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Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management.
Tedde, Miguel L; Vasconcelos Filho, Paulo; Hajjar, Ludhmila Abrahão; de Almeida, Juliano Pinheiro; Flora, Gustavo Fagundes; Okumura, Erica Mie; Osawa, Eduardo A; Fukushima, Julia Tizue; Teixeira, Manoel Jacobsen; Galas, Filomena Regina Barbosa Gomes; Jatene, Fabio Biscegli; Auler, José Otávio Costa.
Afiliação
  • Tedde ML; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), Thoracic Surgery Department, São Paulo/SP, Brazil. tedde@usp.br
Clinics (Sao Paulo) ; 67(11): 1265-9, 2012 Nov.
Article em En | MEDLINE | ID: mdl-23184201
OBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov: NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Marca-Passo Artificial / Respiração Artificial / Traumatismos da Medula Espinal / Diafragma / Terapia por Estimulação Elétrica / Implantação de Prótese / Anestesia Tipo de estudo: Clinical_trials Aspecto: Patient_preference Limite: Adolescent / Adult / Female / Humans / Male Idioma: En Revista: Clinics (Sao Paulo) Assunto da revista: MEDICINA Ano de publicação: 2012 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos
Texto completo
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XML
PubMed Links
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Marca-Passo Artificial / Respiração Artificial / Traumatismos da Medula Espinal / Diafragma / Terapia por Estimulação Elétrica / Implantação de Prótese / Anestesia Tipo de estudo: Clinical_trials Aspecto: Patient_preference Limite: Adolescent / Adult / Female / Humans / Male Idioma: En Revista: Clinics (Sao Paulo) Assunto da revista: MEDICINA Ano de publicação: 2012 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos