Complicaciones en pacientes usuarios de traqueostomía en unidades de cuidados intensivos. Scoping Review / Complications associated with tracheostomy in adult patients in intensive care units between 2015-2020. A Scoping Review / Complicações associadas à traqueostomia em pacientes adultos em unidades de terapia intensiva no período 2015-2020. Revisão sistemática

Introducción: Los procedimientos de traqueostomía van en aumento en las unidades de cuidados intensivos en el adulto, por lo que las complicaciones asociadas a este procedimiento también incrementan. Se ha identificado que la traqueostomía puede conllevar a complicaciones tanto preoperatorias como postoperatorias, que varían ampliamente entre un 5-40%, entre las más frecuentes están, estenosis traqueal, fístula traqueoesofágica, hemorragia, lesión peristomal, decanulación, infecciones, entre otras, que podrían causar la muerte hasta en 1,4% de las personas. Sin embargo, a nivel mundial muy pocos estudios abordan los conceptos causales o factores de riesgo mecánicos y no mecánicos de este importante tema. Objetivo: Revisar el alcance de la literatura científica disponible sobre las complicaciones de origen mecánico y no mecánico asociadas a la traqueostomía en pacientes adultos en las unidades de cuidados intensivos entre el periodo 2015-2020. Materiales y métodos: se establecieron la pregunta de investigación con metodología "Patient, Intervention, Comparation, Outcome, Time (PICOT)" y los criterios de inclusión para la búsqueda de los referentes bibliográficos de estudios observacionales y experimentales. La información fue consultada en las bases de datos PubMed y EBSCO y los artículos científicos seleccionados fueron los publicados entre los años 2015-2020. Como guía metodológica y de calidad para el presente estudio se utilizó la lista de chequeo PRISMA-ScR. Resultados: las complicaciones con mayor frecuencia son: sangrado 61% presentada (13/21 artículos), estenosis traqueal 28,5% (5/21 artículos), decanulación 23,6% (5/21 artículos), infección de la estoma 19% (4/21 artículos) muerte 19% (4/21) y la dificultad en la inserción de la cánula 19% (4/21 artículos), en cuanto a factores de riesgo mecánicos para éstas sólo se identifica el uso de la técnica Bjork flap (OR=0,4). Entre los no mecánicos se encontraron, obesidad (OR=5,15), diámetro de cánula >6 (OR= 2,6) y ventilación mecánica preoperatoria (OR=3,14). Conclusión:Se logró identificar que las complicaciones relacionadas con la traqueostomía con mayor incidencia son sangrado, estenosis traqueal, decanulación accidental y la muerte. Sin embargo, aún se desconoce si se originan por una causa mecánica o no mecánica durante su manejo en UCI.

Introduction:Tracheostomy procedures in intensive care units are on the rise; however, they can lead to both perioperative and postoperative complications, with a variable incidence from 5 to 40% and even death in up to 1.4% of individuals. Despite this, few studies address causal concepts or mechanical and nonmechanical risk factors about this important topic. Objetive: To review the scope of the available scientific literature on complications of mechanical and non-mechanical origin associated with a tracheostomy. Materials and Methods:The research question and inclusion criteria were established to conduct the search in PubMed and EBSCO databases between 2015 and 2020. The PRISMA-ScR checklist was used in the present study as a methodological and quality guideline. Results:The most frequent complications were bleeding 61%, tracheal stenosis 28.5%, decannulation 23.6% (5/21) , stoma infection 19%, death 19%, and difficult tracheostomy tube insertion 19%. Regarding mechanical risk factors, only the use of the Bjork flap (OR=0.4) was identified as a protective factor. Among the non-mechanical factors, obesity (OR=5.15), tube diameter >6 (OR=2.6), and preoperative mechanical ventilation (OR=3.14) were found. Conclusions: It was possible to identify that the highest incidence of tracheostomy-related complications were bleeding, tracheal stenosis, accidental decannulation, and death; however, it is still unknown whether they originate from a mechanical or non-mechanical cause during intensive care management.

