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1.
Autops. Case Rep ; 11: e2021275, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249035

ABSTRACT

Introduction Cervical erector spinae plane block (ESPB) provides postoperative pain relief when administered at the level of first thoracic costotransverse junction (CTJ) for surgeries on the proximal shoulder and cervical spine. We propose to describe the spread of 20 ml radiocontrast - dye solution administered at this level from caudad to cephalad direction in a fresh frozen cadaveric model through imaging and cross-sections. Methods An observational study with four thoracic to cervical ESP blocks at the level of first thoracic CTJ level on two fresh cadavers (total 4 specimens) was conducted using 20 ml of radiocontrast- methylene blue combination (10 ml through the needle and 10 ml through the catheter). Both cadavers were subjected to computed tomography (CT) scan. An anatomist and radiologist, respectively, analyzed cross-sections of cadavers and CT contrasted images. Results The spread was assessed in axial, sagittal, and coronal at the levels of C4, C5, C6, C7and T1. The medial limit was articular processes in both cadavers. The lateral limits were the outer border of the middle scalene muscle in cadaver 1 and posterior to the sternocleidomastoid muscle in cadaver 2. Contrast spread was visualized on the superior and anterior aspect of anterior scalene muscle in cadaver 2. An epidural spread was observed at the level of C5-6 and C6-7 in axial and coronal planes in cadaver 1. Conclusions The cervical ESPB administered at the first thoracic CTJ with injections directed cephalad has a consistent action on the dorsal spinal nerves of thoracic and cervical area, and spreads in the paravertebral space dorsal to the ventral cervical roots.


Subject(s)
Humans , Anesthesia, Conduction/methods , Nerve Block , Cadaver , Ultrasonography , Dissection
2.
Rev. cuba. anestesiol. reanim ; 19(2): e589, mayo.-ago. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126361

ABSTRACT

Introducción: El cáncer de labio es el tumor más frecuente de la cavidad oral que afecta, sobre todo, el labio inferior. La braquiterapia es un tratamiento único eficaz en estadios tempranos y como terapia adyuvante a la cirugía en estadios avanzados. Esta técnica es un proceso doloroso por lo que para su realización se han empleado sedaciones profundas, infiltraciones intramusculares de anestésico local y técnicas de anestesia regional, entre otras. Objetivo: Presentar una técnica anestésica diferente y poco descrita como alternativa para disminuir el dolor de la intervención. Presentación del caso: Paciente con carcinoma de labio programado para braquiterapia. Se realiza bloqueo del nervio mentoniano de manera bilateral para el tratamiento en labio inferior. Conclusiones: Este tipo de bloqueo, por su sencillez y eficacia, es una alternativa útil a la sedación profunda para la realización de braquiterapia en el labio inferior(AU)


Introduction: Lip cancer is the most frequent tumor of the oral cavity that affects, above all, the lower lip. Brachytherapy is a unique treatment which is effective in early stages and, as adjuvant therapy to surgery, it is also effective in advanced stages. This technique is a painful process, a reason why deep sedation, intramuscular infiltrations of local anesthetic, and regional anesthesia techniques, among others, have been used. Objective: To present a different and scarcely described anesthetic technique as an alternative to reduce the pain of this intervention. Case presentation: Patient with lip carcinoma scheduled for brachytherapy. Bilateral mental nerve block is performed in the lower lip. Conclusions: This type of block, due to its simplicity and effectiveness, is a useful alternative to deep sedation for brachytherapy in the lower lip(AU)


Subject(s)
Humans , Male , Aged , Lip Neoplasms/surgery , Anesthesia, Conduction/methods , Nerve Block/methods , Brachytherapy/methods
3.
Rev. bras. anestesiol ; 70(4): 364-387, July-Aug. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137197

ABSTRACT

Abstract The development of protocols to prevent perioperative Venous Thromboembolism (VTE) and the introduction of increasingly potent antithrombotic drugs have resulted in concerns of increased risk of neuraxial bleeding. Since the Brazilian Society of Anesthesiology 2014 guideline, new oral anticoagulant drugs were approved by international regulating agencies, and by ANVISA. Societies and organizations that try to approach concerns through guidelines have presented conflicting perioperative management recommendations. As a response to these issues and to the need for a more rational approach, managements were updated in the present narrative review, and guideline statements made. They were projected to encourage safe and quality patient care, but cannot assure specific results. Like any clinical guide recommendation, they are subject to review as knowledge grows, on specific complications, for example. The objective was to assess safety aspects of regional analgesia and anesthesia in patients using antithrombotic drugs, such as: possible technique-associated complications; spinal hematoma-associated risk factors, prevention strategies, diagnosis and treatment; safe interval for discontinuing and reinitiating medication after regional blockade.


