Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

Introduction Fluorescence guidance with 5-aminolevulinic acid (5-ALA) is a safe and reliable tool in total gross resection of intracranial tumors, especially malignant gliomas and cases of metastasis. In the present retrospective study, we have analyzed 5-ALA-induced fluorescence findings in different central nervous system (CNS) lesions to expand the indications of its use in differential diagnoses. Objectives To describe the indications and results of 5-ALA fluorescence in a series of 255 cases. Methods In 255 consecutive cases, we recorded age, gender, intraoperative 5-ALA fluorescence tumor response, and 5-ALA postresection status, as well the complications related to the method. Postresection was classified as '5-ALA free' or '5-ALA residual'. The diagnosis of histopathological tumor was established according to the current classification of the World Health Organization (WHO). Results There were 195 (76.4%) 5-ALA positive cases, 124 (63.5%) of whom underwent the '5-ALA free' resection. The findings in the positive cases were: 135 gliomas of all grades; 19 meningiomas; 4 hemangioblastomas; 1 solitary fibrous tumor; 27 metastases; 2 diffuse large B cell lymphomas; 2 cases of radionecrosis; 1 inflammatory disease; 2 cases of gliosis; 1 cysticercosis; and 1 immunoglobulin G4-related disease.

Assistência de enfermagem no uso da eletrocirurgia: revisão integrativa / Nursing care in electrosurgery: integrative review / El cuidado de enfermería en el uso de la electrocirugía: una revisión integradora

Objetivo: Identificar o conhecimento científico produzido sobre os cuidados de enfermagem relacionados ao uso da eletrocirurgia no período intraoperatório. Método: Revisão integrativa, realizada nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) e na biblioteca virtual Scientific Electronic Library Online (SciELO), por meio dos descritores "eletrocirurgia", "cuidados de enfermagem" e "recuperação pós-cirúrgica melhorada", correlacionados pelo operador booleano and, nos idiomas português, inglês, espanhol e francês. Dos 213 estudos encontrados, sete compuseram a amostra. Utilizou-se o software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), por meio dos métodos de análise lexical e de similitude. Para a análise da qualidade metodológica, aplicou-se o nível de evidência científica, segundo recomendações da Agency for Healthcare Research and Quality (AHRQ). Resultados: Destacam-se publicações entre 2010 e 2012, com nível de evidência V, indexadas nas bases de dados LILACS e CINAHL. Verificaram-se, na nuvem de palavras, termos com maior frequência relativa: "paciente" (n=14); "risco cirúrgico" (n=12); "eletrocirurgia" (n=10); "enfermeiro" (n=8); "conhecimento" (n=6), "cuidado" (n=6) e "prevenção" (n=5). Feita a análise de similitude, identifica-se um leque semântico de palavras mais frequentes. Conclusão: Evidencia-se escassez de estudos, na literatura, com informações significativas para agregação de conhecimentos e construção de novos trabalhos.

Objective: To identify the scientific knowledge produced under the care of nursing related to the use of electrosurgery in the intraoperative period. Method: Integrative review based on the databases: Latin American and Caribbean Health Sciences Literature (LILACS), PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and in the virtual library Scientific Electronic Library Online (SciELO), using the descriptors "electrosurgery", "nursing care" and "enhanced recovery after surgery", correlated by the Boolean operator and, in Portuguese, English, Spanish and French. Of the 213 studies we found, seven composed the sample. We used the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ) software, through methods of lexical analysis and similitude. For the analysis of methodological quality, we applied the scientific level of evidence, according to recommendations from the Agency for Healthcare Research and Quality (AHRQ). Results: The publications of 2010 to 2012 stand out, with level of evidence V, indexed in LILACS and CINAHL. In the word cloud, we observed the following terms had higher relative frequency: "patient"(n=14); "surgical risk" (n=12); "electrosurgery" (n=10); "nurse" (n=8); "knowledge" (n=6); "care" (n=6); and "prevention" (n=5). After the similitude analysis, we identified the semantic range of more frequent words. Conclusion: There are a few studies in the literature with significant information to aggregate knowledge and build new analyses.

Objetivo: Identificar el conocimiento científico producido sobre la atención de enfermería relacionada con el uso de electrocirugía en el período intraoperatorio. Método: Revisión integradora, realizada en las bases de datos LILACS, PubMed, CINAHL y en la biblioteca virtual SciELO, a través de los descriptores Electrocirugía, Atención de enfermería y Recuperación posquirúrgica mejorada, correlacionados por el operador booleano and, en portugués, inglés, español y francés. Siete de los 213 estudios encontrados compusieron la muestra. Se utilizó el software IRAMUTEQ, mediante los métodos de análisis léxico y de similitud. Para el análisis de la calidad metodológica se aplicó el nivel de evidencia científica, según las recomendaciones de la Agency for Healthcare Research and Quality (AHRQ). Resultados: Destacan las publicaciones entre 2010 y 2012, con nivel de evidencia V, indexadas en las bases de datos LILACS y CINAHL. En la nube de palabras se encontró términos con mayor frecuencia relativa: Paciente (n=14); Riesgo quirúrgico (n=12); Electrocirugía (n=10); Enfermero (N=08); Conocimiento (N=6), Atención (N=6) y Prevención (n=5). Se identifica un rango semántico de palabras más frecuentes a partir del análisis de similitud. Conclusión: Se demostró la escasez de estudios en la literatura, con información significativa para la agregación del conocimiento y la construcción de nuevas obras.

