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1.
Rev. colomb. anestesiol ; 49(4): e401, Oct.-Dec. 2021. graf
Article in English | LILACS, COLNAL | ID: biblio-1341244

ABSTRACT

Abstract The illegal use of liquid silicone products or biopolymers in gluteal augmentation procedures is giving rise to multiple complications, with a significant negative health impact, both in the short and long-term. The migration of polymers to the sacral and lumbar region represents a major limitation to conducting neuraxial anesthesia procedures. This silicon migration is unpredictable through the superficial tissue as is widely described in the literature. Caudal, spinal and epidural anesthesia may cross the silicone in the fascia and contaminate the neural axis with substances that are highly capable of causing inflammation, edema and tissue necrosis. In order to improve the safety of neuraxial anesthetic procedures and avoid the potential risk of dissemination and contamination of the neural axis, this complication must be ruled out, or be considered an emerging contraindication for these anesthetic procedures.


Resumen La aplicación ilegal de productos como silicona líquida o biopolímeros en procedimientos de aumento de glúteos está generando múltiples complicaciones con gran impacto negativo para la salud tanto a corto como a largo plazo. La migración de polímeros a la región sacra y lumbar representa una importante limitación para la realización de procedimientos de anestesia neuroaxial. Esta migración de silicona es impredecible a través del tejido superficial, la cual está ampliamente descrita en la literatura. Los procedimientos anestésicos caudal, espinal y epidural podrían atravesar los silicomas en la fascia del tejido y contaminar el neuroeje con sustancias con alta capacidad de generar inflamación, edema y necrosis de tejidos. Con el fin de aumentar la seguridad de los procedimientos anestésicos neuroaxiales y evitar el riesgo potencial de dispersión y contaminación del neuroeje, es necesario descartar esta complicación o considerar una contraindicación emergente en estos procedimientos anestésicos.


Subject(s)
Humans , Male , Female , Patient Safety , Anesthesia, Conduction , Silicones , Biopolymers , Contraindications, Drug , Anesthesia
2.
Rev. colomb. anestesiol ; 49(4): e202, Oct.-Dec. 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1341238

ABSTRACT

Abstract Introduction Information regarding the clinical behavior and the anesthetic and perioperative management in pregnant patients with SARS-CoV-2 is starting to appear in the literature in the form of case reports or case series. However, strong evidence and recommendations are still limited. Objective To describe the clinical characteristics, the results of anesthetic and perioperative management, and complications in seroprevalent pregnant women for SARS-CoV-2 infection, delivered by cesarean section. Methodology Observational study in which 107 clinical records of pregnant women who were seroprevalent for SARS-CoV-2 infection were reviewed and analyzed between April and June, 2020. Demographic, clinical and serological data were collected, as well as data on the anesthetic technique and intraoperative and postoperative complications. Results Of the 107 pregnant women with SARS-CoV-2 infection, 99 (92.52%) were asymptomatic and 8 (7.48%) had mild symptoms. The most frequent reasons for cesarean section were cephalo-pelvic disproportion in 20 (18.68%), previous cesarean section in 20 (18.68%) and non-reassuring fetal status in 14 (13.08%). Anesthesia technique was neuraxial in all cases, with spinal used in 100 (93.5%), combined spinal-epidural in 4 (3.7%) and epidural catheter in 3 (2.8%) patients. No deaths had occurred until the third postoperative day of follow-up. Conclusions The majority of pregnant women with SARS-CoV-2 infection are asymptomatic. In this work, spinal, combined spinal-epidural and epidural neuroxial anesthesia techniques were shown to be effective and safe for these patients and their newborn babies.


Resumen Introducción La información del comportamiento clínico, manejo anestésico y perioperatorio en gestantes con SARS-CoV-2 empieza a aparecer en la literatura mediante reportes de casos o serie de casos. Aún son limitadas la evidencia contundente y las recomendaciones. Objetivo Describir las características clínicas, resultados del manejo anestésico, perioperatorio y complicaciones en gestantes seroprevalentes para infección por SARS-CoV-2, cuyo parto fue por cesárea. Metodología Estudio observacional en el cual se revisaron y analizaron 107 historias clínicas de gestantes seroprevalentes para infección por SARS-CoV-2, de abril a junio del 2020. Se recolectaron datos demográficos, clínicos, serología, técnica anestésica y complicaciones intra y postoperatorias. Resultados De las 107 gestantes con infección por SARS-CoV-2, 99 (92,52 %) fueron asintomáticas y 8 (7,48 %) presentaron síntomas leves. Los motivos más frecuentes de cesárea fueron: desproporción céfalo-pélvica 20 (18,68 %), cesárea previa 20 (18,68 %) y estado fetal no tranquilizador 14 (13,08 %). La técnica anestésica fue neuro axial en su totalidad, espinal en 100 (93,5 %), combinada espinal-epidural en 4 (3,7 %) y epidural con catéter en 3 (2,8 %) pacientes. No se registraron muertes hasta el tercer día postoperatorio de seguimiento. Conclusiones Las gestantes con infección por SARS-CoV-2 presentan -en su mayoría- infecciones asintomáticas. En este trabajo, la anestesia neuro axial: espinal, combinada espinal-epidural y epidural, se presentan como técnicas efectivas y seguras para estas pacientes y sus recién nacidos.


Subject(s)
Humans , Female , Pregnancy , Cesarean Section , SARS-CoV-2 , Anesthesia , Peru , COVID-19 , Anesthesia, Epidural
3.
Arq. ciências saúde UNIPAR ; 25(3): 231-235, set-out. 2021.
Article in Portuguese | LILACS | ID: biblio-1348219