Resumo Os padrões evolutivos para a prevenção do tromboembolismo venoso perioperatório e a introdução de medicações antitrombóticas cada vez mais potentes resultaram em preocupações com o aumento do risco de sangramento neuroaxial. Após o consenso da Sociedade Brasileira de Anestesiologia em 2014, novos medicamentos anticoagulantes orais foram aprovados pelas instituições reguladoras internacionais, assim como pela ANVISA. As sociedades que buscam abordar o manejo perioperatório desses fármacos apresentam recomendações conflitantes. Em resposta a essas questões e à necessidade de uma abordagem mais racional, as condutas foram atualizadas nesta revisão narrativa e feitas declarações de consenso. Elas foram projetadas para encorajar a assistência ao paciente de forma segura e de qualidade, mas não podem garantir um resultado específico. Tal como acontece com qualquer recomendação de orientação clínica, estas estão sujeitas a revisão com o conhecimento de avanços específicos de complicações. O objetivo foi avaliar aspectos da segurança em anestesia e analgesia regional em pacientes em uso de medicações antitrombóticas, tais como: possíveis complicações decorrentes da técnica; fatores de risco associados ao hematoma espinhal, estratégias de prevenção, diagnóstico e tratamento; intervalo seguro para suspensão e reinício da medicação após o bloqueio regional.


Subject(s)
Humans , Practice Guidelines as Topic , Anesthesia, Conduction/methods , Anticoagulants/administration & dosage , Postoperative Complications/prevention & control , Brazil , Risk Factors , Perioperative Care/methods , Venous Thromboembolism/prevention & control , Hemorrhage/chemically induced , Anticoagulants/adverse effects
4.
Rev. bras. anestesiol ; 70(4): 398-418, July-Aug. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1137194

ABSTRACT

Abstract The purpose of the Brazilian Society of Anesthesiology (SBA)'s Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.


Resumo O propósito desta atualização das Recomendações da Sociedade Brasileira de Anestesiologia (SBA) para Segurança em Anestesia Regional foi apresentar novas diretrizes com base na relevância e atualidade clínica nos aspectos de segurança relacionados a analgesia e anestesia regional. Este artigo visa prover uma visão ampla sobre o conhecimento atual no tocante a assepsia e antissepsia pré-procedimento, fatores de risco, diagnóstico e tratamento das complicações infecciosas decorrentes das técnicas anestésicas. Também visa esclarecer sobre o uso de materiais reprocessados na prática da anestesia regional, estabelecer as implicações no manejo asséptico de frascos e ampolas e elucidar sobre a relação custo-efetividade no preparo de soluções a serem administradas continuamente em bloqueios regionais. As bases de dados eletrônicas foram pesquisadas entre Janeiro de 2011 (final da pesquisa de literatura das diretrizes anteriores da SBA sobre segurança em anestesia regional) e Setembro de 2019. Um total de 712 artigos foram encontrados, dos quais 201 foram incluídos para análise posterior e 82 novos estudos foram acrescentados nesta revisão. O sistema de Avaliação, Desenvolvimento e Avaliação da Classificação das Recomendações (GRADE) foi utilizado para avaliar a qualidade do estudo individual e classificar a força da evidência. Esta revisão foi elaborada por membros da Comissão de Normas Técnicas da SBA.


Subject(s)
Humans , Infections/etiology , Anesthesia, Conduction/adverse effects , Nerve Block/adverse effects , Brazil , Risk Factors , Practice Guidelines as Topic , Anesthesia, Conduction/methods , Nerve Block/methods
5.
Medwave ; 20(6): e7950, 31-07-2020.
Article in English, Spanish | LILACS | ID: biblio-1119716

ABSTRACT

El objetivo de este artículo es revisar las características del SARS-CoV-2, los aspectos clínico-epidemiológicos de COVID-19 y las implicaciones que tienen para los anestesiólogos al realizar procedimientos generadores de aerosoles. Se realizó una búsqueda en las bases de datos PubMed, Scopus, SciELO y Web of Science hasta el 9 de abril de 2020, utilizando las palabras: "COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia". Se incluyeron 48 artículos con información sobre el manejo del paciente en el perioperatorio o en la unidad de cuidados intensivos ante la sospecha o confirmación de infección por SARS-CoV-2. En general, se recomienda el aplazamiento de las cirugías electivas por no más de seis a ocho semanas, de acuerdo a las condiciones clínicas de los pacientes. En el caso de cirugías de urgencia o emergencia, se revisan tópicos del sistema de protección personal así como las estrategias recomendadas para la realización de los procedimientos.