Introdução: Os procedimentos de traqueostomia estão aumentando nas unidades de terapia intensiva, entretanto, podem levar a complicações perioperatórias e pós-operatórias com uma incidência variável entre 5-40% e até a morte em até 1,4% dos indivíduos, apesar disso, poucos estudos abordam os conceitos causais ou fatores de risco mecânicos e não-mecânicos sobre este importante tópico. Objetivo: Rever o escopo da literatura científica disponível sobre complicações mecânicas e não mecânicas associadas à traqueostomia. Materiais e Métodos: a questão da pesquisa e critérios de inclusão foram estabelecidos para a pesquisa nas bases de dados PubMed e EBSCO entre os anos 2015-2020, como guia metodológico e de qualidade para o presente estudo foi utilizada a lista de verificação PRISMAScR. Resultados: As complicações com maior freqüência foram, sangramento 61%, estenose traqueal 28,5%, decanulação 23,6% (5/21, infecção por estoma 19%, morte 19% e dificuldade na inserção da cânula 19%, em relação aos fatores de risco mecânico, apenas o uso da técnica de Bjork Flap (OR=0,4) foi identificado como fator de proteção, entre os fatores não mecânicos foram encontrados: obesidade (OR=5,15), diâmetro da cânula >6 (OR= 2,6) e ventilação mecânica pré-operatória (OR=3,14). Conclusões: Conseguimos identificar que as complicações relacionadas à traqueostomia com maior incidência foram sangramento, estenose traqueal, decanulação acidental e morte, no entanto, ainda não se sabe se elas se originam de uma causa mecânica ou não mecânica durante a gestão dos cuidados intensivos.

Effectiveness of levodropropizine on post-operative sore throat after endotracheal intubation for head and neck surgery: A double-blind randomized controlled trial

@#Objective: To determine the effectiveness of levodropropizine in reducing the incidence of post-operative sore throat (POST) among ear, nose, throat, head and neck (ENT-HNS) patients undergoing general endotracheal anesthesia. Methods: Design: Double-Blind, Randomized, Placebo Controlled Trial Setting: Tertiary Government Training Hospital Participants: Sixty (60) ENT-HNS patients aged between 19 to 60 years old admitted to the Southern Philippines Medical Center from January to March 2019 for surgeries on benign thyroid tumors, benign submandibular gland tumors and tonsils requiring orotracheal intubation were randomized into control and treatment groups of 30 patients each. Results: There was a statistically significant difference (p=.0016) in the incidence of POST 6 hours after surgery between control (25/30; 83%) and treatment (16/30; 53.33%) groups. However, confounders such as length and type of surgery (more females and tonsillectomy cases in the control group) were not fully eliminated by randomization. Conclusion: Perioperative levodropropizine significantly decreases the incidence of moderate (as well as mild) postoperative sore throat. It was not shown to decrease the incidence of severe sore throat. A larger cohort (adjusted for other confounders) may better describe the benefit of this treatment.

Análise das complicações de pacientes idosos no período do pós-operatório até a alta hospitalar / Analysis of complications presented by elderly patients in the post-opertive period until deischarge from hospital