ABSTRACT

Objetivo: descrever a aplicação da Sistematização da Assistência de Enfermagem a um paciente com Fratura de Colo de Fêmur no período perioperatório. Metodologia: Relato de experiência realizado no centro cirúrgico de um hospital geral, o qual atende demanda espontânea da capital e do interior do estado da Bahia. O período de realização do estudo foi em agosto de 2019, na cidade de Feira de Santana- BA. Esta experiência foi fruto da vivência de acadêmicos de enfermagem do sexto semestre da Universidade Estadual de Feira de Santana. Foram respeitados os aspectos éticos da Resolução 466/2012. Resultados: Foi aplicada a Sistematização da Assistência de Enfermagem no Perioperatório a paciente idoso com fratura de colo de fêmur, conforme cinco fases do processo de enfermagem: Histórico, Diagnóstico, Planejamento, Implementação e Avaliação. Ressalta-se que o referido caso foi analisado de acordo com as Diretrizes Terapêuticas para Fratura de Colo de Fêmur, que demostraram a importância da aplicação da sistematização para um cuidado diferenciado ao paciente idoso com diagnóstico de fratura de fêmur, considerando que a população idosa cada vez mais vem alcançando a longevidade e as quedas são um dos eventos adversos que mais acometem essa população, seguido pela fratura. Conclusão: Este estudo pretende contribuir como instrumento gerencial e de cuidado relevante para a instituição no centro cirúrgico que visem acelerar o tempo de alta, minimizar o risco de complicações, reduzir os custos e favorecer a qualidade de vida dos pacientes idosos com fratura de fêmur a partir da sistematização da assistência de enfermagem perioperatória.


Objective: Describe the application of Nursing Care Systematization to a patient with a femoral neck fracture during the perioperative period. Methodology: Report of an experience carried out in the operating room of a general hospital, which cares for the spontaneous demand of the capital city and the interior of the state of Bahia. The study was held in August 2019 in the city of Feira de Santana, in the state of Bahia. This was the result of the academic experience of nursing students in the sixth semester at the State University of Feira de Santana. The ethical aspects of Resolution 466/2012 were respected. Results: Perioperative Nursing Care Systematization was applied to an elderly patient with a femoral neck fracture, according to five phases of the nursing process: History, Diagnosis, Planning, Implementation, and Evaluation. It emphasizes whether the case was analyzed according to the Therapeutic Guidelines for Femoral Neck Fractures, which demonstrated the importance of applying systematization for differentiated care for elderly patients diagnosed with femoral fractures, considering that the elderly population is living longer, and falls are one of the adverse events most frequently affecting such population, followed by fracture. Conclusion: This study aims at contributing as a relevant management and care instrument for the institution of any surgical center that aims at speeding up discharge time, minimizing the risk of complications, reducing costs, and favoring the quality of life of elderly patients with femur fracture from the systematization of perioperative nursing care.


Subject(s)
Humans , Male , Aged , Students, Nursing , Femoral Fractures , Nursing Process , Quality of Life , Perioperative Nursing/education , Surgicenters/supply & distribution , Accidental Falls , Aged , Perioperative Period/nursing , Anesthesia/nursing , Nursing Care/organization & administration
4.
SOBECC ; 26(3): 165-171, 30-09-2021.
Article in Portuguese | LILACS, BDENF | ID: biblio-1342664

ABSTRACT

Objetivo: Testar uma ação educativa entre enfermeiros de centro cirúrgico para discutir as limitações na assistência durante a anestesia. Método: Estudo descritivo de uma situação problema fundamentada na aprendizagem baseada em problemas. Amostra composta de 19 enfermeiros, divididos em três grupos, com a realização de dois encontros para levantamento, resolução de problemas e síntese de conceitos. Resultados: No primeiro encontro, identificaram-se problemas relacionados a operacionalização da assistência, conhecimento e treinamento dos profissionais para execução de cuidados e problemas no processo de trabalho, que impactam as ações dos enfermeiros. No segundo encontro, responderam-se às questões elaboradas com base na revisão de literatura sobre anestesia, diretrizes de cuidados e uniformidade de condutas. Mais da metade dos enfermeiros avaliou que a atividade contribuiu para refletir sobre as ações do enfermeiro na anestesia, as atividades diárias e a postura profissional, a necessidade de envolvimento com a assistência e a revisão de conceitos. Conclusão: O uso da situação problema como metodologia para educação em enfermagem favoreceu a discussão sobre conceitos de anestesia entre os enfermeiros e a reflexão sobre a atuação em sala cirúrgica.


Objective: To test an educational procedure among operating room nurses in order to discuss care limitations during anesthesia. Method: A descriptive study about a problem situation based on problem-based learning. A sample composed of 19 nurses that were divided into three groups which resulted in two meetings for a survey, problem resolution and concept synthesis. Results: In the first meeting, problem limitations were identified in relation to care organization, knowledge, professionals' training for care practice and problems in the work process, which influenced the nurses' actions. In the second meeting, the formulated questions were answered according to the literature review about anesthesia, care protocols and uniformity of actions. More than half of the nurses investigated considered that the activity contributed as a means to reflect on the nurses' actions in anesthesia, daily activities and professional attitudes as well as on the need for involvement with care and review of concepts. Conclusion: The use of problem situation as a methodology for education in nursing supported the conceptual discussions among nurses about anesthesia and the reflection on performance in the operating room


Objetivo: Probar una acción educativa entre enfermeras de un centro quirúrgico para discutir las limitaciones en la atención durante la anestesia. Método: Estudio descriptivo de una situación problemática, basado en el aprendizaje basado en problemas. Muestra compuesta por diecinueve enfermeros, divididos en tres grupos, con dos reuniones de encuesta, resolución de problemas y síntesis de conceptos. Resultados: En la primera reunión se identificaron problemas relacionados con dificultades en la operacionalización de la atención; conocimiento y formación de profesionales para realizar cuidados; y problemas en el proceso de trabajo, que impactan la acción de enfermeros. En el segundo encuentro se respondieron las preguntas elaboradas a partir de la revisión de la literatura sobre anestesia, pautas de atención y estandarización de conducta. Más de la mitad de los enfermeros evaluaron que la actividad contribuyó a reflexionar sobre las acciones de los enfermeros en anestesia, acciones cotidianas y postura profesional, la necesidad de involucramiento con el cuidado y revisión de conceptos. Conclusión: El uso de la situación problema como metodología para la formación en enfermería favoreció la discusión sobre conceptos de anestesia entre enfermeros y la reflexión sobre el trabajo en quirófano.


