RESUMO
BACKGROUND: Anesthesiologists frequently use intraoperative transesophageal echocardiography (TEE) to aid in the diagnosis and management of hemodynamic problems during liver transplantation (LT). Although the use of TEE in US centers continues to increase, data regarding international use are lacking. METHODS: This prospective, global, survey-based study evaluates international experience with TEE for LT. Responses from 252 LT (105 US and 147 non-US) centers representing 1789 anesthesiologists were analyzed. RESULTS: Routine use of TEE in the United States has increased in the last 5 y (from 37% to 47%), but only 21% of non-US LT anesthesiologists use TEE routinely. Lack of training (44% US versus 70% non-US) and equipment (9% non-US versus 34% US) were cited as obstacles. Most survey participants preferred not to perform a complete cardiac examination but rather use only 6 of 11 basic views. Although non-US LT anesthesiologists more frequently had additional clinical training than their US counterparts, they had less TEE experience (13% versus 44%) and less frequently, TEE certification (22% versus 35%). Most LT anesthesiologists agreed that TEE certification is essential for proficiency. Of all respondents, 89% agreed or strongly agreed that TEE provides valuable information needed for immediate clinical decision-making, and >86% agreed or strongly agreed that that information could not be derived from other sources. CONCLUSIONS: The use of TEE for LT surgery in the US LT centers is currently higher compared with non-US LT centers. This may become a standard monitoring modality during LT in the near future.
Assuntos
Ecocardiografia Transesofagiana , Transplante de Fígado , Padrões de Prática Médica , Humanos , Ecocardiografia Transesofagiana/estatística & dados numéricos , Estudos Prospectivos , Padrões de Prática Médica/tendências , Pesquisas sobre Atenção à Saúde , Anestesiologistas , Monitorização Intraoperatória/métodos , Monitorização Intraoperatória/estatística & dados numéricos , Hemodinâmica , Competência Clínica , Anestesiologia/educação , CertificaçãoRESUMO
INTRODUCTION: To obtain the optimal anesthesia depth is not easy in cardiovascular surgery patients where the haemodynamic reserve is limited, due to reasons such as not being able to give the desired dose of anesthetic agent, or the change in the pharmacokinetics of the agent in the heart-lung machine. This study was planned to assess the contribution of bispectral index (BIS) monitoring in the depth of anesthesia. METHODS: The patients were divided into 2 groups, and BIS monitoring was used for each patient. Group 1 (G1 n=35): keeping the BIS monitor screen open, the anesthesia need was set. Group 2 (G2 n=35): BIS monitor was tied to the patient and the monitor screen was closed in such a way that the anaesthesist couldn't see the BIS value. When the recording time came, the data on the monitor was recorded. The need for the anesthetic agent was set according to the parameters such as haemodynamics or follow up of pupils, instead of BIS value, by titrating the anesthetic infusion doses. RESULTS: BIS values were similar in both groups before the induction, BIS values in both groups showed a decrease, showing no significant statistical difference (P>0.05). One patient in each group said that he dreamt, and one patient in G2 said that he had heard a noise and felt that he was taken from one place to another. CONCLUSION: The management should be done with clinical evaluation, haemodynamics and other monitorization methods and BIS monitoring findings together.