Necesidad y tipo de tratamiento en cirugía bucomaxilofacial durante la pandemia por COVID-19 en un servicio de urgencias odontológicas del AMBA / Need and type of treatment in maxillofacial surgery during the COVID-19 pandemic in a dental emergency department in the AMBA

Objetivo: Analizar y describir los requerimientos de atención quirúrgica bucomaxilofacial de urgencia en el Servicio de Urgencias Odontológicas y Orientación de Pacientes de la Facultad de Odontología de la Universidad de Buenos Aires durante el aislamiento social preventivo y obligatorio por la pandemia de COVID-19. Materiales y métodos: Se realizó un estudio observacional descriptivo de análisis retrospectivo durante el período de aislamiento social preventivo y obligatorio inicial de 93 días, comprendido entre el 20 de marzo y el 20 de junio de 2020. Se evaluó la totalidad de historias clínicas de los pacientes que acudieron al Servicio de Urgencias Odontológicas y Orientación de Pacientes de la Facultad de Odontología de la Universidad de Buenos Aires y se caracterizó a aquellos que requerían distintos tipos de tratamiento quirúrgico bucal y maxilofacial. Resultados: Durante el período estudiado, se atendieron 4564 pacientes, de los cuales 1337 (29,3%) requirieron tratamientos quirúrgicos como terapéutica para la resolución de la urgencia. De estos, el 93,2% fueron exodoncias de piezas erupcionadas o retenidas; el 1,7%, biopsias quirúrgicas; el 2,4%, tratamientos agudos de infecciones que involucran espacios anatómicos vecinos; el 0,8%, resolución de traumatismos en los maxilares, y el 1,9%, tratamientos de complicaciones posquirúrgicas. Conclusión: Los resultados ponen de relieve la necesidad de disponer de servicios de guardia odontológica en el ámbito del AMBA que cuenten con recursos humanos calificados y entrenados para resolver urgencias de tipo quirúrgico

Aim: The objective of this study was to analyze and describe the requirements for the emergency care of oral and maxillofacial surgical treatment in the emergency dental department of the School of Dentistry of the University of Buenos Aires during the Preventive and Mandatory Social Isolation. Materials and methods: We conducted a retrospective analysis of a descriptive observational study during the initial period of 93 days of Preventive and Compulsory Social Isolation, from March 20, 2020 to June 20, 2020. All the medical records of the patients who attended the emergency dental department of the School of Dentistry of the University of Buenos Aires were evaluated and those who required different types of oral and maxillofacial surgical treatment were characterized. Results: A total of 4564 patients were attended during the period studied, of which 1337 (29.3%) required surgical treatment as a therapy for the resolution of their emergencies. Of these, 93.2% were exodontia of erupted or retained teeth, 1.7% surgical biopsies, 2.4% acute treatment of infections involving neighboring anatomical spaces, 0.8% resolution of maxillary alveolar trauma and 1.9% treatment of post-surgical complications. Conclusion: The results highlight the need to have dental emergency services in the AMBA area that have qualified and trained human resources to solve the surgical type emergencies that may arise (AU)

Risco de hipotermia perioperatória: revisão integrativa / Risk of perioperative hypothermia: An integrative review / Riesgo de hipotermia perioperatoria: Una revisión integradora

Objetivo: Identificar a ocorrência e os fatores de risco determinantes para o desenvolvimento do diagnóstico de enfermagem risco de hipotermia perioperatória. Método: Revisão integrativa, usando o acrônimo PIO (pacientes, intervenção, outcomes/desfecho), em que P=pacientes adultos e idosos; I=cirurgias eletivas; O=fatores de risco associados à hipotermia perioperatória. A revisão foi conduzida e reportada com base no Check-list Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), seguindo-se as sete etapas propostas pelo método PRISMA. Resultados: A busca gerou 854 artigos, sendo retirados os duplicados e os sem relevância. Após aplicação dos critérios de exclusão, 13 artigos foram submetidos à análise final. Índice de massa corporal baixo, idade avançada e tempo cirúrgico prolongado foram os fatores mais relacionados ao desenvolvimento de hipotermia nos pacientes cirúrgicos. O manejo da hipotermia colabora para diminuição dos riscos de eventos adversos cardíacos, complicações infecciosas, sangramentos e traz maior conforto para o paciente. Conclusão: O enfermeiro precisa agir antes do quadro hipotérmico se instalar, reconhecendo os fatores de risco inerentes ao paciente e identificando quais tecnologias do cuidado aplicar.

Objective: To identify the occurrence and the risk factors that determine the development of the nursing diagnosis 'risk for perioperative hypothermia'. Method: Integrative review, using the acronym PIO (patients, intervention, outcomes), in which P=adult and older adults; I=elective surgeries; O=risk factors associated with perioperative hypothermia. The review was conducted and reported based on the Check-list Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA), following the seven steps proposed by the PRISMA method. Results: The search generated 854 articles, excluding duplicates and non-relevant titles. After applying the exclusion criteria, 13 articles were submitted to the final analysis. Low body mass index, advanced age and prolonged surgical time were the factors most related to the development of hypothermia in surgical patients. The management of hypothermia helps to reduce the risk of adverse cardiac events, infectious complications, and bleeding, besides bringing greater comfort to patients. Conclusion: Nurses need to act before the hypothermic condition sets in, recognizing the risk factors inherent to each patient and identifying which care technologies to apply.