Subject(s)
Humans , Surgicenters , Anesthesia , Nursing Care , Nursing , Health Personnel
5.
Rev. colomb. anestesiol ; 49(3): e602, July-Sept. 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1280185

ABSTRACT

Abstract Radical penectomy (RP) is infrequently performed as it is reserved for specific cases of penile cancer, hence the paucity of reports regarding surgical and anesthetic considerations. Acute postoperative pain, chronic post-surgical pain, concomitant mood disorders as well as a profound impact on the patient's quality of life have been documented. This case is of a patient with diabetes and coronary heart disease, who presented with advanced, over infected penile cancer, depressive disorder and a history of pain of neuropathic characteristics. The patient underwent radical penectomy using a combined spinal-epidural technique for anesthesia. Preoperatively, the patient was treated with pregabalin and magnesium sulphate, and later received a blood transfusion due to intraoperative blood loss. Adequate intra and postoperative analgesia was achieved with L-bupivacaine given through a peridural catheter during one week. Recovery was good, pain was stabilized to preoperative levels and the patient received pharmacological support and follow-up by psychiatry and the pain team.


Resumen La penectomía radical (PR) es una cirugía infrecuente, reservada para casos específicos de cáncer de pene, por lo que hay escasos informes sobre sus consideraciones quirúrgicas y anestésicas. Se ha documentado dolor agudo postoperatorio, dolor crónico posquirúrgico y alteraciones del estado de ánimo concomitantes, así como un profundo impacto en la calidad de vida posterior del paciente. Se presenta el caso de un paciente diabético y cardiópata coronario con cáncer de pene avanzado y sobreinfectado, trastorno depresivo y dolor previo de características neuropáticas, que recibe técnica combinada espinal-peridural para cirugía de penectomía radical. Se le trata también con pregabalina preoperatoria, sulfato de magnesio y transfusión por sangrado quirúrgico. Se otorgó una adecuada analgesia intra y postoperatoria, mediante catéter peridural con L-bupivacaína hasta por una semana. El paciente tuvo una buena recuperación, estabilización del dolor a niveles preoperatorios, controles y apoyo farmacológico por psiquiatría de enlace y equipo del dolor.


Subject(s)
Humans , Male , Aged , Penile Neoplasms , Penile Neoplasms/surgery , Catheters , Anesthetics , Pain, Postoperative , Psychiatry , Quality of Life , Blood Transfusion , Bupivacaine , Coronary Disease , Depressive Disorder , Pain Management , Analgesia , Anesthesia , Magnesium Sulfate
6.
Rev. colomb. anestesiol ; 49(3): e400, July-Sept. 2021. tab
Article in English | LILACS, COLNAL | ID: biblio-1280181

ABSTRACT

Abstract Several findings paved the way to the use of the spinal approach for anesthesia. Information about the originators and dates of their discoveries is controversial. According to personal communications, doctors Juan Bautista Montoya y Flórez, in Medellín, and Lisandro Leyva, in Bogotá, in 1904 and 1905 respectively, would appear to be the pioneers of spinal anesthesia in Colombia. Pioneering cases of this procedure carried out in 1901 by doctor Juan Evangelista Manrique and which continued to be performed by his colleagues and assistants of the medical community at the time are documented in the Corporis Fabrica dissertation collection of the National University of Colombia.


Resumen Son varios los hallazgos que contribuyeron al abordaje de la columna vertebral como vía para la administración de anestesia. Los autores y las fechas de tales descubrimientos han sido controvertidos. En Colombia, según fuentes orales, los doctores Juan Bautista Montoya y Flórez, en Medellín, y Lisandro Leyva, en Bogotá, en 1904 y 1905 respectivamente, serían los pioneros de la anestesia raquídea en Colombia. En las tesis de la Facultad de Medicina de la Universidad Nacional, Colección Corporis Fabrica, se documentan los casos pioneros de este procedimiento realizados en 1901, por el doctor Juan Evangelista Manrique y continuados enseguida por sus colegas y ayudantes de la comunidad médica de ese entonces.


Subject(s)
Humans , Anesthesia , Anesthesia, Spinal/history , Anesthetics, Local , Schools, Medical , Spine , Methods
7.
Rev. colomb. anestesiol ; 49(3): e201, July-Sept. 2021. tab
Article in English | LILACS, COLNAL | ID: biblio-1280177

ABSTRACT

Abstract Introduction: Post-anesthetic complications, particularly respiratory complications, continue to be a source of concern due to their high frequency, particularly in pediatrics. Objective: To describe the incidence of respiratory complications in the post-anesthesia care unit of an intermediate complexity center during a six-month period, and to explore the variables associated with major respiratory complications. Materials and Methods: Retrospective cohort study based on clinical record reviews. The records of the post-anesthesia care unit of an intermediate complexity pediatric institution located in Medellin, Colombia, were reviewed. This center uses a nursing-based care model that includes patient extubation in the post-anesthesia care unit. Results: The records of 1181 patients were analyzed. The cumulative incidences of major complications were bronchospasm 1.44%, laryngospasm 0.68% and respiratory depression 0.59%. There were no cases of cardiac arrest or acute pulmonary edema. A history of respiratory infection less than 15 days before the procedure, rhinitis and female sex were associated with major respiratory complications. Conclusions: A low frequency of respiratory complications was found during care provided by nursing staff trained in anesthesia recovery and pediatric airway in the post-anesthesia care unit.


Resumen Introducción: Las complicaciones postanestésicas, especialmente las respiratorias, siguen siendo causa de preocupación por su alta frecuencia, en particular, en la población pediátrica. Objetivo: Describir la incidencia de complicaciones respiratorias en la unidad de cuidados postanestésicos de una institución de mediana complejidad, en un período de seis meses y explorar las variables relacionadas con las complicaciones respiratorias mayores. Materiales y métodos: Estudio de cohorte retrospectivo, basado en la valoración de historias clínicas. Se revisaron los registros de la unidad de cuidados postanestésicos de una institución pediátrica de mediana complejidad ubicada en Medellín. Esta institución utiliza un modelo de atención -basado en enfermería- que incluye la extubación del paciente en la unidad de cuidados postanestésicos. Resultados: Se analizaron los registros de 1181 pacientes. La incidencia acumulada de complicaciones mayores fue: broncoespasmo 1,44 %, laringoespasmo 0,68 % y depresión respiratoria 0,59 %. No se presentaron casos de paro cardiaco ni de edema agudo de pulmón. El antecedente de infección respiratoria menor a 15 días, rinitis y sexo femenino se asociaron con complicaciones respiratorias mayores. Conclusiones: Durante la atención en la unidad de cuidados postanestésicos por parte del personal de enfermería entrenado en la recuperación de la anestesia y de la vía aérea de los pacientes pediátricos, se encontró una baja frecuencia de complicaciones respiratorias.


