ABSTRACT
The care of patients with coronary stents in the perioperative period of non-cardiac surgery requires anesthesiologists, surgeons and cardiologists. The management of dual antiplatelet therapy should be handled depending on type and urgency of the surgery, the risk of bleeding, type of coronary stent implanted, time from placement and the risk of stent thrombosis. For patients identified as high risk of stent thrombosis, surgery should be planned at hospitals with cardiac catheterization facilities. These patients require postoperative monitoring and antiplatelet therapy should be restarted immediately. Stent thrombosis should be recognized early and treated aggressively with percutaneous coronary intervention.
Subject(s)
Humans , Hemorrhage/prevention & control , Stents , Surgical Procedures, Operative/adverse effects , Thrombosis/prevention & control , Perioperative Care/methods , Platelet Aggregation Inhibitors/therapeutic use , Risk FactorsABSTRACT
Pulmonary hypertension is a clinical condition with a low prevalence, but carries high morbidity and mortality. Important advances in the understanding of this disease and in its therapy have occurred. A particular scenario is pulmonary hypertension in patients undergoing non-cardiac as well as cardiac surgery. The aim of this review is to present information that may allow diagnostic and therapeutic approaches of this clinical condition in patients undergoing surgery.
Subject(s)
Humans , Antihypertensive Agents/therapeutic use , Hypertension, Pulmonary/therapy , Surgical Procedures, Operative , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/physiopathology , Postoperative Period , Preoperative Period , Risk Factors , Elective Surgical ProceduresABSTRACT
Recombinant activated factor VII (rFVIIa) is a new haemostatic drug, originally used for the treatment of patients with hemophilia A and B. At the present time it is used for other bleeding conditions such as the perioperative period. When used prophylactically there is a reduction in the number of bleeding episodes but no changes in the need for blood transfusion or other blood products. The adverse effects are arterial or venous thromboembolic events that are mostly related to the severity of the underlying disease of the patient and the concurrent administration of other haemostatic agents, rather than the use of rFVIIa. Its use is recommended when there is a persistent bleeding after the reposition of blood products and when surgical causes of bleeding have been discarded. The cost of the medication should also be considered before its use.