RESUMO
Background: Several pulmonary and hemodynamic complications may occur during mechanical ventilation of the lungs. The use of a positive end-expiratory pressure (PEEP) can improve oxygenation and prevent atelectasis, although this method can cause important hemodynamic side effects. Mostly, these hemodynamic effects are due to increased airway pressure that is transferred to the intrapleural space, increasing the intrathoracic pressure, which decreases venous return to the heart. Cardiac output is significantly reduced with high PEEP levels which in turn precludes the improvement effects on blood oxygenation. The aim of this study was to evaluate hemodynamic and respiratory effects of different levels of carbon dioxide insufflations associated with different levels of PEEP under conventional two-lung ventilation in isoflurane anesthetized pigs.Materials, Methods & Results: Twelve juvenile pigs were anesthetized with ketamine and midazolam, and end tidal isoflurane 2.0 V% for maintenance. Animals were submitted to tension pneumothorax through an acute intrathoracic insufflation with carbon dioxide at 0, 5, and 10 mmHg. Mechanical lung ventilation with 100% oxygen was started with zero PEEP then increased to 5 and 10 cmH2 O. Ventilatory, respiratory and hemodynamic parameters were measured, as well as blood gases. Tension pneumothorax of 10 mmHg, with both PEEP levels, induced...
Assuntos
Animais , Hemodinâmica , Pneumotórax Artificial/veterinária , Respiração com Pressão Positiva/veterinária , Suínos , IsofluranoRESUMO
Background: Several pulmonary and hemodynamic complications may occur during mechanical ventilation of the lungs. The use of a positive end-expiratory pressure (PEEP) can improve oxygenation and prevent atelectasis, although this method can cause important hemodynamic side effects. Mostly, these hemodynamic effects are due to increased airway pressure that is transferred to the intrapleural space, increasing the intrathoracic pressure, which decreases venous return to the heart. Cardiac output is significantly reduced with high PEEP levels which in turn precludes the improvement effects on blood oxygenation. The aim of this study was to evaluate hemodynamic and respiratory effects of different levels of carbon dioxide insufflations associated with different levels of PEEP under conventional two-lung ventilation in isoflurane anesthetized pigs.Materials, Methods & Results: Twelve juvenile pigs were anesthetized with ketamine and midazolam, and end tidal isoflurane 2.0 V% for maintenance. Animals were submitted to tension pneumothorax through an acute intrathoracic insufflation with carbon dioxide at 0, 5, and 10 mmHg. Mechanical lung ventilation with 100% oxygen was started with zero PEEP then increased to 5 and 10 cmH2 O. Ventilatory, respiratory and hemodynamic parameters were measured, as well as blood gases. Tension pneumothorax of 10 mmHg, with both PEEP levels, induced...(AU)
Assuntos
Animais , Suínos , Hemodinâmica , Respiração com Pressão Positiva/veterinária , Pneumotórax Artificial/veterinária , IsofluranoRESUMO
INTRODUCTION: Carbon dioxide pneumothorax is a rare complication in laparoscopic urology, but with the widespread use of laparoscopy and the increasing surgical pathologies managed by this technique this infrequent complication has become a potential risk. MATERIALS AND METHODS: A total of 786 laparoscopic transperitoneal urologic operations were reviewed at our institution. All procedures were performed by the same surgeon and included 213 adrenalectomies, 181 simple nephrectomies, 143 lymphadenectomies, 118 radical nephrectomies, 107 partial nephrectomies and 24 nephroureterectomies. Mean patient age was 53.2 years (range 24 to 70). Mean BMI was 28.15 Kg/m2 (range 20 to 48.9). RESULTS: A total of 6 cases (0.7%) of diaphragmatic injury were found. All reported patients had additional factors that may have contributed to diaphragmatic injury. Diaphragmatic repair was always carried out by intracorporeal suturing and only one case required chest tube placement. All patients evolved uneventfully. CONCLUSIONS: Repair of diaphragmatic injuries should always be attempted with intracorporeal suture since this is a feasible, reproducible and reliable technique.
Assuntos
Diafragma/lesões , Complicações Intraoperatórias/cirurgia , Laparoscopia/métodos , Pneumotórax Artificial/efeitos adversos , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Adulto , Idoso , Dióxido de Carbono , Diafragma/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
INTRODUCTION: Carbon dioxide pneumothorax is a rare complication in laparoscopic urology, but with the widespread use of laparoscopy and the increasing surgical pathologies managed by this technique this infrequent complication has become a potential risk. MATERIALS AND METHODS: A total of 786 laparoscopic transperitoneal urologic operations were reviewed at our institution. All procedures were performed by the same surgeon and included 213 adrenalectomies, 181 simple nephrectomies, 143 lymphadenectomies, 118 radical nephrectomies, 107 partial nephrectomies and 24 nephroureterectomies. Mean patient age was 53.2 years (range 24 to 70). Mean BMI was 28.15 Kg/m2 (range 20 to 48.9). RESULTS: A total of 6 cases (0.7 percent) of diaphragmatic injury were found. All reported patients had additional factors that may have contributed to diaphragmatic injury. Diaphragmatic repair was always carried out by intracorporeal suturing and only one case required chest tube placement. All patients evolved uneventfully. CONCLUSIONS: Repair of diaphragmatic injuries should always be attempted with intracorporeal suture since this is a feasible, reproducible and reliable technique.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diafragma/lesões , Complicações Intraoperatórias/cirurgia , Laparoscopia/métodos , Pneumotórax Artificial/efeitos adversos , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Dióxido de Carbono , Diafragma/cirurgia , Laparoscopia/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
OBJECTIVE: To report initial experience with myocardial revascularization surgery (MRS) performed on patients who were totally awake and without an endotracheal tube. METHODS: Between January 1994 and May 2001, 272 patients underwent MRS without extracorporeal circulation. In 24, the operations were performed without the use of an endotracheal tube and with the patients totally awake and breathing normally. The age ranged from 51-75 years with the predominant male sex. Epidural thoracic administrations of the anesthesia was performed. Surgery was performed through a habitual anterolateral thoracotomy. During the entire procedure, the left lung remained partially collapsed. RESULTS: The 24 patients progressed well through the surgery. Pneumothorax time ranged from 70-190 minutes. No electrocardiographic, echocardiographic, or enzymatic alterations occurred that characterized pre- and postoperative infarcts. Twenty-three patients were stable enough to be released after 24 hours. CONCLUSION: This technique could be performed on an large number of selected patients. However, more experience is necessary.