Objetivo: Identificar la ocurrencia y los factores de riesgo que determinan el desarrollo del Diagnóstico de Enfermería Riesgo de Hipotermia Perioperatoria. Método: Revisión integrativa, utilizando el acrónimo PIO (Pacientes, Intervención, Outcomes/Resultado), donde P=pacientes adultos y ancianos; I=cirugías electivas; O=factores de riesgo asociados a hipotermia perioperatoria. La revisión se llevó a cabo y se informó utilizando los elementos de informe preferidos de la lista de verificación para revisiones sistemáticas y metaanálisis (Check-list Preferred Reporting Items for Systematic Reviews and Meta-Analyses ­ PRISMA), siguiendo los siete pasos propuestos por el método PRISMA. Resultados: La búsqueda generó 854 artículos, eliminando los duplicados y los no relevantes. Tras aplicar los criterios de exclusión, se sometieron 13 artículos al análisis final. El bajo índice de masa corporal, la edad avanzada y el tiempo quirúrgico prolongado fueron los factores más relacionados con el desarrollo de hipotermia en los pacientes quirúrgicos. El manejo de la hipotermia ayuda a reducir los riesgos de eventos cardíacos adversos, complicaciones infecciosas, hemorragias y brinda mayor comodidad al paciente. Conclusión: La enfermera debe actuar antes de que se presente la condición hipotérmica, reconociendo los factores de riesgo inherentes al paciente e identificando qué tecnologías de atención aplicar.

Revisión de cirugía laparoscópica durante la pandemia por COVID-19 / Laparoscopic surgery during the COVID-19 pandemic a review

The SARS-CoV-2 pandemic has changed the management protocols of the different surgical areas and practices of health institutions around the world. The countries most affected by the disease have reported an alarming impact on the number of infected and deceased by COVID-19 among health workers. Personnel specialized in airway management have a greater risk of contagion when directly exposed to the aerosolization of the virus. This leads us to consider the probability of postponing or restricting procedures due to limited resources and/or due to patient conditions that increase the risk of death, given that the usual surgical techniques generate more aerosols. This narrative review article aims to analyze the risk of contamination of professionals in laparoscopic surgery of patients infected by COVID-19, proposing strategies to minimize the risk of exposure, identifying the necessary protection measures for health professionals, providing recommendations and adaptations of both the surgical technique and the organization of the operating room according to clinical and scientific evidence.

La pandemia por el SARS-CoV-2 ha cambiado los protocolos de manejo de las distintas áreas y prácticas quirúrgicas de las instituciones de salud en el mundo. Los países con mayor afectación de la enfermedad han reportado un impacto alarmante sobre el número de infectados y fallecidos por COVID-19 entre trabajadores de la salud. El personal especializado en el manejo de la vía aérea, posee un mayor riesgo de contagio al exponerse directamente a la aerosolización del virus. Esto conlleva a considerar la probabilidad de posponer o restringir procedimientos por limitación de los recursos y/o por condiciones del paciente que aumenten el riesgo de muerte, dado que las técnicas quirúrgicas habituales generan más aerosoles. Este artículo, de revisión narrativa, pretende analizar el riesgo de contaminación de los profesionales en cirugía laparoscópica de pacientes infectados por COVID-19, proponiendo estrategias para minimizar el riesgo de exposición, identificando las medidas necesarias de protección para los profesionales de la salud, aportando recomendaciones y adaptaciones tanto de la técnica quirúrgica como de la organización del quirófano según la evidencia clínica y científica

O volume de fluxo e a velocidade de pico sistólico ao ultrassom vascular com Doppler intraoperatório como preditores de perviedade precoce na fístula arteriovenosa autógena para hemodiálise / Intraoperative vascular Doppler ultrasound blood flow and peak systolic velocity predict early patency in hemodialysis arteriovenous fistula

Resumo Contexto A insuficiência renal crônica é um problema de saúde pública mundial. A hemodiálise é a principal terapia renal substitutiva. As fístulas arteriovenosas (FAV) são uma possível escolha, mas apresentam altas taxas de falência. Objetivos Este estudo tem como objetivo avaliar a relação entre as variáveis hemodinâmicas ao ultrassom vascular com Doppler no intraoperatório e a perviedade precoce da FAV para hemodiálise. Métodos Tratou-se de um estudo prospectivo observacional. Os pacientes consecutivos foram submetidos a FAV com ultrassonografia vascular com Doppler em intraoperatório nos dias 1, 7, 30 e 60. Eles foram divididos em grupos quanto à presença ou não de perviedade primária e secundária, e o volume de fluxo (VF) e a velocidade de pico sistólico (VPS) foram comparados. Foram realizadas curvas receiver operating characteristic (ROC), com definição de valores de VPS e VF com sensibilidade (S) e especificidade (E). Resultados Foram analisados 47 pacientes, os quais preencheram os critérios de inclusão. Os valores de VPS e VF intraoperatório foram maiores nos pacientes com perviedade primária e secundária comparados àqueles com falência. Os seguintes valores apresentaram maiores sensibilidade e especificidade para predizer perviedade primária aos 30 dias: 106 cm/s para VPS venoso, S: 75%, E: 71,4%; e 290,5 mL/min para VF arterial, S: 80,6%, E: 85,7%. Para perviedade secundária aos 30 dias, foram observados: 106 cm/s para VPS arterial, S: 72,7%, E: 100%; e 230 mL/min para VF venoso, com S: 86,4%, E: 100%. Para a perviedade primária no 60º dia, foram observados: 106 cm/s para VPS venoso, S: 74,4%, E: 62,5%; e 290,5 mL/min para VF arterial, S: 80%, E: 75%. Conclusões A velocidade de pico sistólico e o VF ao ultrassom vascular com Doppler intraoperatório são preditores de perviedade precoce na FAV para hemodiálise.

Abstract Background Chronic kidney disease is a major public health problem. Hemodialysis is the most common renal replacement therapy. Arteriovenous fistulas (AVF) are a possible access option, but early failure rates remain high. Objectives to investigate the value of intraoperative vascular Doppler ultrasound for predicting early AVF patency. Methods Prospective observational study. Consecutive patients undergoing AVF were assessed with vascular Doppler ultrasonography intraoperatively and on days 1, 7, 30, and 60. Patients were divided into groups according to presence or absence of primary and secondary patency. Blood flow (BF) and peak systolic velocity (PSV) were compared. ROC curves were plotted and used to define the PSV and BF values that yielded greatest sensitivity (Sens) and specificity (Spec). Results 47 patients met the inclusion criteria and were analyzed. Higher intraoperative PSV and BF values were observed in patients who had primary and secondary patency than in patients with access failure. The values with greatest sensitivity and specificity for predicting 30-day primary patency were 106 cm/s for venous PSV (Sens: 75% and Spec: 71.4%) and 290.5 ml/min for arterial blood flow (Sens: 80.6% and Spec 85.7%). Values for 30-day secondary patency were 106 cm/s for arterial PSV (Sens: 72.7%, Spec: 100%) and 230 ml/min for venous blood flow (Sens: 86.4%, Spec100%). Values for 60-day primary patency were 106 cm/s for venous PSV (Sens: 74.4%, Spec: 62.5%) and 290.5 ml/min for arterial blood flow (Sens: 80%, Spec: 75%). Conclusions Peak systolic velocity and blood flow measured using intraoperative vascular Doppler ultrasound can predict early patency of hemodialysis arteriovenous fistulas.

Incidencia de complicaciones intra y posoperatorias en pacientes geriátricos durante la cirugía abdominal mayor electiva / Incidence of intraoperative and postoperative complications in geriatric patients during major elective abdominal surgery

Introducción: El aumento de la expectativa de vida determina un incremento en la incidencia de enfermedades con indicación quirúrgica. El avance en las técnicas quirúrgicas, los cuidados intensivos y el conocimiento más profundo del proceso de envejecimiento tiende a favorecer la disminución de la morbimortalidad perioperatoria del paciente geriátrico. Objetivo: Determinar la incidencia de complicaciones intra y posoperatorias en pacientes geriátricos durante la cirugía abdominal mayor electiva. Métodos: Se realizó un estudio observacional descriptivo, de corte transversal a 373 pacientes geriátricos programados para intervención quirúrgica abdominal mayor desde enero de 2017 hasta diciembre de 2019 en el Hospital Clínico Quirúrgico Dr. Miguel Enríquez. Se registró la incidencia de complicaciones perioperatorias relacionándolas con las variables de estudio. Resultados: Las complicaciones más frecuentes fueron las cardiovasculares. La mortalidad fue escasa. Conclusiones: Las complicaciones perioperatorias detectadas en los pacientes geriátricos estudiados, se relacionan con las enfermedades previas, el tipo y la envergadura de la cirugía y con el tiempo quirúrgico(AU)

Introduction: The increase in life expectancy determines an increase in the incidence of diseases with surgical indication. Advances in surgical techniques, intensive care and deeper understanding of the aging process tend to favor the reduction of perioperative morbidity and mortality among geriatric patients. Objective: To determine the incidence of intraoperative and postoperative complications among geriatric patients during elective major abdominal surgery. Methods: A descriptive, cross-sectional and observational study was carried out with 373 geriatric patients scheduled for major abdominal surgery from January 2017 to December 2019 at Dr. Miguel Enríquez Clinical-Surgical Hospital. The incidence of perioperative complications was recorded, relating them to the study variables. Results: The most frequent complications were the cardiovascular ones. Mortality was low. Conclusions: The perioperative complications identified among the geriatric patients studied are related with previous diseases, with the type and extent of surgery, and with the surgical time(AU)

Eficacia del ácido tranexámico en la disminución del sangrado intraoperatorio en pacientes sometidas a cesárea segmentaria / Effectiveness of tranexamic acid in intraoperative bleeding reduction in C-section patients

Con el objetivo de determinar la eficacia del ácido tranexámico (AT) en la disminución del sangrado intraoperatorio en pacientes sometidas a cesárea segmentaria que ingresaron al Servicio de Emergencias Obstétricas del Hospital Central Universitario Dr. Antonio María Pineda, se realizó un estudio tipo ensayo clínico controlado, simple ciego, con una muestra de 30 pacientes distribuidas aleatoriamente en dos grupos: grupo A recibió AT 30 minutos previos a la intervención quirúrgica y el grupo B recibió cristaloides. En el grupo B se observó una discreta disminución en el valor promedio de la hemoglobina post-cesárea comparado con el valor basal. Los efectos adversos del AT fueron nauseas 53,3%, taquicardia (33,3%) y edema facial (6,6%). Ninguna paciente requirió la administración de hemoderivados durante el transoperatorio. El valor promedio de pérdidas sanguíneas observadas en los grupos con y sin AT fue de 390 ± 160,5 cc y 773,3 ± 174,9 cc, respectivamente (p = 0,000). Se concluye que la administración de AT disminuye las pérdidas sanguíneas observadas en pacientes sometidas a cesárea segmentaria(AU)