The purpose of this article is to review the characteristics of SARS-CoV-2, the clinical-epidemiological aspects of COVID-19, and the implications anesthesiologists when performing aerosol-generating procedures. A search of PubMed/MEDLINE, Scopus, SciELO, and Web of Science databases was performed until April 9, 2020, using the words: "COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia". Forty-eight articles with information on the management of the patient in the perioperative period or the intensive care unit when suspected or confirmed SARS-CoV-2 infection were included. In general, the postponement of elective surgeries for no more than 6 to 8 weeks, depending on the clinical condition of the patients is recommended. In the case of urgent or emergency surgeries, we review the use of personal protection gear, as well as the recommended strategies for carrying out the procedure.


Subject(s)
Humans , SARS-CoV-2/genetics , COVID-19/complications , COVID-19/epidemiology , Anesthesiology/standards , Occupational Diseases/prevention & control , Respiration, Artificial/methods , Respiration, Artificial/standards , Surgical Procedures, Operative/methods , Elective Surgical Procedures , Aerosols , Pandemics , Symptom Assessment/methods , Personal Protective Equipment , COVID-19/diagnosis , COVID-19/transmission , Intensive Care Units , Intubation, Intratracheal/methods , Intubation, Intratracheal/standards , Anesthesia, Conduction/methods , Anesthesia, Epidural/methods , Anesthesia, General/methods , Anesthesia, Spinal/methods , Anesthesiology/organization & administration , Nerve Block/methods
6.
Rev. bras. anestesiol ; 70(2): 159-164, Mar.-Apr. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1137165

ABSTRACT

Abstract Since the beginning of the COVID-19 pandemic, many questions have come up regarding safe anesthesia management of patients with the disease. Regional anesthesia, whether peripheral nerve or neuraxial, is a safe alternative for managing patients with COVID-19, by choosing modalities that mitigate pulmonary function involvement. Adopting regional anesthesia mitigates adverse effects in the post-operative period and provides safety to patients and teams, as long as there is compliance with individual protection and interpersonal transmission care measures. Respecting contra-indications and judicial use of safety techniques and norms are essential. The present manuscript aims to review the evidence available on regional anesthesia for patients with COVID-19 and offer practical recommendations for safe and efficient performance.


Resumo Desde o início da pandemia de COVID-19, muitas questões surgiram referentes à segurança do manejo anestésico de pacientes acometidos pela doença. A anestesia regional, seja esta periférica ou neuroaxial, é alternativa segura no manejo do paciente COVID-19, desde que o emprego de modalidades que minimizam o comprometimento da função pulmonar seja escolhido. A adoção dessa técnica anestésica minimiza os efeitos adversos no pós-operatório e oferece segurança para o paciente e equipe, desde que sejam respeitados os cuidados com proteção individual e de contágio interpessoal. Respeito às contraindicações e emprego criterioso das técnicas e normas de segurança são fundamentais. Este manuscrito tem por objetivo revisar as evidências disponíveis sobre anestesia regional em pacientes com COVID-19 e oferecer recomendações práticas para sua realização segura e eficiente.


Subject(s)
Humans , Pneumonia, Viral/therapy , Coronavirus Infections/therapy , Anesthesia, Conduction/methods , Anesthesia, Local/methods , Pneumonia, Viral/transmission , Postoperative Period , Coronavirus Infections/transmission , Pandemics , COVID-19 , Anesthesia, Conduction/adverse effects , Anesthesia, Local/adverse effects
9.
Int. j. med. surg. sci. (Print) ; 5(4): 160-163, dic. 2018.
Article in English | LILACS | ID: biblio-1254230

ABSTRACT

Before the advent of anaesthesia in surgical practice, surgeons battled with patient's maximal co-operation during surgical procedures, management of pain intra-operatively and post-operatively. Anaesthesia has greatly aided in overcoming these challenges, but a sizable proportion of reduction in these challenges but approximately 30-80% of patients complain of moderate to severe pain post-operatively indicating that post-operative pain remains a problem. Controlled epidural anaesthesia and controlled peripheral nerve block which are types of regional anaesthesia provide superior pain relief during and after surgery, making regional anaesthesia of particular relevance in orthopaedic surgery. More so, general anaesthesia has some adverse effects on the outcome of operation and the patient. These adverse effects are rare but may be disastrous and life-threatening necessitating close supervision during and after general anaesthesia. Hence, the preference should be towards regional anaesthesia with regards to the choice of anaesthesia in orthopaedic surgery. This review aims to highlight some concepts and techniques on regional anaesthesia in orthopaedic surgery.