Introdução: O crescimento pela demanda por serviços de saúde dentre a população idosa está diretamente relacionado ao aumento da expectativa de vida, não somente para a população brasileira, mas mundialmente. Observa-se a expansão no número de procedimentos cirúrgicos realizados em indivíduos com idade ≥ 60 anos e as complicações manifestadas por estes posteriormente a uma intervenção anestésica cirúrgica. Objetivo: Analisar as complicações apresentadas pelos pacientes idosos no período pós-operatório até a alta hospitalar. Método: Trata-se de estudo longitudinal retrospectivo com abordagem quantitativa. A amostra compõe-se de 49 prontuários referente à pacientes idosos que foram acompanhados na Sala de Recuperação Pós Anestésica no período de Junho a Setembro de 2013 em um estudo primário. A coleta dos dados desses pacientes no período em Pós- operatório - dividido em pós-operatório imediato e pós-operatório tardio até a alta hospitalar - foi realizada em prontuários de junho a agosto de 2016. Os testes Exato de Fisher, Mann-Whitney e McNemar foram utilizados para a análise estatística. Resultados: Dos 49 prontuários analisados, mais da metade (53,1%) eram do sexo feminino. A mediana da idade correspondeu a 70 anos. 67,3% foram submetidos à cirurgia na região do abdómen e pelve. O tipo de anestesia de maior percentual foi geral, com 36,7%. A classificação de risco teve 89,8% dos idosos com ASA II. A complicação secreção na Ferida Operatória demostrou correlação significativa com o tipo de anestesia e os tempos de anestesia e cirurgia. A alteração da Frequência Cardíaca também apresentou correlação significativa com o tempo de cirurgia. Marginalmente significativa às complicações hipotermia, dor e motilidade intestinal disfuncional demostraram correlação com o local da cirurgia. Ao comparar as complicações descritas no período de permanência na Sala de Recuperação Pós Anestésica nos tempos zero e 60 minutos com as do período de Pós-operatório até a alta hospitalar, apresentaram correlação significativa quanto à complicação hipertensão; hipotensão; bradipneia e hipotermia. Conclusão: Com base nos resultados expostos, é permissível constatar que as complicações presentes nos idosos no período de permanência em Sala de Recuperação Pós-Anestésica permanecem ao longo do período de Pós-operatório, em especial nas primeiras 48 horas em que o idoso se encontra na unidade de internação cirúrgica.(AU)

Introduction: The growth of the demand for health services among the elderly population is directly related to the increase in life expectancy, not only for the Brazilian population, but worldwide. One can highlight the expansion in the number of surgical procedures performed on individuals aged ≥ 60 years and the complications expressed by these to an anesthetic surgical intervention. Objective: to Analyze the complications presented by the elderly patients in the postoperative period until hospital discharge. Method: retrospective, longitudinal study, with a quantitative approach. The sample consists of 49 records pertaining to the elderly patients who were accompanied in the Post-Anesthesia Recovery Room in the period from June to September 2013 in a primary study. The data collection of these patients in the period of postoperative - divided into immediate postoperative and late post-operative period until hospital discharge - was performed on medical records from June to August of 2016. The tests Fisher's Exact, Mann-Whitney and McNemar were used for the statistical analysis. Results: Of the 49 records reviewed, more than half (53,1%) were female. The average age was 70 years. 67,3% were submitted to surgery in the region of the abdomen and pelvis. The the highest percentage type of anesthesia was general, with 36,7%. The risk rate was 89,8% of the elderly with ASA II. The complication secretion in the Surgical Wound showed a significant correlation with the type of anesthesia and the duration of anesthesia and surgery. The change of the Heart rate also showed significant correlation with the duration of the surgery. Marginally significant to the complications of hypothermia, pain and intestinal motility dysfunctional demonstrated correlation with the location of the surgery. To compare the complications described in the period of rest in the Post-Anesthesia Recovery Room in from zero to 60 minutes to the Post-operative period until hospital discharge, presented a significant correlation as to the complication of hypertension; hypotension; bradipneia and hypothermia. Conclusion: based on the results exposed, it is permissible to find that the complications present in the elderly in the period of rest in the Post-Anesthetic Recovery Room remain throughout the Postoperative period, especially in the first 48 hours in which the elderly person is in the surgical unit.(AU)

Prevention and treatment of complications after transjugular intrahepatic portosystemic shunt / 临床肝胆病杂志

The application of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of cirrhotic portal hypertension has been widely accepted both at home and abroad. This article focuses on the fatal complications of TIPS (including intraperitoneal bleeding and acute pulmonary embolism), shunt failure, and recurrent portosystemic hepatic encephalopathy, and elaborates on the reasons for such conditions and related preventive measures, in order to improve the accuracy and safety of intraoperative puncture, reduce common complications such as shunt failure and hepatic encephalopathy, and improve the clinical effect of TIPS in the treatment of cirrhotic portal hypertension.