In order to determine the effectiveness of tranexamic acid (TA) in the reduction of intraoperative bleeding in patients undergoing cesarean section (C-section) admitted to the Obstetric Emergency Service of the Hospital Central Universitario Dr. Antonio Maria Pineda we performed a controlled, single blind, clinical trial with 30 patients who were randomly assigned in two groups: group A received TA and group B received crystalloids, 30 minutes before surgery. Lower mean hemoglobin post-surgery values compared to baseline were observed in the group that did not receive TA. Adverse effects of TA were nausea (53.3%), tachycardia (33.3%) and facial edema (6.6%). No patient required the administration of blood products during the transoperative period. Average observed blood losses in the AT and control groups were 390 ± 160.5 cc to 773.3 ±174.9 cc, respectively (p = 0.000). We conclude that tranexamic acid decreases observed blood losses in patients undergoing C-section(AU)

Pulse pressure variation guided fluid therapy during kidney transplantation: a randomized controlled trial / Reposição de volume orientada pela variação da pressão de pulso durante transplante renal: estudo randomizado controlado

Abstract Purpose: Kidney transplantation is the gold-standard treatment for end stage renal disease. Although different hemodynamic variables, like central venous pressure and mean arterial pressure, have been used to guide volume replacement during surgery, the best strategy still ought to be determined. Respiratory arterial Pulse Pressure Variation (PPV) is recognized to be a good predictor of fluid responsiveness for perioperative hemodynamic optimization in operating room settings. The aim of this study was to investigate whether a PPV guided fluid management strategy is better than a liberal fluid strategy during kidney transplantation surgeries. Identification of differences in urine output in the first postoperative hour was the main objective of this study. Methods: We conducted a prospective, single blind, randomized controlled trial. We enrolled 40 patients who underwent kidney transplantation from deceased donors. Patients randomized in the "PPV" group received fluids whenever PPV was higher than 12%, patients in the "free fluid" group received fluids following our institutional standard care protocol for kidney transplantations (10 mL.kg-1. h-1). Results: Urinary output was similar at every time-point between the two groups, urea was statistically different from the third postoperative day with a peak at the fourth postoperative day and creatinine showed a similar trend, being statistically different from the second postoperative day. Urea, creatinine and urine output were not different at the hospital discharge. Conclusion: PPV guided fluid therapy during kidney transplantation significantly improves urea and creatinine levels in the first week after kidney transplantation surgery.

Resumo Objetivo: Transplante renal é o tratamento padrão-ouro na doença renal em estágio terminal. Embora diferentes variáveis hemodinâmicas, tais como pressão venosa central e pressão arterial média, têm sido usadas para orientar a estratégia de reposição volêmica durante a cirurgia, a melhor estratégia ainda não foi determinada. A Variação da Pressão de Pulso (VPP) durante o ciclo respiratório é reconhecida como um bom preditor da resposta à infusão de volume para otimização hemodinâmica perioperatória no centro cirúrgico. O objetivo do estudo foi estudar se a estratégia de reposição de volume orientada por VPP é melhor do que a estratégia liberal de reposição de volume durante cirurgia de transplante renal. O principal objetivo do estudo foi identificar diferença no débito urinário na primeira hora do pós-operatório. Método: Realizamos estudo prospectivo, unicego, randomizado, controlado. Incluímos 40 pacientes submetidos a transplante renal de doador cadáver. Pacientes randomizados para o Grupo VPP receberam volume quando a VPP estava acima de 12%, e os pacientes no Grupo Reposição Liberal receberam volume de acordo com o nosso protocolo institucional padrão de assistência para transplante renal (10 mL.kg-1.h-1). Resultados: O débito urinário foi semelhante em todos os tempos nos dois grupos, a ureia foi estatisticamente diferente a partir do terceiro dia do pós-operatório com pico no quarto dia do pós-operatório e a creatinina apresentou tendência semelhante, tornando-se estatisticamente diferente a partir do segundo dia do pós-operatório. Ureia, creatinina e débito urinário não estavam diferentes na alta hospitalar. Conclusões: A terapia orientada por VPP durante transplante renal melhorou de forma significativa os níveis de ureia e creatinina na primeira semana pós-transplante renal.

Intraoperative Use of Analgesics in Tonsillar Fossa and Postoperative Evaluation with Visual analogue Scale Scores-A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Abstract Introduction Posttonsillectomy pain results in significant morbidity to the patients. There is a disagreement in the literature regarding the use of local anesthetics during tonsillectomy. The aim of this placebo-controlled, double-blind study is to evaluate the effect of peritonsillar administration of local anesthetics. Objective To evaluate the role of intraoperative use of analgesics in tonsillar fossa and postoperative evaluation with visual analogue scale (VAS) scores in achieving pain relief after tonsillectomy procedure Methods In this study, 180 patients were randomized to 1 of the 6 groups: bupivacaine infiltration, lidocaine infiltration, normal saline infiltration, bupivacaine packing, lidocaine packing, and normal saline packing. Pain caused by speaking, swallowing, and on rest was assessed using VAS at 4, 8, 12, 16 hours, and at discharge. Results Significant analgesia was obtained in patients who received bupivacaine infiltration and packing compared with placebo (p < 0.05). The majority of the study subjects had no postoperative complications, and patients receiving bupivacaine infiltration required less additional analgesics in the first 24 hours after surgery. Conclusion We advocate the use of bupivacaine infiltration or packing immediately following the procedure to achieve adequate postoperative analgesia.