Subject(s)
Humans , Orthopedic Procedures/methods , Anesthesia, Conduction/methods , Pain, Postoperative , Pain, Procedural
10.
Int. j. med. surg. sci. (Print) ; 5(4): 164-170, dic. 2018.
Article in English | LILACS | ID: biblio-1254237

ABSTRACT

The relevance of regional anaesthesia in orthopaedic surgery cannot be overemphasized because it has aided reduction in intra-operative and post-operative pain which has always been a challenge in surgical practice. It also reduces the risk of haemorrhage and infection. Though there are complications associated with regional anaesthesia, these complications are rare and can be anticipated; thus prompt intervention measures can be instituted. The outcome of every surgical procedure takes into consideration the risks and benefit of the method, and hence, since the benefits of regional anaesthesia in orthopaedic surgery outweighs the risks, it is highly recommended. Regional anaesthesia is of great importance in orthopaedic surgery because it offers continuous but controlled analgesia. It induces hypotension which leads to a reduction in blood loss during operation. It allows early recovery and ambulation of patients, thus reducing the risks associated with prolonged bed stay, which may, in turn, affect the overall outcome of surgery. This review aims to highlight the advantages and challenges of regional anaesthesia in orthopaedic surgery


Subject(s)
Humans , Orthopedic Procedures/methods , Anesthesia, Conduction/adverse effects , Anesthesia, Conduction/methods
11.
Dolor ; 28(70): 30-34, dic. 2018. tab
Article in Spanish | LILACS | ID: biblio-1117989

ABSTRACT

La anestesia regional pediátrica, ya sea los bloqueos neuroaxiales como periféricos, constituye actualmente un pilar fundamental en el manejo analgésico multimodal orientado a los periodos intra y postoperatorio; facilitando una recuperación postquirúrgica óptima y un alta precoz en niños. La inyección única de anestésicos locales en el bloqueo regional posee una duración limitada. Para conocer las técnicas y fármacos coadyuvantes de los anestésicos locales disponibles, destinados a prolongar la duración del bloqueo en inyección única, hemos efectuado una revisión del uso de fármacos coadyuvantes de los anestésicos locales utilizados, describiendo los mecanismos de acción, la evidencia clínica de sus beneficios; como también, la incidencia de complicaciones y los riesgos asociados a su uso.


Pediatric regional anesthesia, whether neuro axial or peripheral nerve blocks, is currently a base in multimodal analgesic management aimed at the intra and postoperative periods; enabling optimal postoperative recovery and early discharge in children. Single injection of local anesthetics in regional blockade has a limited duration. In order to know the techniques and adjuvant drugs of the available local anesthetics, designed to prolong the duration of block in single injection, we have reviewed the use of adjuvants, describing the mechanisms of action, the clinical evidence of their benefits; as well as, the incidence of complications and the risks associated with its use.


Subject(s)
Humans , Child , Pain, Postoperative/prevention & control , Pain Management/methods , Adjuvants, Anesthesia/administration & dosage , Anesthesia, Conduction/methods
12.
Rev. cuba. anestesiol. reanim ; 17(1): 1-6, ene.-abr. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-991019

ABSTRACT

Introducción: El bloqueo de rama izquierda del haz de His dependiente de la frecuencia cardíaca no es una entidad común en la práctica clínica del anestesiólogo, sino que se presenta como consecuencia de enfermedades cardiacas o no que ocurren por lentitud de la frecuencia ventricular sobre todo, con enfermedad de las arterias coronarias planteadas solo como diagnóstico después de haberlas descartado. Objetivo: Describir el manejo clínico-anestésico de una paciente que presentó bloqueo de rama izquierda del haz de His para cirugía torácica electiva por tumor de mediastino. Desarrollo: Se presenta un caso clínico de una paciente con bloqueo de rama izquierda dependiente de la frecuencia cardiaca que se anunció para cirugía del tórax, sin historia previa de coronariopatía. La cirugía trascurrió sin complicaciones y con buenos resultados. Conclusiones: el bloque de rama izquierda dependiente de la frecuencia cardiaca es una entidad rara y un diagnóstico excluyente de otras entidades cardiovasculares o no como la isquemia miocárdica. Un adecuado manejo intraoperatorio del paciente proporciona excelentes resultados sin traducción clínica ni complicaciones(AU)