Subject(s)
Humans , Male , Female , Pulmonary Edema , Respiratory Insufficiency , Anesthesia , Anesthetics , Bronchial Spasm , Rhinitis , Laryngismus , Cohort Studies , Colombia , Edema , Heart Arrest , Infections , Nursing Staff
8.
Rev. cuba. anestesiol. reanim ; 20(2): e748, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289353

ABSTRACT

Introducción: Se exponen los resultados de la intervención anestesiológica de pacientes sospechosos o confirmados con COVID-19 (enfermedad por el nuevo coronavirus), atendidos en un hospital clínico quirúrgico designado para la atención de pacientes en el curso de la pandemia. Objetivo: Presentar las experiencias del manejo de los pacientes quirúrgicos afectados o sospechosos de contagio por el nuevo coronavirus (COVID-19). Métodos: Se recogieron los datos de todos los casos atendidos en el Hospital Militar Central Dr. Luis Díaz Soto fueran obstétricos (cesárea) o de otras especialidades (cirugía, ortopedia, urología). Resultados: Se realizaron 49 intervenciones anestésico-quirúrgicas, de ellas 13 cesáreas, 9 traqueostomías, 7 apendicectomías, 7 salpingectomías, 3 fracturas de cadera, y 1 amputaciones, 1 trepanación de cráneo, 2 drenajes de abscesos y 1 necrectomia, 1 nefrostomía, 1 nefrectomía, 1 cura y 2 laparotomías. Se realizaron las cesáreas con anestesia neuroaxialepidural (inyección única 13-26,5 por ciento) el resto de los procederes se realizaron con anestesia general orotraqueal (32-65,30 por ciento) y general endovenosa (4-8,16 por ciento). Fueron confirmados a la COVID-19 el 38,77 por ciento (19). Se egresaron a terapia intensiva 18 pacientes (36 por ciento), de ellos ventilados 12 (24 por ciento). Fueron casos sospechosos a la COVID-19, 30 casos para el 61,2 por ciento. Conclusiones: No ocurrieron accidentes anestésicos, o fallas en el control de la vía aérea, y no ocurrieron muertes perioperatorias. No existió personal contagiado con la COVID 19; el alto número de sospechosos constituyen un riesgo potencial de contagio(AU)


Introduction: The results are presented regarding anesthesiological intervention of patients suspected of or confirmed with COVID-19 (the disease caused by the new coronavirus), treated in a clinical surgical hospital designated for the care of patients during the pandemic. Objectives: To present the experiences regarding management of surgical patients affected by or suspected of infection by the new coronavirus (COVID-19). Methods: The data of all the cases treated in Hospital Militar Central Dr. Luis Díaz Soto were collected, regardless if they were obstetric cases (by cesarean section) or corresponding to other specialties (surgery, orthopedics, urology). Results: Forty-nine anesthetic-surgical interventions were performed, including thirteen caesarean sections, nine tracheostomies, seven appendectomies, the same number of salpingectomies, three hip fracture surgeries, and one amputation, one skull trepanation, two abscess drains and one necrectomy, one nephrostomy, one nephrectomy, one cure and two laparotomies. Cesarean sections were performed under neuraxial (epidural) anesthesia (thirteen single injections, accounting for 26.5 percent of cases). The rest of the procedures were performed under general orotracheal anesthesia (32 single injections, accounting for 65.30 percent of cases) and general intravenous anesthesia (4 single injections, accounting for 8.16 percent of cases). 38.77 percent (19) of cases were confirmed to COVID-19. Eighteen patients (36 percent) were discharged from the intensive care unit, twelve of which had been ventilated, a figure accounting for 24 percent of cases. There were thirty positive cases of COVID-19, accounting for 61.2 percent. Conclusions: There were no anesthetic accidents, failures in the airway control nor perioperative deaths. There were no personnel infected with COVID-19. The high number of suspects constitute a potential risk of contagion(AU)


Subject(s)
Humans , Critical Care , COVID-19 , Intensive Care Units , Anesthesia
9.
Semina cienc. biol. saude ; 42(2): 187-200, jun./dez. 2021. Tab
Article in Portuguese | LILACS | ID: biblio-1293122

ABSTRACT

Introdução: os sistemas de classificação com linguagens padronizadas se estabelecem em um conjunto de conhecimentos estruturados, conceitos fundados de forma lógica e coerente, com base em suas similaridades. Nesse sentido, identificar um perfil junto a populações pode cooperar para uma melhor definição e compreensão situacional para aquela unidade e/ou pacientes. Objetivos: realizar mapeamento cruzado entre os diagnósticos de enfermagem da NANDA-I com os registros manuais de enfermagem em sala de recuperação pós-anestésica; e propor intervenções e resultados, segundo linguagens padronizadas. Método: estudo exploratório, retrospectivo com análise estatística descritiva de registros de enfermagem de 187 pacientes que estiveram hospitalizados no período de junho a julho de 2018, em sala de recuperação pós-anestésica de um hospital oncológico. O mapeamento cruzado foi realizado em três etapas: identificação dos indicadores dos diagnósticos; proposição de intervenções e atividades; e indicadores de resultados. Os dados foram analisados e descritos em frequências absoluta e relativa. Resultados: dos 13 domínios da NANDA-I, cinco foram representados; identificaram-se cinco diagnósticos de risco e 11 com foco no problema; observou-se 100% de frequência para os diagnósticos de: Risco de aspiração; Risco de infecção; Risco de queda; Capacidade de transferência prejudicada; Mobilidade no leito prejudicada; Integridade da pele/tissular prejudicada e Conforto prejudicado. Conclusões: para os 16 diagnósticos de enfermagem mapeados, foram selecionadas 22 intervenções e 58 atividades; 23 resultados e 48 indicadores de resultados.


Introduction: the classification systems with standardized languages are established in a set of structured knowledge, concepts founded in a logical and coherent way, based on their similarities. In this sense, identifying a profile with the populations can cooperate for a better definition and situational understanding for that unit and/or patients. Objectives: to perform cross-mapping between the nursing diagnoses of NANDA-I with the manual nursing records in the post-anesthetic recovery room; and, to propose interventions and outcomes, according to standardized language. Method: exploratory, descriptive and retrospective analysis of the nursing records of 187 patients hospitalized from June to July 2018, in the post-anesthetic recovery room of an oncology hospital. Cross-mapping was carried out in three stages: identification of diagnostic indicators; proposition of interventions and activities; and outcomes indicators. The data were analyzed and described in absolute and relative frequencies. Results: of the 13 NANDA-I domains, five were highlighted; were identified five risk diagnoses and 11 focused on the problem; 100% frequency was observed for the diagnoses of: Aspiration, infection and falling risk; Impaired transfer capacity; Impaired bed mobility; Impaired skin/tissue integrity and impaired comfort. Conclusions: from the 16 nursing diagnoses mapped, were selected 22 interventions and 58 activities; 23 results and 48 outcomes indicators.


Subject(s)
Humans , Nursing Records , Postanesthesia Nursing , Standardized Nursing Terminology , Anesthesia
10.
Rev. colomb. anestesiol ; 49(2): e400, Apr.-June 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1251500

ABSTRACT

Abstract Perioperative morbidity and mortality are high among patients in the extremes of life undergoing anesthesia. Complications in children occur mainly as a result of airway management-related events such as difficult approach, laryngospasm, bronchospasm and severe hypoxemia, which may result in cardiac arrest, neurological deficit or death. Reports and new considerations that have changed clinical practice in pediatric airway management have emerged in recent years. This narrative literature review seeks to summarize and detail the findings on the primary cause of morbidity and mortality in pediatric anesthesia and to highlight those things that anesthetists need to be aware of, according to the scientific reports that have been changing practice in pediatric anesthesia. This review focuses on the identification of "new" and specific practices that have emerged over the past 10 years and have helped reduce complications associated with pediatric airway management. At least 9 practices grouped into 4 groups are described: assessment, approach techniques, devices, and algorithms. The same devices used in adults are essentially all available for the management of the pediatric airway, and anesthesia-related morbidity and mortality can be reduced through improved quality of care in pediatrics.


Resumen Los pacientes en extremos de la vida sometidos a anestesia tienen la más alta morbimortalidad perioperatoria. Los niños se complican principalmente por eventos derivados del manejo de la vía aérea pediátrica (VAP), como dificultad en su abordaje, laringoespasmo, broncoespasmo e hipoxemia severa, que pueden terminar en paro cardiaco, déficit neurológico o muerte. En los últimos años se han informado y retomado aspectos que cambian la práctica clínica sobre la VAP Esta revisión narrativa de la literatura busca concretar y resumir estos hallazgos sobre la primera causa de morbimortalidad en anestesia pediátrica y enfatizar en lo que los anestesiólogos deben conocer, con base en los informes científicos que vienen cambiando la práctica anestésica pediátrica. Esta revisión busca identificar las conductas "nuevas" y concretas que han surgido en los últimos 10 años, y que ayudan a disminuir las complicaciones derivadas del manejo de la VAP Se señalan y describen al menos nueve conductas agrupadas en 4 bloques: Evaluación, técnicas de abordaje, dispositivos y algoritmos. Actualmente se cuenta con prácticamente todos los dispositivos de adultos para el manejo de la VAP y con consideraciones específicas se puede mejorar la calidad de la atención y reducir la morbimortalidad anestésica en pediatría.


Subject(s)
Humans , Child, Preschool , Child , Algorithms , Airway Management , Indicators of Morbidity and Mortality , Equipment and Supplies , Anesthesia
11.
Rev. cuba. anestesiol. reanim ; 20(1): e701, ene.-abr. 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1156367

ABSTRACT

Introducción: La convivencia con la infección por COVID-19 en Cuba supone un reto actual de adaptación a todos los entornos hospitalarios y de salud, creación de protocolos y nuevos modelos de asistencia. La intervención sobre la vía aérea en sus diferentes formas, conlleva un riesgo de contaminación al personal de la salud. Objetivo: Describir las consideraciones anestésicas en los procedimientos laparoscópicos y endoscópicos durante la pandemia COVID-19. Métodos: Se realizó un estudio cualitativo, de investigación-acción, apoyado en el análisis de documentos y la observación participante de las acciones tomadas en el Centro Nacional de Cirugía de Mínimo Acceso en el curso de los cuatro meses transcurridos a partir de que se identificara el primer caso de COVID-19 en Cuba. Resultados: Se establecieron las recomendaciones anestésicas para el procedimiento de actuación durante la COVID-19 en el Centro Nacional de Cirugía de Mínimo Acceso, que dictan las acciones para el tratamiento de los pacientes y la protección de los trabajadores. Esto posibilita mantener la calidad de los servicios médico quirúrgicos en estos escenarios de riesgo. Conclusiones: La evaluación y tratamiento anestésico estandarizado de los pacientes ante el brote de COVID-19 y en la fase poscovid permite optimizar la seguridad del paciente y el personal sanitario. Es importante el cumplimiento de los protocolos dirigidos hacia el control estricto de la parada quirúrgica, uso adecuado de los equipos de protección personal, disminución de los aerosoles con métodos de barrera y la desinfección del salón y equipos al concluir la intervención(AU)


Introduction: Coexistence with COVID-19 infection in Cuba is a current challenge of adaptation to all hospital and health settings, creation of protocols and new models of care. The airway approach in its different forms represents a risk of contamination of the health personnel. Objective: To describe the anesthetic considerations in laparoscopic and endoscopic procedures during the COVID-19 pandemic. Methods: A qualitative, action-research study was carried out, supported by the analysis of documents and participant observation of the actions taken in the National Center for Minimally-Invasive Surgery in the course of four months after the first case of COVID-19 was identified in Cuba. Results: Anesthetic recommendations were established for the action procedure during COVID-19 in the National Center for Minimally-Invasive Surgery, which dictate the actions for the treatment of patients and the protection of workers. This makes it possible to maintain the quality of surgical medical services in these risk settings. Conclusions: Assessment and standardized anesthetic treatment of patients in the face of the COVID-19 outbreak and in the post-COVID phase allows optimizing the safety of the patient and the healthcare personnel. It is important to comply with the protocols aimed at controlling strictly the surgical setting, proper use of personal protective equipment, reduction of aerosols with barrier methods, and disinfection of the room and equipment at the conclusion of the intervention(AU)