Utilidad de la ecocardiografía transtorácica focalizada en emergencias hemodinámicas intraoperatorias / Usefulness of Focalized transthoracic ecocardiography in intraoperative hemodynamic emergencys

INTRODUCTION: Echocardiography represents one of the most important advances in the monitoring of critical patients. Initially available only in cardiovascular surgery, currently, there is transesophageal echocardiography (TEE) and transthoracic echocardiography (ETT) in non-cardiac surgery, for anesthesiologists. The advantages of ETT is a non-invasive tool, of lower cost than the transesophageal transducer and therefore more feasible to be overcrowded and available in the pavilion. OBJECTIVE: To evaluate the usefulness of TTE in patients with hemodynamic compromise during non-cardiac surgery. NATERIAL AND METHODS: In a prospective manner between April 2016 and September 2018, patients were studied who during their intraoperative period presented a compromise of their hemodynamic state, defined as an average blood pressure under 55 mm Hg, for more than 3 minutes and without response to the usual therapy based on vasopressors and volume. Each of these patients had a prospective protocol for focused ETT looking for the cause of this disorder, by a duly trained operator. RESULTS: 124 patients, with an average age of 67 years (range 42 to 93 years) were evaluated. In all cases, at least one echocardiographic window was obtained that allowed a diagnosis to be made and/or to guide the therapy. The main causes of hemodynamic compromise were hypovolemia (52%), poor left ventricular function (21%) and other causes such as pericardial effusion, suspected pulmonary thromboembolism, pulmonary pathology and suspected myocardial ischemia. DISCUSSION: The ETT could be a feasible tool to use in acute hemodynamic events, since it offers good quality windows that allow new decisions based on the diagnosis and also allows to guide the selected therapies. In addition, it has been shown to positively impact clinical behaviors in the perioperative period. ETT is a non-invasive monitor, reasonably easy to learn to use; In addition to directly visualizing cardiac structures, it allows differential diagnoses of the causes of intraoperative hypotension. The therapies can also be decided according to the echocardiographic images and control how they generate changes in the cardiac cavities and in the hemodynamic state of the patient.

INTRODUCCIÓN: La ecocardiografía representa uno de los más importantes avances en la monitorización de pacientes críticos. Inicialmente disponible sólo en cirugía cardiovascular, en la actualidad, se cuenta con ecocardiografía transesofágica (ETE) y ecocardiografía transtorácica (ETT) en cirugía no cardíaca, para los anestesiólogos. Las ventajas del ETT están en ser una herramienta no invasiva, de menor costo que el transductor transesofágico y, por lo tanto, más factible de ser masificada y estar disponible en pabellón. OBJETIVO: Evaluar la utilidad de ETT en pacientes con compromiso hemodinámico durante cirugía no cardiaca. MATERIAL Y MÉTODOS: En forma prospectiva entre abril de 2016 y septiembre del 2018, se estudiaron enfermos que durante su intraoperatorio presentaron compromiso de su estado hemodinámico, definido como una presión arterial media bajo 55 mm Hg, por más de 3 minutos y sin respuesta a la terapia habitual basada en vasopresores y volumen. A cada uno de estos enfermos se le realizó un protocolo prospectivo de ETT focalizado buscando la causa de esta alteración, por un operador debidamente entrenado. RESULTADOS: 124 pacientes, con edad promedio de 67 años (rango 42 a 93 años) fueron evaluados. En todos los casos se obtuvo al menos una ventana ecocardiográfica que permitió realizar un diagnóstico y/o guiar la terapia. Las principales causas de compromiso hemodinámico fueron hipovolemia (52%), mala función del ventrículo izquierdo (21%) y otras causas como derrame pericárdico, sospecha de tromboembolismo pulmonar, patología pulmonar y sospecha de isquemia miocárdica. La ETT podría ser una herramienta factible de utilizar en eventos hemodinámicos agudos, ya que ofrece ventanas de buena calidad que permiten tomar decisiones nuevas basadas en el diagnóstico y, además, permite guiar las terapias seleccionadas. Además, ha mostrado impactar de forma positiva las conductas clínicas en el perioperatorio. DISCUSIÓN: La ETT es un monitor no invasivo, razonablemente fácil de aprender a utilizar que además de visualizar de manera directa las estructuras cardíacas, permite realizar diagnósticos diferenciales de las causas de hipotensión intraoperatoria. Además, se puede decidir las terapias de acuerdo a las imágenes ecocardiográficas y controlar cómo éstas generan cambios en las cavidades cardíacas y en el estado hemodinámico del paciente.