Anestesia para colecistectomia videolaparoscópica em paciente portador de doença de Steinert: relato de caso e revisão de literatura / Anesthesia for videolaparoscopic cholecystectomy in a patient with Steinert disease: case report and review of the literature / Anestesia para colecistectomía videolaparoscópica en oaciente oortador de enfermedad de Steinert: relato de caso y revisión de la literatura

JUSTIFICATIVA E OBJETIVOS: As distrofias miotônicas são doenças neuromusculares de transmissão autossômica dominante. Dentre elas, a distrofia miotônica tipo 1 (DM1), ou doença de Steinert, é a mais comum no adulto e, além do envolvimento muscular, apresenta manifestações sistêmicas importantes. A DM1 representa um desafio para o anestesiologista. Os pacientes apresentam maior sensibilidade às drogas anestésicas e complicações, principalmente cardíacas e pulmonares. Além disso, há a possibilidade de apresentarem hipertermia maligna e crise miotônica. Descreveu-se o caso de um paciente que teve complicação pulmonar importante após ser submetido à anestesia geral. RELATO DO CASO: Paciente de 39 anos, portador de DM1, foi submetido à anestesia geral para colecistectomia videolaparoscópica. A anestesia foi venosa total com propofol e remifentanil e rocurônio. O procedimento cirúrgico de 90 minutos não apresentou intercorrências, mas após a extubação o paciente apresentou insuficiência respiratória e crise miotônica, que tornou a intubação traqueal impossível. Utilizou-se a máscara laríngea, que possibilitou a oxigenação adequada, e a ventilação mecânica foi mantida até a recuperação total da atividade respiratória. Evolução ocorreu sem outras complicações. CONCLUSÕES: A DM1 é uma doença que apresenta várias peculiaridades para o anestesiologista. O conhecimento minucioso do seu envolvimento sistêmico, associado à ação diferenciada das drogas anestésicas nesses pacientes, proporcionará um ato anestésicocirúrgico mais seguro.

BACKGROUND AND OBJECTIVES: Myotonic dystrophies are autosomal dominant neuromuscular diseases. Among them, myotonic dystrophy type 1 (MD1), or Steinert disease, is the most common in adults, and besides muscular involvement it also has important systemic manifestations. Myotonic dystrophy type 1 poses a challenge to the anesthesiologist. Those patients are more sensitive to anesthetics and prone to cardiac and pulmonary complications. Besides, the possibility of developing malignant hyperthermia and myotonic episodes is also present. CASE REPORT: This is a 39-year old patient with DM1 who underwent general anesthesia for videolaparoscopic cholecystectomy. Total intravenous anesthesia with propofol, remifentanil, and rocuronium was the technique chosen. Intercurrences were not observed in the 90-minute surgical procedure, but after extubation, the patient developed respiratory failure and myotonia, which made tracheal intubation impossible. A laryngeal mask was used, allowing adequate oxygenation, and mechanical ventilation was maintained until full recovery of the respiratory function. The patient did not develop further complications. CONCLUSIONS: Myotonic dystrophy type 1 presents several particularities to the anesthesiologist. Detailed knowledge of its systemic involvement along with the differentiated action of anesthetic drugs in those patients will provide safer anesthetic-surgical procedure.