Subject(s)
Humans , Coronavirus Infections/prevention & control , Protocols , Patient Safety , Laparoscopy/methods , Endoscopy/methods , Evaluation Studies as Topic , Anesthesia/standards
12.
São Paulo; s.n; HSPM; 2021.
Thesis in Portuguese | LILACS, ColecionaSUS, SMS-SP, HSPM-Producao, SMS-SP | ID: biblio-1348506

ABSTRACT

RESUMO Na última década, o número de procedimentos bariátricos cresceu exponencialmente. A anestesia em pacientes obesos com comorbidades apresenta um conjunto de desafios para os anestesiologistas. Um dos desafios é manter a analgesia pós-operatória e ao mesmo tempo que diminuir os efeitos colaterais relacionados ao uso de opioides. Deste modo, o presente trabalho tem por finalidade, avaliar a eficácia da anestesia multimodal no controle da dor aguda e a redução do uso de opioides no pós-operatório em pacientes submetidos a cirurgias bariátricas. Trata-se de uma revisão sistemática, onde o tema foi abordado a partir de uma consulta de artigos publicados nas bases "Descritores em Ciência da Saúde" (DeCS) disponibilizada pela Biblioteca Regional de Medicina (BIREME), Literatura Latino-Americana e do Caribe em Ciências de Saúde (LILACS), ScientificElectronic Library Online (SciELO); Medical Literature Online (Medline) e National Center for Biotechnology Information (PubMed ­ NCBI) na língua inglesa e espanhola entre os anos de 2017 e 2021. As Palavras chaves foram: post "operative", "adult and multimodal", "bariatric surgery". Dos 16 artigos utilizados para a revisão sistemática, 50,00% são de origem europeia, seguido por artigos de origem Norte-americana (18,75%) e por artigos Brasileiros (12,50%). A maior parte das publicações ocorreram nos anos de 2019 (37,50%) e 2020 (31,25%). Entre os trabalhos avaliados, 62,50% apresentaram redução da dor e 75,00% obtiveram redução no uso de opioides pós-operatório. Entre os principais tratamentos utilizados nos experimentos, destacam o uso da cetamina, presente em 18,75% dos artigos e o uso de bupivacaina e paracetamol, ambos presentes em 12,50% dos trabalhos. O uso da cetamina diminuíram consideravelmente a quantidade de opioides. Já o uso da bupivacaína demonstrou redução do uso de opioides e a diminuição da dor. Além disso, trabalhos utilizando aplicação de Vitamina E nas anastomoses, associados a analgésicos não-esteroidais (AINES), fentanil ou metadona na indução, apresentaram resultados positivos sobre a redução da dor e queda no uso de opioides pós-operatório. Deste modo, nota-se que o tratamento da dor pós-operatória após procedimentos bariátricos é um componente importante para reduzir o tempo de internação hospitalar e outras complicações, além de melhorar o bem-estar do paciente. Porém novos estudos devem ser realizados para confirmar o uso de anestesia multimodal em pacientes bariátricos, para que possam ser feitos novos protocolos de anestesias multimodal. Palavras-chave: "cirurgia multimodal", "cirurgia bariátrica", anestesia multimodal.


Subject(s)
Humans , Male , Female , Bariatric Surgery , Anesthesia
13.
Braz. j. med. biol. res ; 54(2): e10466, 2021. tab
Article in English | LILACS | ID: biblio-1153513

ABSTRACT

Preoperative evaluation in elective surgeries has been associated with successful surgical treatment. However, there is no solid scientific evidence that screening for coronary artery disease (CAD) reduces surgical risk. The aims of this study were to describe the frequency of inappropriate investigation of obstructive CAD induced by pre-anesthetic assessment in individuals without cardiovascular symptoms (candidates for low- to intermediate-risk surgeries) and to evaluate predictors of this conduct. We performed a retrospective evaluation of medical records of anesthesiology services from patients undergoing pre-anesthesia assessment between May 2015 and May 2016, including those with functional capacity ≥4 metabolic equivalents without a diagnosis of heart disease. A total of 778 medical records (47±16 years of age, 62.6% female) were studied. A private hospital performed 50.1% of the surgeries and 60.4% were of intermediate risk. Only 2.7% (95%CI: 1.7-4.1%) were screened for CAD, and 91% of these requests were mediated by cardiology consultations performed during pre-anesthetic testing visits. Factors associated with screening for CAD were hypertension, diabetes, moderate systemic disease (ASA III), cardiac consultation, previous diagnosis of CAD, and admission to a private hospital. Independent predictors were private hospitals (OR: 3.9; 95%CI: 1.3-11.0), ASA III (OR: 5.3; 95%CI: 1.7-16.2), and hypertension (OR: 3.8; 95%CI: 1.5-9.8). The frequency of inappropriate requests for CAD screening in asymptomatic individuals without untreated systemic diseases was low in pre-anesthetic visits. Although infrequent, screening for CAD is more common in the private setting, in patients with poorer health status, and is usually prescribed during cardiology consultation.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Coronary Artery Disease/surgery , Coronary Artery Disease/diagnosis , Unnecessary Procedures , Anesthesia , Mass Screening , Retrospective Studies , Risk Factors , Risk Assessment , Heart Diseases
14.
Rev. Col. Bras. Cir ; 48: e20202722, 2021. graf
Article in English | LILACS | ID: biblio-1250705

ABSTRACT

ABSTRACT The anesthesia for awake craniotomy (AC) is a consecrated anesthetic technique that has been perfected over the years. Initially used to map epileptic foci, it later became the standard technique for the removal of glial neoplasms in eloquent brain areas. We present an AC anesthesia technique consisting of three primordial times, called awake-asleep-awake, and their respective particularities, as well as delve into the anesthetic medications used. Its use in patients with low and high-grade gliomas was favorable for the resection of tumors within the functional boundaries of patients, with shorter hospital stay and lower direct costs. The present study aims to systematize the technique based on the experience of the largest philanthropic hospital in Latin America and discusses the most relevant aspects that have consolidated this technique as the most appropriate in the surgery of gliomas in eloquent areas.