Assuntos
Monitores de Consciência/estatística & dados numéricos , Ponte de Artéria Coronária/instrumentação , Consciência no Peroperatório/diagnóstico , Monitorização Intraoperatória/métodos , Idoso , Anestésicos Intravenosos/administração & dosagem , Monitores de Consciência/normas , Fentanila/administração & dosagem , Hemodinâmica , Humanos , Pessoa de Meia-Idade , Monitorização Intraoperatória/estatística & dados numéricos , Propofol/administração & dosagemRESUMO
Abstract Introduction: To obtain the optimal anesthesia depth is not easy in cardiovascular surgery patients where the haemodynamic reserve is limited, due to reasons such as not being able to give the desired dose of anesthetic agent, or the change in the pharmacokinetics of the agent in the heart-lung machine. This study was planned to assess the contribution of bispectral index (BIS) monitoring in the depth of anesthesia. Methods: The patients were divided into 2 groups, and BIS monitoring was used for each patient. Group 1 (G1 n=35): keeping the BIS monitor screen open, the anesthesia need was set. Group 2 (G2 n=35): BIS monitor was tied to the patient and the monitor screen was closed in such a way that the anaesthesist couldn't see the BIS value. When the recording time came, the data on the monitor was recorded. The need for the anesthetic agent was set according to the parameters such as haemodynamics or follow up of pupils, instead of BIS value, by titrating the anesthetic infusion doses. Results: BIS values were similar in both groups before the induction, BIS values in both groups showed a decrease, showing no significant statistical difference (P>0.05). One patient in each group said that he dreamt, and one patient in G2 said that he had heard a noise and felt that he was taken from one place to another. Conclusion: The management should be done with clinical evaluation, haemodynamics and other monitorization methods and BIS monitoring findings together.
Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Ponte de Artéria Coronária/instrumentação , Monitorização Intraoperatória/métodos , Monitores de Consciência/estatística & dados numéricos , Consciência no Peroperatório/diagnóstico , Propofol/administração & dosagem , Fentanila/administração & dosagem , Monitorização Intraoperatória/estatística & dados numéricos , Anestésicos Intravenosos/administração & dosagem , Monitores de Consciência/normas , HemodinâmicaRESUMO
BACKGROUND: Intraoperative neurophysiological monitoring (IOM) during spine surgery consists of several functional tests including somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), dermatomal potentials (DPs) and EMG (electromyography). Permanent neurological damage after spine surgery performed without intraoperative neurophysiological monitoring is frequent and often very costly. The main goal of IOM is the immediate detection, prevention and correction of neurological damage during surgery, which may go unnoticed without using these tests. METHODS: A total of 351 clinical files of patients with spinal surgery and continuous neurophysiological monitoring were transversally and descriptively reviewed from 2007 to 2008. RESULTS: There were 135 male patients (38.46%) and 216 female patients (61.54%); 82% of the cases were osteodiscal pathology with or without medullar involvement, 12% were patients with traumatic injuries, 4% with scoliosis and 2% had medullary tumors. Regarding localization, 62.1% were lumbar, 33% cervical, 4.3% thoracic and 0.5% sacral involvement; 12.4% of our cases showed significant improvement of the basal responses on SSEPs, and 56.8% showed no significant change during the procedure. In 28.4% of the cases, the surgical team had to be advised of potential neurological damage and in 2.4% there was absence of neurophysiological responses. No patient showed complete loss of any neurophysiological response. All patients reported clinical improvement after hospital discharge. CONCLUSIONS: Intraoperative neurophysiological monitoring may help avoid certain neurological risks during spine surgery, which may go unnoticed without the use of this technique.
Assuntos
Potenciais Evocados , Monitorização Intraoperatória , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Complicações Pós-Operatórias/prevenção & controle , Traumatismos da Medula Espinal/prevenção & controle , Medula Espinal/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Disco Intervertebral/cirurgia , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Monitorização Intraoperatória/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Escoliose/cirurgia , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/cirurgia , Doenças da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/cirurgia , Adulto JovemRESUMO
BACKGROUND: Despite possible advantages, few surgical series report specifically on awake craniotomy for intrinsic brain tumors in eloquent brain areas. OBJECTIVES: Primary: To evaluate the safety and efficacy of fully awake craniotomy (FAC) for the resection of primary supratentorial brain tumors (PSBT) near or in eloquent brain areas (EBA) in a developing country. Secondary: To evaluate the impact of previous surgical history and different treatment modalities on outcome. PATIENTS AND METHODS: From 1998 to 2007, 79 consecutive FACs for resection PSBT near or in EBA, performed by a single surgeon, were prospectively followed. Two groups were defined based on time period and surgical team: group A operated on from March 1998 to July 2004 without a multidisciplinary team and group B operated on from August 2004 to October 2007 in a multidisciplinary setting. For both time periods, two groups were defined: group I had no previous history of craniotomy, while group II had undergone a previous craniotomy for a PSBT. Forty-six patients were operated on in group A, 46 in group B, 49 in group I and 30 in group II. Psychological assessment and selection were obligatory. The preferred anesthetic procedure was an intravenous high-dose opioid infusion (Fentanil 50 microg, bolus infusion until a minimum dose of 10 microg/kg). Generous scalp and periosteous infiltrations were performed. Functional cortical mapping was performed in every case. Continuous somato-sensory evoked potentials (SSEPs) and phase reversal localization were available in 48 cases. Standard microsurgical techniques were performed and monitored by continuous clinical evaluation. RESULTS: Clinical data showed differences in time since clinical onset (p < 0.001), slowness of thought (p = 0.02) and memory deficits (p < 0.001) between study periods and also time since recent seizure onset for groups I and II (p = 0.001). Mean tumor volume was 51.2 +/- 48.7 cm3 and was not different among the four groups. The mean extent of tumor reduction was 90.0 +/- 12.7% and was similar for the whole series. A trend toward a larger incidence of glioblastoma multiforme occurred in group B (p = 0.05) and I (p = 0.04). Recovery of previous motor deficits was observed in 75.0% of patients, while motor worsening in 8.9% of cases. Recovery of semantic language deficits, control of refractory seizures and motor worsening were statistically more frequent in group B (p = 0.01). Satisfaction with the procedure was reported by 89.9% of patients, which was similar for all groups. Clinical complications were minimal, and surgical mortality was 1.3%. CONCLUSIONS: These data suggest that FAC is safe and effective for the resection of PSBT in EBA as the main technique, and in a multidisciplinary context is associated with greater clinical and physiological monitoring. The previous history of craniotomy for PSBT did not seem to influence the outcome.
Assuntos
Neoplasias Encefálicas/cirurgia , Córtex Cerebral/cirurgia , Craniotomia/métodos , Período Intraoperatório , Monitorização Intraoperatória/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Mapeamento Encefálico/métodos , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/fisiopatologia , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/patologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/cirurgia , Estudos de Coortes , Craniotomia/mortalidade , Craniotomia/estatística & dados numéricos , Potenciais Somatossensoriais Evocados/fisiologia , Feminino , Fentanila/uso terapêutico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/mortalidade , Monitorização Intraoperatória/estatística & dados numéricos , Invasividade Neoplásica , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Paresia/etiologia , Paresia/fisiopatologia , Paresia/cirurgia , Estudos Prospectivos , Radiografia , Recuperação de Função Fisiológica/fisiologia , Tempo , Resultado do Tratamento , Adulto JovemRESUMO
CONTEXT AND OBJECTIVE: Intraoperative nerve monitoring has emerged as a valuable tool to facilitate recurrent laryngeal nerve identification during thyroid surgery, thereby avoiding its injury. The aim was to evaluate vocal fold mobility in patients who underwent thyroidectomy with intraoperative nerve monitoring. DESIGN AND SETTING: Cohort formed by a consecutive series of patients, at a tertiary cancer hospital. METHODS: The subjects were patients who underwent thyroidectomy using intraoperative laryngeal nerve monitoring, between November 2003 and January 2006. Descriptive analysis of the results and comparison with a similar group of patients who did not undergo nerve monitoring were performed. RESULTS: A total of 104 patients were studied. Total thyroidectomy was performed on 65 patients. Vocal fold immobility (total or partial) was detected in 12 patients (6.8% of the nerves at risk) at the first postoperative evaluation. Only six (3.4% of the nerves at risk) continued to present vocal fold immobility three months after surgery. Our previous series with 100 similar patients without intraoperative nerve monitoring revealed that 12 patients (7.5%) presented vocal fold immobility at the early examination, and just 5 (3.1%) maintained this immobility three months after surgery, without significant difference between the two series. CONCLUSION: In this series, the use of intraoperative nerve monitoring did not decrease the rate of vocal fold immobility.