JUSTIFICATIVA Y OBJETIVOS: Las distrofias miotónicas son enfermedades neuromusculares de transmisión autosómica dominante. Entre ellas está la distrofia miotónica tipo 1 (DM1), o enfermedad de Steinert, que es la más común en el adulto y además de la involucración muscular, presenta manifestaciones sistémicas importantes. La DM1 representa un reto para el anestesiólogo. Los pacientes presentan una mayor sensibilidad a los fármacos anestésicos y complicaciones, principalmente cardíacas y pulmonares. Además de eso, existe la posibilidad de presentar hipertermia maligna y crisis miotónica. Se ha descrito el caso de un paciente que tuvo una complicación pulmonar importante después de haber sido sometido a la anestesia general. RELATO DEL CASO: Paciente de 39 años, portador de DM1, sometido a la anestesia general para colecistectomía videolaparoscópica. La anestesia fue venosa total con propofol y remifentanil y rocuronio. El procedimiento quirúrgico de 90 minutos no presentó intercurrencias, pero después de la extubación, el paciente presentó insuficiencia respiratoria y crisis miotónica, que hizo la intubación traqueal imposible. Se utilizó la máscara laríngea, que posibilitó la oxigenación adecuada, y la ventilación mecánica se mantuvo hasta la recuperación total de la actividad respiratoria. Evolucionó sin otras complicaciones. CONCLUSIONES: La DM1 es una enfermedad que presenta varias peculiaridades para el anestesiólogo. El conocimiento minucioso de su involucración sistémica, asociado a la acción diferenciada de los fármacos anestésicos en esos pacientes, proporcionará un acto anestésico-quirúrgico más seguro.

Prevention of complications of video-assisted thoracoscopic surgery / 中华胸心血管外科杂志

Objective To retrieval the ways of prevent complications of video-assisted thoracoscopic surgery. Methods The operation included bullectomy in 462 patients, resection of mediastinal tumor or cyst in 86; esophageal diseases in 94, lobectomy or wedge resection of lung in 140, VATS hemostasis in 22, partial pericardial or pleural excision in 54 and biopsy for undetermined chest diseases in 54. Combined anesthesia with intubations of double lumen tracheal tube was performed in 866 patients and single-lumen tracheal tube in 46. Results 886 operations were completed by VATS, and 26cases were converted into thoracotomy for various reasons. Complications occurred in 36 patients (3.95%), including 10 cases occurred during the operation (esophageous mucous rupture in 4, nerve injury in 2 and insufficient hemostasis leading to postoperative bleeding in 4). 26 cases (2.85%) developed complications postoperatively, including persistent air leak (≥7 days) in 19, pleural effusion making a second water-sealed drainage necessary in 3, atrial fibrillation in 2 and infection in 1. One died for respiratory failure on the fifth postoperative day. Conclusion VATS experience should be gained systematically. In order to reduce the complications, more attentions must be paid to training of the thoracic surgeons in order to master the skill and the correlated knowledge of VATS.

Surgical management of the complications after endoscopic sphincterotomy / 中国普通外科杂志

ObjectiveTo review surgical management of the complications caused by iatrogenic endoscopic sphincterotomy(EST).MethodsEleven patients with complications of EST were surgically treated, including 4 patients with hemorrhage, 3 patients with perforation, 3 patients with perforation plus hemorrhage, and one patient with perforation plus severe pancreatitis. ResultsTwo patients with perforation plus hemorrhage and the patient with perforation plus severe pancreatitis died, other patients survived.ConclusionEarly diagnosis and surgical intervention was very important to lower the mortality. For patients suffering from perforation and hemorrhage or pancreatitis, it′s very important to make an unobstructed peritoneal drainage as well as other maneuvers.

Early diagnosis of vascular complications following orthotopic liver transplantation / 中国普通外科杂志

ObjectiveTo establish early diagnosis of vascular complications following orthotopic liver transplantation (OLT).MethodsThe surveillance and diagnosis making of vascular complications in 53 cases of OLT patients from April 1990 to June 2000 were carried out by color Doppler imaging (CDI), selective-angiography and analyzing relevant clinical features.ResultsThe incidence of vascular complication after OLT is 15%(8/53) including 3 cases of hepatic artery thrombosis, 2 of hepatic artery stenosis, 1 of celiac artery stenosis, and 2 of inferior vena cava stenosis. Diagnosis was confirmed by selective angiography in 7 cases and by autopsy in one. The sensitivity and specificity of CDI were 100%(8/8) and 98% (45/46) respectively. Conclusions Clinical feature of vascular complications following OLT lacks specificity. Continuous monitoring using CDI is a sensitive and specific method in the detection and diagnosis of vascular complications.Duration of surveillance should be no less than 2 months.

Status Epilepticus Following General Anesthesia in an Unrecognized Epilepsy Patient / 대한마취과학회지

Epileptic patients, who may be deprived of antiepileptic medication, are subject to stimuli that can result in seizures in the postoperative period. Status epilepticus is defined as a continuous seizure that lasts more than 30 minutes or serial seizures in which the patient does not regain a premorbid level of consciousness. Status epilepticus is considered a serious neurologic emergency that requires immediate recognition and prompt treatment to avoid life-threatening complications. We report a case in which status epilepticus developed unexpectedly after several recurrences of generalized convulsions on a 39 year old man who underwent the emergency repair of a bladder perforation. We should consider the influence of poor antiepileptic drug compliance on the precipitation of epileptic seizures when planning anesthesia for epileptic patients.

Detection of Lumbar Disc Herniation after General Anesthesia: A case report / 대한마취과학회지

Reports of neural and non-neural injury associated with anesthesia have appeared in the medical literature. The majority of these injuries were due to improper patient positioning on the operating table and mostly correlated with the duration of surgery. We observed a case of lumbar disc herniation that was detected after general anesthesia in the traditional supine position. A 34-year-old woman underwent an operation for removal of uterine myoma. She complained of newly developed severe back pain that radiated down the lower right leg. HIVD L4~5 confirmed by lumbar MRI at POD 4th. We felt the cause of HIVD was related to the supine position or preexisting back pain with HIVD was exacerbated during surgery. This is possible to be prevented by evaluating the patient's postural limitation during the visit before anesthesia, padding under lumbar area and a more appropriate position to suit the patient needs for example, Lawn-chair position. The patient was treated with epidural injection of steroid at pain clinic.

Detection of Lumbar Disc Herniation after General Anesthesia: A case report / 대한마취과학회지

Reports of neural and non-neural injury associated with anesthesia have appeared in the medical literature. The majority of these injuries were due to improper patient positioning on the operating table and mostly correlated with the duration of surgery. We observed a case of lumbar disc herniation that was detected after general anesthesia in the traditional supine position. A 34-year-old woman underwent an operation for removal of uterine myoma. She complained of newly developed severe back pain that radiated down the lower right leg. HIVD L4~5 confirmed by lumbar MRI at POD 4th. We felt the cause of HIVD was related to the supine position or preexisting back pain with HIVD was exacerbated during surgery. This is possible to be prevented by evaluating the patient's postural limitation during the visit before anesthesia, padding under lumbar area and a more appropriate position to suit the patient needs for example, Lawn-chair position. The patient was treated with epidural injection of steroid at pain clinic.

Complication and its Prevention during the Treatment of Femoral Shaft Fracture with Interlocking Intramedullary Nail / 中华骨科杂志

Objective: In order to popularize the use of interlocking nail, the authors reviewed 81 femoral shaft fractures in 80 patients who were treated with interlocking nail from July 1988 to October 1997. Material and Method: There are 60 males and 20 females. Forty-one fractures were of left femur and 40 of right. The average age was 33 years(range 15-79 years) . Results: The results showed that 60 cases of fractures that followed up over half a year had bony union. The complications included one bone union failure due to incorrect indication. two fractures during the operation, misinserting the proximal screw in 2, and misinserting the distal screw in 3, lengthening of the extremity in 2, valgus knee in 2, deep infection in 1, delayed infection in 1, nail broken in 3, proximal screw broken in 1, distal screw broken in 1, distal screw loosening in 2. Conclusion: 1) The indication must be correctly chosen. 2) Well-trained operative technique for interlocking nail is necessary to reduce the compli cation. 3 )The patient with old or comminuted fracture fixed with G - K nail should properly delay the time to start weight bearing.