RESUMO A anestesia para craniotomia em paciente acordado (CPA ou awake craniotomy) é técnica anestésica consagrada e aperfeiçoada ao longo dos últimos anos. Utilizada inicialmente para mapeamento de focos epilépticos, consolidou-se posteriormente como técnica padrão para a remoção de neoplasias de origem glial em áreas eloquentes cerebrais. A técnica de anestesia CPA apresentada constitui-se em três tempos primordiais denominados acordado-dormindo-acordado (asleep-awake-asleep) e respectivas particularidades, assim como o manejo quanto às medicações anestésicas utilizadas de forma pormenorizada. A utilização em gliomas de baixo e de alto grau se demonstrou favorável para a ressecção de tumores dentro dos limites funcionais dos pacientes, com menor tempo de internação hospitalar e de custos diretos. O presente estudo visa realizar a sistematização da técnica baseada na experiência do maior Hospital Filantrópico da América Latina e discute os aspectos mais relevantes que consolidaram essa técnica como a mais adequada na cirurgia dos gliomas em áreas eloquentes.


Subject(s)
Humans , Brain Neoplasms/surgery , Glioma/surgery , Anesthesia , Wakefulness , Craniotomy
15.
Rev. colomb. anestesiol ; 48(4): e203, Oct.-Dec. 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1144314

ABSTRACT

Abstract Introduction: Postoperative nausea and vomiting are frequent adverse effects of anesthesia and surgery. Impact is greater in pediatric populations compared to adults and the reported incidences are heterogeneous. Objective: To describe the incidence of postoperative vomiting in a pediatric population and to identify associated risk factors. Materials and methods: This prospective cohort study included 190 children aged 3 to 12 years undergoing surgery and anesthesia in a maternal and child health clinic in Bucaramanga (Colombia). The main outcome variable was postoperative vomiting. Data were analyzed using bivariate, multivariate analysis and logistic regression to assess the associated risk factors. Results: The overall incidence of postoperative vomiting was 18.95% (95% CI: 13.32 - 24.57), with a higher incidence at home vs. hospital (12.63% vs. 9.47%). After adjustment, associated risk factors were anesthesia time longer than 45 minutes (OR: 2.33; 95% CI: 1.10-4.90) and postoperative use of opioids (OR: 4.17; 95% IC: 1.6510.5). The incidence of postoperative vomiting was higher in patients who underwent emergency surgery. Conclusion: This is the first study in Colombia that evaluates the incidence of postoperative vomiting in children. The incidence in our pediatric population is within the ranges reported worldwide. Associated risk factors were anesthesia time longer than 45 minutes and postoperative use of opioids. Further research is required in order to study emergency surgery as a potential risk factor.


Resumen Introducción: Las náuseas y el vómito postoperatorios son un resultado adverso frecuente derivado del acto anestésico y/o quirúrgico. La magnitud de este problema es mayor en la población pediátrica en comparación con la población adulta, con una considerable heterogeneidad de datos respecto a la incidencia. Objetivo: Describir la incidencia de vómito postoperatorio en población pediátrica y sus factores de riesgo asociados. Materiales y métodos: Estudio de cohorte prospectivo realizado en Clínica Materno Infantil de III-IV nivel de Bucaramanga (Colombia), en 190 pacientes pediátricos con edades entre 3 y 12 años, sometidos a cirugía sin discriminar técnica anestésica. Se realizó análisis bivariado, multivariado y regresión logística. Resultados: La incidencia de vómito postoperatorio en el estudio fue de 18,95 % (IC-95 % [13,32-24,57]), y es mayor en la casa que en la institución hospitalaria (12,63 % vs. 9,47 %). Tras el ajuste, los factores de riesgo establecidos fueron el tiempo anestésico mayor de 45 minutos (OR 2,33; IC-95 % [1,10-4,90]) y uso de opioide postoperatorio (OR 4,17; IC-95 % [1,65-10,5]). Hubo una incidencia importante de vómito postoperatorio en pacientes sometidos a cirugía de urgencias. Conclusiones: Este es el primer estudio en Colombia que evalúa la incidencia de vómito postoperatorio en población pediátrica. La incidencia se encuentra dentro del rango reportado en la literatura mundial y se establecieron como factores asociados el tiempo anestésico mayor a 45 minutos y uso de opioides en el postoperatorio. Consideramos que debe estudiarse la cirugía de urgencias como posible factor de riesgo en estudios posteriores.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Pediatrics , Postoperative Nausea and Vomiting , Postoperative Complications , Analgesics, Opioid , Anesthesia
16.
Article in Spanish | LILACS, BDNPAR | ID: biblio-1337592

ABSTRACT

El Síndrome de Treacher Collins (STC) constituye un reto para el anestesiólogo por malformaciones craneofaciales que complican el manejo de su vía aérea e intubación. Presentamos el caso de una paciente (8 años) con diagnóstico de STC que debía someterse a una cirugía de colocación de implante de conducción ósea bajo anestesia general. Presentaba un antecedente de intubación difícil, marcada micrognatia y distancia tiromentoniana de 2 cm. Se planteó un esquema de intubación en dos etapas secuenciales. En la primera etapa se realizó una evaluación de la vía aérea (visualización de la glotis) bajo sedación con dexmedetomidina, remifentanilo y propofol. Al visualizar la glotis se pasó a la segunda etapa para realizar la intubación posterior a la inducción anestésica.El manejo exitoso se fundamentó en una sedación adecuada y la utilización de un videolaringoscopio con pala curva para la evaluación previa de la vía aérea y posterior intubación sin complicaciones


Treacher Collins Syndrome (TCS) constitutes a challenge for the anesthesiologist due to craniofacial malformations that make management of the airway and intubation difficult. We present a case of a patient (8-year-old) diagnosed with TCS who had to undergo surgery for the placement of a bone conduction implant under general anesthesia. She had a history of difficult intubation, marked micrognathia and a thyromental distance of 2 cm. An intubation scheme in two sequential stages was proposed. In the first stage, an evaluation of the airway (visualization of the glottis) was carried out under sedation with dexmedetomidine, remifentanil and propofol. When the glottis was visualized, we proceeded to the second stage to carry out intubation after anesthetic induction.The successful management of this case was based on adequate sedation and the use of a video laryngoscope with a curved blade for prior evaluation of the airway and subsequent intubation without complications


