Anesthesia preoperative evaluation clinic (APEC) restructuring plan for improving the quality of surgical patient flow

Introduction: Anesthesia preoperative evaluation clinics (APECs) are useful for high-risk surgical patient care, as they improve perioperative outcomes and optimize patient care flow. At Hospital de Clínicas de Porto Alegre, APEC assesses 20% of all patients undergoing surgery, showing the importance of implementing strategies to improve outpatient clinic efficiency by prioritizing high-risk patients. Methods: Using a specific quality management tool for process improvement (PDCA, which stands for Plan/Do/Check/Act), new protocols were developed for patient referral and preoperative evaluation. Clinical staff was trained in the new routines, and an electronic screening system for patient referral was adopted. Data on patient profiles, referring surgical specialties, type of surgery, and waiting times for appointment and surgical procedure were compared before and after the intervention. Results: APEC performed 1,286 appointments between 2013 and 2016, including 733 pre-intervention and 553 post-intervention. There was a significant decrease in the appointments for patients undergoing minor surgery and an increase in the appointments for those undergoing major surgery. The waiting time between referral to APEC and first APEC appointment reduced from 46 to 16 days. In addition, there was an increase in vascular, orthopedic, and urology referrals, as well as a reduction in ophthalmology and general surgery referrals. Conclusions: The PDCA method assisted with conceiving, executing, and monitoring the implemented strategies for changing the profile of patients evaluated at APEC. The major challenge is to measure the long-term impact of this intervention and expand care through specific strategies for surgical specialties and procedures.(AU)

Monitorização cardiovascular no transoperatório / Cardiovascular monitoring in transoperatory

Neste capítulo apresentaremos os principais métodos de monitorização cardiovascular no transoperatório, suas indicações e contra-indicações, além das complicações.

In this chapter we will be presented the main cardiovascular monitoring methods in intraoperative anesthesia, their indications and contraindications, along with their complications.

Monitorização do bloqueio neuromuscular / Monitoring of neuromuscular block

Tradicionalmente, o bloqueio neuromuscular é avaliado através de critérios clínicos, entretanto a melhor maneira para se estimar a recuperação de um BNM é através do uso de estímulos elétricos em nervos motores periféricos. Este artigo visa à discutir como pode ser feito o monitoramento de bloqueios neuromusculares e os benefícios alcançados com essas técnicas.

Although neuromuscular blockade (NMB) is routinely estimated using clinical criteria, the best way to assess recovery of NMB is using electrical stimulus in peripheral motor nerves. This article aims to describe how neuromuscular blockade can be monitored and the benefits of using these techniques.

Complete spontaneous thrombosis of a non-giant middle cerebral artery aneurysm: report of two cases / Trombose espontânea de aneurisma da artéria cerebral média: relato de dois casos

Spontaneous intra-aneurysmal thrombosis occurs in approximately 50% of giant intracranial aneurysms. The incidence of this process is associated to location, size, and origin, and the natural history of spontaneous thrombosis occurrence in non-giant aneurysms is rare and still unclear. We describe two non-giant middle cerebral artery (MCA) aneurysms that spontaneously thrombosed and comment the aspects of the literature.

Trombose intra-aneurismática espontânea ocorre em aproximadamente 50% dos aneurismas intracranianos gigantes. A incidência é associada a localização, tamanho e origem, e a história natural da ocorrência de trombose espontânea em aneurismas não gigantes é rara e ainda indefinida. Descrevemos dois aneurismas de artéria cerebral média com trombose espontânea e comentamos os aspectos da literatura.

Reação inflamatória após cranioplastia utilizando pericárdio bovino como substituto dural / Inflammatory reaction after cranioplasty using bovine pericardium as a dural susbstitute

Enxertos substituindo dura-máter são comumente aplicados em Neurocirurgia. O pericárdio bovino é considerado seguro e associado a raras complicações. Objetivamos mostrar caso de uma paciente com meningeoma do tubérculo selar, que apresentou uma complicação atípica após duroplastia utilizando pericárdio bovino para reconstrução da região fronto-temporal. Após dois dias de boa evolução pósoperatória, a paciente apresentou piora neurológica e a TC de crânio evidenciou hematoma intraparenquimatoso à direita, com edema peri-lesional, sendo necessária cirurgia para drenagem, e substituição do pericárdio bovino por enxerto de fáscia lata, com boa evolução pós-operatória. Pericrânio pediculado, fáscia temporal e fáscia lata constituem as mais efetivas e seguras escolhas para substituir dura-máter. Dentre os enxertos heterólogos e sintéticos utilizados, o pericárdio bovino é associado a poucas complicações. Todavia, intercorrências como reação inflamatória e infecção tem sido descritas relacionadas à substância glutaraldeído, presente neste enxerto.

Tumores intracranianos primários na infância / Primary intracranial tumors in childhood

Os tumores cerebrais da infância são a principal causa de morbimortalidade por câncer, diferindo dos tumores do sistema nervoso central nos adultos. Seu diagnóstico e tratamento evoluíram nas ultimas décadas, mas ainda há um longo caminho pela frente. Este capitulo tem o intuito de fazer uma revisão breve sobre este assunto.

Identification of candida spp. by phenotypic tests and PCR

The correct identification of Candida species is of great importance, as it presents prognostic and therapeutical significance, allowing an early and appropriate antifungical therapy. The purpose of this study was to identify isolates of Candida spp. from oral mucosa of 38 patients with oral candidosis evaluated in 2004 by phenotypic methods and PCR, discriminating C. albicans from the other Candida species. The tests used for phenotypic analysis were germ-tube and chlamydoconidia production, culture in CHROMAgarTM Candida, carbohydrate assimilation test, growth at 45ºC and culture in Tween 80 agar. Genotypic confirmation was performed by PCR. Phenotypic tests showed that 63.2 percent strains formed germ-tubes, 73.7 percent produced chlamydoconidia, and 63.2 percent showed green colonies in chromogenic medium, presumptively indicating C. albicans or C. dubliniensis. The carbohydrate assimilation test confirmed these results. A total of 21 percent strains were identified as C. krusei and 13.2 percent were indicative of C. tropicalis. Of these later strains, three produced chlamydoconidia. The association of other phenotypic tests with culture in Tween 80 agar identified 95.8 percent of strains as C. albicans and 4.2 percent as C. dubliniensis. All 24 strains indicative of C. albicans and C. dubliniensis were confirmed by PCR as C. albicans.