Assuntos
Monitorização Intraoperatória/métodos , Traumatismos do Nervo Laríngeo Recorrente , Tireoidectomia/efeitos adversos , Paralisia das Pregas Vocais/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/estatística & dados numéricos , Período Pós-Operatório , Nervo Laríngeo Recorrente/fisiologia , Paralisia das Pregas Vocais/epidemiologia , Paralisia das Pregas Vocais/etiologiaRESUMO
CONTEXT AND OBJECTIVE: Intraoperative nerve monitoring has emerged as a valuable tool to facilitate recurrent laryngeal nerve identification during thyroid surgery, thereby avoiding its injury. The aim was to evaluate vocal fold mobility in patients who underwent thyroidectomy with intraoperative nerve monitoring. DESIGN AND SETTING: Cohort formed by a consecutive series of patients, at a tertiary cancer hospital. METHODS: The subjects were patients who underwent thyroidectomy using intraoperative laryngeal nerve monitoring, between November 2003 and January 2006. Descriptive analysis of the results and comparison with a similar group of patients who did not undergo nerve monitoring were performed. RESULTS: A total of 104 patients were studied. Total thyroidectomy was performed on 65 patients. Vocal fold immobility (total or partial) was detected in 12 patients (6.8 percent of the nerves at risk) at the first postoperative evaluation. Only six (3.4 percent of the nerves at risk) continued to present vocal fold immobility three months after surgery. Our previous series with 100 similar patients without intraoperative nerve monitoring revealed that 12 patients (7.5 percent) presented vocal fold immobility at the early examination, and just 5 (3.1 percent) maintained this immobility three months after surgery, without significant difference between the two series. CONCLUSION: In this series, the use of intraoperative nerve monitoring did not decrease the rate of vocal fold immobility.
CONTEXTO E OBJETIVO: A monitorização intra-operatória de nervos surgiu como uma ferramenta valiosa para facilitar a identificação do nervo laríngeo recorrente durante a cirurgia de tireóide, evitando a sua lesão. O objetivo foi avaliar a mobilidade das pregas vocais em pacientes submetidos a tireoidectomia com monitorização intra-operatória do nervo laríngeo recorrente. TIPO E LOCAL DO ESTUDO: Coorte de uma série consecutiva de pacientes em um hospital terciário de tratamento de câncer. MÉTODOS: Pacientes foram submetidos à cirurgia de tireóide usando a monitorização intra-operatória do nervo laríngeo recorrente, entre novembro de 2003 e janeiro de 2006. Uma análise descritiva dos resultados e uma comparação com um grupo similar de pacientes que não foram submetidos a monitorização dos nervos foram realizadas. RESULTADOS: Um total de 104 pacientes foi estudado. Tireoidectomia total realizada em 65 pacientes. Imobilidade de pregas vocais (parcial ou total) foi detectada em 12 pacientes (6.8 por cento dos nervos sob risco) na primeira avaliação pós-operatória. Apenas 6 (3.4 por cento dos nervos sob risco) permaneceram com imobilidade de prega vocal três meses após a cirurgia. Nossa série prévia com 100 pacientes similares sem a monitorização intra-operatória revelou que 12 pacientes (7.5 por cento) apresentaram imobilidade de prega vocal na avaliação precoce, e apenas 5 (3.1 por cento) mantiveram a imobilidade três meses após a cirurgia, sem diferença significativa entre as séries. CONCLUSÃO: Nesta série, o uso da monitorização intra-operatória do nervo laríngeo recorrente não diminuiu a taxa de imobilidade de prega vocal.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Nervo Laríngeo Recorrente/lesões , Tireoidectomia/efeitos adversos , Paralisia das Pregas Vocais/diagnóstico , Métodos Epidemiológicos , Monitorização Intraoperatória/estatística & dados numéricos , Período Pós-Operatório , Nervo Laríngeo Recorrente/fisiologia , Paralisia das Pregas Vocais/epidemiologia , Paralisia das Pregas Vocais/etiologiaRESUMO
El documento presenta un estudio de ensayo clínico realizado en el Servicio de Anestesiología del Hospital Escuela "Dr. Oscar Danilo Rosales Argüello" en Sala de Operaciones (Quirófanos), la población de estudio fue de 108 pacientes progrmados para cirugía abdominal elecctiva, durante el periodo de marzo a noviembre del año 2005. Para el estudio se aplicaron criterios de inclusión como: Pacientes con ASA I - II, Pacientes programados para cirugía abdominal electiva bajo anestesía general, edad de 20 a 60 años. Se realizó a dos grupos de la siguiente forma: 1 er grupo se le denominó (Control) al que se le hizo diagnóstico de Hipotermia Introperatoria: 2 do. Grupo Experimental Intervención donde se hicieron medidas prevención de Hipotermia Intraoperatoría. El estudio a permitido conocer que los pacientes sometidos a cirugía electiva sin medidas de prevención de hipotermia intraoperatoria y que superaron las dos horas quirúrgicas presentaqron hipotermia intraoperatoria de forma gradual, con perdida de la temperatura corporal de 0.5 grado c- 15 grado c durante la primera hora de cirugía...
