique implementation in routine practice in the Brazilian anesthesiology occurred in 2011 with the formation of the ETI/SBA Course. Since then, the SBA has been promoting a continuing education of its members and disseminating the ETI/SBA Course throughout Brazil. More than 200 associates have taken this course, and the vast majority works with cardiac surgery. Conclusion: Intraoperative echocardiography is a reality in the practice of the Brazilian anesthesiology, and the ETI/SBA Course has been promoting its continuing education, however, we still do not have a grounded guideline. As occurred in major worldwide centers, we have to promote a Task Force along with the SBC in order to begin the drawing up of the Brazilian Guidelines on Intraoperative Echocardiography.
Resumo Justificativa e objetivos: A Sociedade Brasileira de Anestesiologia (SBA) vem promovendo a educação continuada em ecocardiografia intraoperatória no Brasil desde 2011, com a implantação do Curso de Ecocardiografia Intraoperatória (ETI/SBA). Apesar de a ecocardiografia ser uma realidade do anestesiologista brasileiro, ainda não temos uma diretriz estabelecida no que diz respeito à área de atuação, capacitação profissional e ao reconhecimento junto às demais sociedades, como, por exemplo, a Sociedade Brasileira de Cardiologia (SBC). O objetivo deste artigo é contextualizar a anestesiologia na ecocardiografia intraoperatória no Brasil e promover uma discussão sobre a formação de uma força-tarefa junto à SBC para iniciarmos a formação das Diretrizes Brasileiras em Ecocardiografia Intraoperatória. Relato do caso: Os primeiros relatos do envolvimento da anestesiologia no Brasil com a ecocardiografia intraoperatória são da década de 1980 e 90. Contudo, a implantação dessa técnica na prática rotineira na anestesiologia brasileira ocorreu em 2011, com a formação do Curso ETI/SBA. Desde então, a SBA vem promovendo a educação continuada de seus associados e divulgando o Curso ETI/SBA em todo o Brasil. Já fizeram esse curso mais de 200 associados. A grande maioria trabalha com cirurgia cardíaca. Conclusão: A ecocardiografia intraoperatória é uma realidade na anestesiologia brasileira e o Curso ETI/SBA vem promovendo a sua educação continuada. Contudo, ainda não temos uma diretriz fundamentada. Como ocorreu nos grandes centros mundiais, temos de promover uma força-tarefa junto à SBC a fim de iniciarmos a formulação das Diretrizes Brasileiras em Ecocardiografia Intraoperatória.
Assuntos
Humanos , Ecocardiografia/normas , Monitorização Intraoperatória/normas , Anestesia/normas , Brasil , Monitorização Intraoperatória/métodos , Guias de Prática Clínica como Assunto , Comitês ConsultivosRESUMO
BACKGROUND AND OBJECTIVES: The Brazilian Society of Anesthesiology (SBA) has been promoting continuing education in intraoperative echocardiography in Brazil since 2011, with the implementation of an Intraoperative Echocardiography Course (ETI/SBA). Although echocardiography is a reality of anesthesiology practice in Brazil, we still do not have an established policy on the area of expertise, job training, and recognition by the other societies, such as the Brazilian Society of Cardiology (SBC). The aim of this paper is to contextualize the anesthesiology in the intraoperative echocardiography in Brazil and promote a discussion on the formation of a Task Force along with the SBC to begin drawing up the Brazilian Guidelines on Intraoperative Echocardiography. CASE REPORT: The first reports on the involvement of anesthesiology in Brazil with intraoperative echocardiography are from the 80s and 90s. However, this technique implementation in routine practice in the Brazilian anesthesiology occurred in 2011 with the formation of the ETI/SBA Course. Since then, the SBA has been promoting a continuing education of its members and disseminating the ETI/SBA Course throughout Brazil. More than 200 associates have taken this course, and the vast majority works with cardiac surgery. CONCLUSION: Intraoperative echocardiography is a reality in the practice of the Brazilian anesthesiology, and the ETI/SBA Course has been promoting its continuing education, however, we still do not have a grounded guideline. As occurred in major worldwide centers, we have to promote a Task Force along with the SBC in order to begin the drawing up of the Brazilian Guidelines on Intraoperative Echocardiography.