Beneficial effect of fluid warming in elderly patients with bladder cancer undergoing Da Vinci robotic-assisted laparoscopic radical cystectomy

OBJECTIVES: The enhanced recovery after surgery (ERAS) protocol recommends prevention of intraoperative hypothermia. However, the beneficial effect of maintaining normothermia after radical cystectomy has not been evaluated. This study aimed to investigate the efficacy of fluid warming nursing in elderly patients undergoing Da Vinci robotic-assisted laparoscopic radical cystectomy. METHODS: A total of 108 patients with bladder cancer scheduled to undergo DaVinci robotic-assisted laparoscopic radical cystectomy were recruited and randomly divided into the control group (n=55), which received a warming blanket (43°C) during the intraoperative period and the warming group (n=53), in which all intraoperative fluids were administered via a fluid warmer (41°C). The surgical data, body temperature, coagulation function indexes, and postoperative complications were compared between the two groups. RESULTS: Compared to the control group, the warming group had significantly less intraoperative transfusion (p=0.028) and shorter hospitalization days (p<0.05). During the entire intraoperative period (from 1 to 6h), body temperature was significantly higher in the warming group than in the control group. There were significant differences in preoperative fibrinogen level, white blood cell count, total bilirubin level, intraoperative lactose level, postoperative thrombin time (TT), and platelet count between the control and warming groups. Multivariate linear regression analysis demonstrated that TT was the only significant factor, suggesting that the warming group had a lower TT than the control group. CONCLUSION: Fluid warming nursing can effectively reduce transfusion requirement and hospitalization days, maintain intraoperative normothermia, and promote postoperative coagulation function in elderly patients undergoing Da Vinci robotic-assisted laparoscopic radical cystectomy.

Adverse Events and Risk Factors of Blood Transfusion in Cardiovascular Surgery: A Prospective Cohort Study

Abstract Background: Hemodilution, transoperative bleeding and cardiopulmonary bypass (CPB) are some of the factors associated with high transfusion rates in cardiac surgery. Objective: To analyze the incidence of blood transfusion and early postoperative outcomes in cardiac surgery patients. Methods: Cohort study of patients undergoing cardiac surgery in a university hospital, consecutively enrolled from May 2015 to February 2017. Data were prospectively collected and comparisons were made between two patients' groups: transfused and not transfused. Student's t-test, chi-square test, and logistic regression were used, and a p-value < 0.05 was considered significant. Results: Among the 271 patients evaluated, 100 (37%) required transfusion in the transoperative (32.1%) and/or postoperative periods (19.5%). The following predictors of transfusion were identified by multivariate analysis: EuroScore II (OR 1.2); chronic kidney disease (CKD) (OR 3.2); transoperative bleeding ≥ 500 mL (OR 6.7); baseline hemoglobin (Hb) ≤ 10 g/dL (OR 11.5); activated partial thromboplastin time (aPTT) (OR 1.1) and CPB duration (OR 1.03). Transfusion was associated with prolonged mechanical ventilation (≥ 24h) (2.4% vs. 23%), delirium (5.9% vs. 18%), bronchopneumonia (1.2% vs. 16%), acute renal failure (3.5% vs. 25%), acute on CKD (0.6% vs. 8%), stroke or transient ischemic attack (1.8% vs. 8%), intensive care unit stay ≥ 72 h (36% vs. 57%), longer hospital stay (8 ± 4 days vs. 16 ± 15 days), as well as increased early mortality (1.75% vs. 15%). Conclusion: EuroScore II, CKD, major transoperative bleeding, preoperative Hb and aPTT values and CPB time were independent predictors of transfusion, which was associated with a higher rate of adverse outcomes, including early mortality.

Intraoperative ultrasound leads to conservative management of benign ovarian tumors: A retrospective, single-center study / Ultrassom intraoperatório leva ao manejo conservador de tumores ovarianos benignos: Um estudo retrospectivo e monoinstitucional

Abstract Objective To evaluate whether the use of intraoperative ultrasound leads to more conservative surgeries for benign ovarian tumors. Methods Women who underwent surgery between 2007 and 2017 for benign ovarian tumors were retrospectively analyzed. The women were classified into two groups: those who underwent intraoperative ultrasound (group A) and those who did not (group B). In group A, minimally-invasive surgery was performed for most patients (a specific laparoscopic ultrasound probe was used), and four patients were submitted to laparotomy (a linear ultrasound probe was used). The primary endpoint was ovarian sparing surgery (oophoroplasty). Results Among the 82 cases identified, only 36 met the inclusion criteria for the present study. Out of these cases, 25 underwent intraoperative ultrasound, and 11 did not. There were no significant differences in arterial hypertension, diabetes, smoking history, and body mass index for the two groups (p=0.450). Tumor diameter was also similar for both groups, ranging from 1 cm to 11 cm in group A and from 1.3 cm to 10 cm in group B (p=0.594). Tumor histology confirmed mature teratomas for all of the cases in group B and for 68.0% of the cases in group A. When the intraoperative ultrasound was performed, a more conservative surgery was performed (p<0.001). Conclusion The use of intraoperative ultrasound resulted in more conservative surgeries for the resection of benign ovarian tumors at our center.

Resumo Objetivo Avaliar se o uso do ultrassom intraoperatório leva a cirurgias mais conservadoras para tumores ovarianos benignos. Métodos Mulheres que foram submetidas a cirurgia entre 2007 e 2017 por tumores ovarianos benignos foram analisadas retrospectivamente. As mulheres foram classificadas em dois grupos: aquelas que foram submetidas ao ultrassom intraoperatório (grupo A), e aquelas que não o foram (grupo B). No grupo A, foi realizada cirurgia minimamente invasiva na maioria das pacientes (foi usada sonda ultrassonográfica laparoscópica específica), e quatro pacientes foram submetidas a laparotomia (foi usada sonda ultrassonográfica linear). O desfecho primário foi a cirurgia preservadora do ovário (ooforoplastia). Resultados Entre os 82 casos identificados, somente 36 atenderam aos critérios de inclusão para este estudo. Destes, 25 pacientes foram submetidas ao ultrassom intraoperatório, e 11 não o foram. Não houve diferenças significantes em relação à pressão arterial, diabetes, tabagismo e índice de massa corporal entre os dois grupos (p=0.450). O diâmetro do tumor também foi similar entre os dois grupos, variando de 1cm a 11cm no grupo A, e de 1,3cma 10cm no grupo B (p=0.594). A histologia dos tumores confirmou teratoma maduro para todos os casos do grupo B, e para 68,0% dos casos do grupo A. Mais cirurgias conservadoras foram realizadas quando o ultrassom intraoperatório foi realizado (p<0.001). Conclusão O uso do ultrassom intraoperatório resultou em mais cirurgias conservadoras na ressecção de tumores benignos do ovário em nossa instituição.