Assuntos
Temperatura Corporal , Hipotermia/classificação , Hipotermia/diagnóstico , Hipotermia/etiologia , Monitorização Intraoperatória/estatística & dados numéricos , Hipotermia/cirurgia , Hipotermia/patologia , Hipotermia/prevenção & controleRESUMO
Objetivos: Comparar la información encontrada en las fichas anestésicas tradicionales confeccionadas de puño y letra con la registrada con el sistema automático de registro anestésico utilizado por nuestro Servicio. Lugar: Hospital de Gastroenterología de Buenos Aires "Dr. Carlos Bonorino Udaondo". Material y Métodos: Se seleccionaron en forma aleatoria para su análisis 100 fichas manuales y 100 automáticas confeccionadas durante el período 1994 - 1995. Se compararon todos los datos consignados contenidos en ambos tipos de fichas y se estudiaron las variables fisiológicas de los pacientes anestesiados. Resultados: Los parámetros registrados en forma automática superan ampliamente los standards de mínima de seguridad intraoperatoria. Es mayor el número de eventos, drogas y datos del paciente documentados en el sistema automático que en las fichas manuales, no existiendo en las primeras el problema de la ilegilibilidad. Conclusión: La ficha anestésica automática resulta una herramienta de gran utilidad en la cabecera del paciente, aporta mayor información sobre lo ocurrido durante el intraoperatorio y se comporta como un elemento de documentación que facilita la defensa médico-legal del anestesiólogo involucrado en una demanda judicial.
Assuntos
Humanos , Anestesia , Processamento Eletrônico de Dados , Ficha Clínica , Interpretação Estatística de Dados , Período Intraoperatório/normas , Monitorização Intraoperatória/estatística & dados numéricos , Medicina Legal , Imperícia/legislação & jurisprudência , Sistemas Computadorizados de Registros MédicosRESUMO
Objetivos: Comparar la información encontrada en las fichas anestésicas tradicionales confeccionadas de puño y letra con la registrada con el sistema automático de registro anestésico utilizado por nuestro Servicio. Lugar: Hospital de Gastroenterología de Buenos Aires "Dr. Carlos Bonorino Udaondo". Material y Métodos: Se seleccionaron en forma aleatoria para su análisis 100 fichas manuales y 100 automáticas confeccionadas durante el período 1994 - 1995. Se compararon todos los datos consignados contenidos en ambos tipos de fichas y se estudiaron las variables fisiológicas de los pacientes anestesiados. Resultados: Los parámetros registrados en forma automática superan ampliamente los standards de mínima de seguridad intraoperatoria. Es mayor el número de eventos, drogas y datos del paciente documentados en el sistema automático que en las fichas manuales, no existiendo en las primeras el problema de la ilegilibilidad. Conclusión: La ficha anestésica automática resulta una herramienta de gran utilidad en la cabecera del paciente, aporta mayor información sobre lo ocurrido durante el intraoperatorio y se comporta como un elemento de documentación que facilita la defensa médico-legal del anestesiólogo involucrado en una demanda judicial. (AU)