Assuntos
Anestesia Epidural/métodos , Revascularização Miocárdica/métodos , Toracotomia , Idoso , Assistência Ambulatorial , Feminino , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Pneumotórax Artificial , Fatores de Tempo , Resultado do TratamentoRESUMO
En los últimos 30 años, la ventilación mecánica ha sido un instrumento indispensable en el manejo de la insuficiencia respiratoria. No obstante, la ventilación mecánica per se también puede iniciar o exacerbar una lesión pulmonar, contribuyendo a la morbimortalidad del paciente. Esta revisión trata de examinar los mecanismos por los cuales se puede producir lesión inducida por la ventilación mecánica incluyendo aquellos que afectan la pared alveolar así como los más recientemente descritos que involucran mediadores celulares que pueden provocar lesión pulmonar.
Assuntos
Animais , Barotrauma/epidemiologia , Barotrauma/mortalidade , Interleucina-1 , Monitorização Fisiológica/métodos , Neutrófilos/patologia , Pulmão/lesões , Edema Pulmonar/etiologia , Respiração Artificial/efeitos adversos , Síndrome do Desconforto Respiratório/fisiopatologia , Ventilação de Alta Frequência/efeitos adversos , Animais de Laboratório , Pneumotórax Artificial/efeitos adversosRESUMO
En los últimos 30 años, la ventilación mecánica ha sido un instrumento indispensable en el manejo de la insuficiencia respiratoria. No obstante, la ventilación mecánica per se también puede iniciar o exacerbar una lesión pulmonar, contribuyendo a la morbimortalidad del paciente. Esta revisión trata de examinar los mecanismos por los cuales se puede producir lesión inducida por la ventilación mecánica incluyendo aquellos que afectan la pared alveolar así como los más recientemente descritos que involucran mediadores celulares que pueden provocar lesión pulmonar. (AU)
Assuntos
Animais , Respiração Artificial/efeitos adversos , Pulmão/lesões , Barotrauma/epidemiologia , Barotrauma/mortalidade , Ventilação de Alta Frequência/efeitos adversos , Síndrome do Desconforto Respiratório/fisiopatologia , Edema Pulmonar/etiologia , Monitorização Fisiológica/métodos , Neutrófilos/patologia , Interleucina-1 , Pneumotórax Artificial/efeitos adversos , Animais de LaboratórioRESUMO
La parálisis diafragmática traumática secundaria al drenaje pleural para la evacuación de un neumotórax hipertensivo es una rara complicación pero que debe ser tenida en cuenta ya que agrava la insuficiencia respiratoria del paciente, prolonga el tiempo de asistencia respiratoria e incrementa los riesgos relacionados a internaciones prolongadas. Es importante la comprobación de la ubicación del catéter en la radiografía post drenaje y la inmediata corrección de la misma en caso que ésta sea inadecuada. Si se comprueba paresia/parálisis diafragmática debe colocarse al paciente en Trendelenburg invertido. De persistir la parálisis la consulta quirúrgica determinará la oportunidad y beneficio de la plicatura.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Diafragma , Drenagem Postural/efeitos adversos , Doença da Membrana Hialina/complicações , Nervo Frênico/lesões , Pneumotórax Artificial/efeitos adversos , Paresia , Paralisia Respiratória , Toracotomia , Hipertensão , Recém-Nascido de muito Baixo Peso , Respiração ArtificialRESUMO
La parálisis diafragmática traumática secundaria al drenaje pleural para la evacuación de un neumotórax hipertensivo es una rara complicación pero que debe ser tenida en cuenta ya que agrava la insuficiencia respiratoria del paciente, prolonga el tiempo de asistencia respiratoria e incrementa los riesgos relacionados a internaciones prolongadas. Es importante la comprobación de la ubicación del catéter en la radiografía post drenaje y la inmediata corrección de la misma en caso que ésta sea inadecuada. Si se comprueba paresia/parálisis diafragmática debe colocarse al paciente en Trendelenburg invertido. De persistir la parálisis la consulta quirúrgica determinará la oportunidad y beneficio de la plicatura.(AU)