Mastectomia: reconstruccion inmediata con colocacion de expansores mamarios / Mastectomy: immediate reconstruction with placement of mammary expansors

La reconstrucción mamaria es parte fundamental del tratamiento de la mujer mastectomizada por cáncer de mama. Tras comprobarse que la reconstrucción no influye negativamente sobre la enfermedad neoplásica, sino que es trascendental para la rehabilitación física y psicológica de la paciente, su desarrollo se ha visto favorecido. Este trabajo monográfco muestra el trababjo en equipo dentro del quirófano y el rol del isntrumentador(AU)

Mammary reconstruction is a fundamental part of the treatment of women mastectomized for breast cancer. After confrming that the reconstruction does not negatively influence the neoplastic disease, but is transcendental for the physical and psychological rehabilitation of the patient, its development has been favored. Tis monographic work shows teamwork within the operating room and the role of the isntrumentor(AU)

A reconstrução mamária é parte fundamental do tratamento de mulheres mastectomizadas para câncer de mama. Após confrmar que a reconstrução não influencia negativamente a doença neoplásica, mas é transcendental para a reabilitação física e psicológica do paciente, seu desenvolvimento tem sido favorecido. Este trabalho monográfco mostra o trabalho em equipe dentro da sala de cirurgia e o papel do instrumental(AU)

Development of a software for intraoperatory nursing assistance / Desarrollo de un software para auxiliar de enfermería intraoperatorio / Desenvolvimento de um software para a assistência de enfermagem intraoperatória

ABSTRACT Objective: to develop a software that allows the nurse of the surgical center to plan intraoperative nursing care through electronic access to the work routines of his/her team. Method: the methodological course was carried out according to systems development theory, which guides five basic activities: communication, planning, modeling, developing and delivery of the product. Results: the activities and functions of the software were arranged in five modules, containing information regarding the inputs and the step-by-step involving the assembly, circulation and disassembly of the operating room to perform the various anesthetic and surgical procedures. Final considerations: The developed software will allow the surgical center's nursing team to access its intraoperative routines in a fast and systematic way, since this allowed to concentrate all the routines of assembly, circulation and disassembly of operating room in a safe space and accessible

RESUMEN Objetivo: desarrollar un software que posibilite al enfermero del centro quirúrgico planear la atención de enfermería intraoperatoria mediante el acceso electrónico a las rutinas de trabajo de su equipo. Método: el recorrido metodológico se realizó según la teoría del desarrollo de sistemas, que orienta cinco actividades básicas: comunicación, planeación, modelado, construcción y despliegue del producto. Resultados: las actividades y funciones del software se dispusieron en cinco módulos con informaciones referentes a los insumos y al paso a paso del equipamiento, la circulación y el desmantelamiento del quirófano para la realización de los diversos procedimientos anestésicos y quirúrgicos. Consideraciones finales: se espera que este software, por su capacidad de concentrar todas las rutinas de equipamiento, circulación y desmantelamiento del quirófano en un espacio seguro y accesible, facilite el acceso al equipo de enfermería del centro quirúrgico a sus rutinas intraoperatorias de manera rápida y sistemática.

RESUMO Objetivo: desenvolver um software que possibilite, ao enfermeiro do centro cirúrgico, planejar a assistência de enfermagem intraoperatória por meio do acesso eletrônico às rotinas de trabalho de sua equipe. Método: o percurso metodológico foi realizado de acordo com a teoria de desenvolvimento de sistemas, que orienta cinco atividades básicas: comunicação, planejamento, modelagem, construção e entrega do produto. Resultados: as atividades e funções do software foram dispostas em cinco módulos, contendo informações referentes aos insumos e o passo-a-passo envolvendo a montagem, circulação e desmontagem da sala operatória para realização dos diversos procedimentos anestésicos e cirúrgicos. Considerações finais: acredita-se que o software desenvolvido permitirá que a equipe de enfermagem do centro cirúrgico possa acessar suas rotinas intraoperatórias de forma rápida e sistemática, uma vez que este permitiu concentrar todas as rotinas de montagem, circulação e desmontagem de sala operatória em um espaço seguro e acessível.

Ecocardiograma transesofágico intraoperatorio: utilidad en reparación de cardiopatías congénitas / Intraoperative transesophagel echocardiogram: Usefulness in congenital heart defects repair

El control ecocardiográfico al momento de la reparación de las cardiopatías congénitas es una estrategia cardiológica para mejorar los resultados quirúrgicos de nuestros pacientes. En este artículo les contamos cómo es el método, qué información nos brinda y cómo influye en la toma de decisiones en el quirófano y en el manejo posoperatorio (AU)

Echocardiographic monitoring at the time of congenital heart defects repair is a strategy to improve the surgical outcomes of our patients. In this article we discuss the method, what information it provides, and how it influences decision-making in the operating room and postoperative management (AU)