A síndrome de Treacher Collins (STC) constitui um desafio para o anestesiologista devido às malformações craniofaciais que dificultam o manejo da via aérea e a intubação. Apresentamos o caso de uma paciente (8 anos) com diagnóstico de STC que foi submetida a uma cirurgia para colocação de implante de condução óssea sob anestesia geral. Ela tinha história de intubação difícil, micrognatia acentuada e distância tiromentoniana de 2 cm. Foi proposto um esquema de intubação em duas etapas sequenciais. Na primeira etapa, foi realizada avaliação das vias aéreas (visualização da glote) sob sedação com dexmedetomidina, remifentanil e propofol. Quando a glote foi visualizada, a segunda etapa foi realizada para realização da intubação após a indução anestésica. O manejo bem-sucedido baseou-se na sedação adequada e no uso de videolaringoscópio com lâmina curva para avaliação prévia da via aérea e posterior intubação sem complicações


Subject(s)
Humans , Female , Child , Laryngoscopy , Mandibulofacial Dysostosis , Airway Management , Intubation , Anesthesia
17.
Rev. SOBECC ; 25(4): 241-246, 21-12-2020.
Article in Portuguese | LILACS, BDENF | ID: biblio-1141402

ABSTRACT

Objetivo: Identificar a frequência, o perfil e o tempo de permanência de pacientes intensivos admitidos na sala de recuperação pós-anestésica (SRPA). Método: Estudo transversal e retrospectivo, realizado com base em registros de admissões na SRPA de um hospital público no Rio Grande do Sul, entre julho de 2012 e julho de 2017. Resultados: No período estudado, admitiram-se no setor 22.333 pacientes, sendo 717 (3,2%) pacientes intensivos por indisponibilidade de leito na unidade de terapia intensiva. Destes, 67,6% eram do sexo feminino, 61,2% em idade adulta, submetidos à neurocirurgia (61,5%). O tempo de permanência médio no setor foi de 10,7 horas, e 4,1% dos pacientes foram a óbito. Conclusão: A permanência de pacientes intensivos na SRPA requer adequação do setor em sua estrutura física e operacional, especialmente no que diz respeito à equipe assistencial tanto em quantidade de pessoal quanto em capacitação técnica necessária para assegurar uma assistência de qualidade.


Objective: To identify the frequency, profile, and length of stay of intensive care patients admitted to the post-anesthesia care unit (PACU). Method: This is a retrospective cross-sectional study based on PACU admission records of a public hospital in Rio Grande do Sul, Southern Brazil, between July 2012 and June 2017. Results: In the study period, 22,333 patients were admitted to the PACU; 717 (3.2%) of them were intensive care patients due to the unavailability of beds in the intensive care unit. Among them, 67.6% were women, 61.2% were adults, and 61.5% were individuals submitted to neurosurgery. The mean length of stay in the unit was 10.7 hours, and 4.1% of patients died. Conclusion: The stay of intensive care patients in the PACU requires adapting the physical and operational structure of the unit, particularly in aspects related to the care team, including the number of personnel and the technical training necessary to ensure the quality of care.


Objetivo: Identificar la frecuencia, perfil y tiempo de estancia de los pacientes de cuidados intensivos ingresados en la Sala de Recuperación Posanestésica (SRPA). Método: Estudio transversal y retrospectivo, realizado a partir de los registros de ingreso en la UCPA de un hospital público de Rio Grande do Sul, entre julio de 2012 y julio de 2017. Resultados: En el período estudiado ingresaron al sector 22.333 pacientes, 717 (3,2%) pacientes de cuidados intensivos por indisponibilidad de camas en la Unidad de Cuidados Intensivos. De estos, el 67,6% eran mujeres, el 61,2% adultos, sometidos a neurocirugía (61,5%). La estancia media en el sector fue de 10,7 horas y falleció el 4,1% de los pacientes. Conclusión: La permanencia de los pacientes de cuidados intensivos en la SRPA requiere la adecuación del sector en su estructura física y operativa, especialmente en lo que se refiere al equipo asistencial, tanto en el número de personal como en la formación técnica necesaria para asegurar una atención de calidad.


Subject(s)
Humans , Quality of Health Care , Anesthesia Recovery Period , Anesthesia , Recovery Room , Residence Time , Length of Stay
19.
An. Fac. Cienc. Méd. (Asunción) ; 53(3): 153-158, 20201201.
Article in Spanish | LILACS | ID: biblio-1178003

ABSTRACT

El Síndrome de Treacher Collins (STC) constituye un reto para el anestesiólogo por malformaciones craneofaciales que complican el manejo de su vía aérea e intubación. Presentamos el caso de una paciente (8 años) con diagnóstico de STC que debía someterse a una cirugía de colocación de implante de conducción ósea bajo anestesia general. Presentaba un antecedente de intubación difícil, marcada micrognatia y distancia tiromentoniana de 2 cm. Se planteó un esquema de intubación en dos etapas secuenciales. En la primera etapa se realizó una evaluación de la vía aérea (visualización de la glotis) bajo sedación con dexmedetomidina, remifentanilo y propofol. Al visualizar la glotis se pasó a la segunda etapa para realizar la intubación posterior a la inducción anestésica. El manejo exitoso se fundamentó en una sedación adecuada y la utilización de un videolaringoscopio con pala curva para la evaluación previa de la vía aérea y posterior intubación sin complicaciones.


Treacher Collins Syndrome (TCS) constitutes a challenge for the anesthesiologist due to craniofacial malformations that make management of the airway and intubation difficult. We present a case of a patient (8-year-old) diagnosed with TCS who had to undergo surgery for the placement of a bone conduction implant under general anesthesia. She had a history of difficult intubation, marked micrognathia and a thyromental distance of 2 cm. An intubation scheme in two sequential stages was proposed. In the first stage, an evaluation of the airway (visualization of the glottis) was carried out under sedation with dexmedetomidine, remifentanil and propofol. When the glottis was visualized, we proceeded to the second stage to carry out intubation after anesthetic induction. The successful management of this case was based on adequate sedation and the use of a video laryngoscope with a curved blade for prior evaluation of the airway and subsequent intubation without complications.


Subject(s)
Dexmedetomidine , Anesthesia , Anesthesia, General , Congenital Abnormalities , Diagnosis
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