The Effect of Deep Breathing Exercise and Incentive Spirometry to Prevent Postoperative Pulmonary Complications after Abdominal Surgery in Geriatric Patients / 대한마취과학회지

BACKGROUND: The purpose of this clinical study was to evaluate the Incentive Spirometry (IS) and Deep Breathing Exercises (DBE) to prevent postoperative pulmonary complications after abdominal surgery in patients over 60 years of age. METHODS: We prospectively randomized 90 patients into 1 of 3 groups: the control group (30 patients) received no respiratory treatment, the IS group (30 patients) was treated with incentive spirometry 4 times daily and DBE group (30 patients) carried out deep breathing exercises under supervision for 15 min 4 times daily. ABGA was taken at ward, PR (preop.room), RR (recovery room), POD1 day and POD2 day. Roentgenographic changes observed at 24 h. and 48 h. after surgery. Pulmonary complications were defined as the development of 3 or more of 6 new findings: cough, sputum, dyspnea, chest discomfort, temperature greater than 38oC, pulse rate more than 100 beats/min. RESULTS: PaO2 in the DBE group and IS group at PR were significantly increased than the values at ward, and the values of the PaO2 in the DBE group at RR and POD1 day, and those of IS group at PR and POD2 day were significant higher than those of the control group (p<0.05). The frequency of development of pulmonary complications (43.3% in the control group, 20% in the DBE group, 20% in the IS group) and roentgenographic changes were comparable in the 3 groups (26.7%, 16.7%, 20% respectively). The DBE group showed the different incidence of postoperative pulmonary complications between upper and lower abdominal surgery (upper: lower= 35.7: 6.3%). CONCLUSIONS: We concluded that DBE and IS were effective in preventing postoperative pulmonary complications after abdominal surgery and lower abdominal surgery causes lesser postoperative pulmonary complications than upper abdominal surgery.

Postoperative Severe Hemorrhage Due to Disseminated Intravascular Coagulation: A case report / 대한마취과학회지

Disseminated intravascular coagulation (DIC) is a pathological syndrome in which activation of coagulation cascade leads to fibrin clot formation, consumption of platelets and coagulation factors, and secondary fibrinolysis. We report a case of severe postoperative hemorrhagic diathesis due to DIC. A 59-year-old man was scheduled for reduction of tibia fracture and anatrophic nephrolithotomy of staghorn calculi. On the fifth postoperative day, second operation was performed for nephrectomy due to perirenal hematoma. Two days later, third operation was performed for hemostasis because of the continuous bleeding. Coagulation tests showed positive DIC profiles of thrombocytopenia, hypofibrinogenemia, increased fibrin degradation products, and prolonged prothrombin time and thrombin time. The patient recovered uneventfully and discharged on the 59th postoperative day.

Pulmonary Thromboembolism Developed in Recovery Period of upper Abdominal Surgery: Case report / 대한마취과학회지

Pulmonary thromboembolism (PTE) is a serious postoperative complication. Prompt diagnosis of PTE is important but it is difficult because clinical manifestations of PTE are not obvious in most cases. A 59 year-old woman received cholecystectomy and choledocholithotomy under general anesthesia. At the 9th postoperative day, syncope, hypoxemia and hypotension were developed suddenly and the patient was transfered to intensive care unit. PTE was suspected with hemodynamic monitoring from pulmonary arterial catheter and echocardiography and diagnosed with lung perfusion scan and venogram of lower extremities. Proper cardiopulmonary support was done and the patient was recovered and discharged in improved condition. In conclusion, if a patient have syncopal attack with shock in postoperative period, PTE must be thought to be an one of possible causes of syncope and thoroughly investigated.