Introduction: Rate-dependent left bundle branch block is not a rare entity for the clinical practice in anesthesiology, but appears as a consequence of heart diseases or not always due to slowness in atrial frequency above all, with coronary artery diseases diagnosed only after their being ruled out. Objective: To describe the clinical-anesthetic management of a patient who presented left bundle branch block for elective thoracic surgery due to mediastinal tumor. Findings: We present a clinical case of a female patient with rate-dependent left bundle branch block who was announced for thoracic surgery, without a previous history of coronary artery disease. The surgery proceeded without complications and with positive outcome. Conclusions: Rate-dependent left-branch block is a rare entity and a diagnosis ruling out other cardiovascular entities or not, such as myocardial ischemia. An adequate intraoperative management of the patient provides excellent outcome without clinical translation or complications(AU)


Subject(s)
Humans , Female , Aged , Heart Rate/drug effects , Anesthesia, Conduction/methods , Bundle-Branch Block/surgery
13.
Rev. ADM ; 74(3): 123-126, mayo-jun. 2017. ilus
Article in Spanish | LILACS | ID: biblio-908008

ABSTRACT

La anestesia dental es un tema importante en la práctica cotidiana enlas diversas especialidades odontológicas, motivo por el que nace lanecesidad de hacer una revisión de las técnicas anestésicas actuales. Con base en nuestra experiencia nos dimos cuenta de que la practicidad de utilizar referencias anatómicas confiables nos sirven de guía para obtener una mejor efi cacia al momento de anestesiar el nervio alveolar mandibular. Lo anterior se traduce en menor dolor posterior a la punción, menor dosis anestésica y una profundidad anestésica adecuada en tejidos blandos y duros, del mismo modo nos permite llevar a cabo diversos tratamientos con un margen de seguridad más amplio y disminuir losriesgos de toxicidad. Cabe mencionar que dicha técnica se ha incluido enla práctica clínica cotidiana en nuestra práctica privada en el Postgradode Ortodoncia del Instituto universitario Franco Inglés de México yen el Servicio de Cirugía Oral y Maxilofacial del Centro Médico Lic.Adolfo López Mateos en la ciudad de Toluca, Estado de México.


Dental anesthesia is an important issue in daily practice in the variousdental specialties, which is why the need for a review of the anesthetictechnique arises. Based on our experience, we realized the practicalityof using reliable anatomical references that serve as a guide, to obtaina better effi cacy when anesthetizing the mandibular alveolar nerve,resulting in less pain after puncture, lower anesthetic dose and anadequate anesthetic depth in soft and hard tissues, which allows us tocarry out various treatments with a wider margin of safety and reducethe risks of toxicity. It is worth mentioning that this technique hasbeen included in daily clinical practice in our private practice, in theorthodontic postgraduate course of the Instituto Franco in Mexico andin the oral and maxillofacial surgery service of the Licensed MedicalCenter «Adolfo Lopez Mateos¼ in the City of Toluca, State of Mexico.


Subject(s)
Humans , Anesthesia, Conduction/methods , Mandibular Nerve , Anatomic Landmarks , Anesthetics/classification , Anesthetics/pharmacology , Anesthetics/therapeutic use , Mandibular Nerve/anatomy & histology
14.
Rev. bras. anestesiol ; 66(5): 499-504, Sept.-Oct. 2016. tab
Article in English | LILACS | ID: lil-794817

ABSTRACT

Abstract The ultrasound guidance in regional anesthesia ensures the visualization of needle placement and the spread of Local Anesthetics. Over the past few years there was a substantial interest in determining the Minimum Effective Anesthetic Volume necessary to accomplish surgical anesthesia. The precise and real-time visualization of Local Anesthetics spread under ultrasound guidance block may represent the best requisite for reducing Local Anesthetics dose and Local Anesthetics-related effects. We will report a series of studies that have demonstrated the efficacy of ultrasound guidance blocks to reduce Local Anesthetics and obtain surgical anesthesia as compared to block performed under blind or electrical nerve stimulation technique. Unfortunately, the results of studies are widely divergent and not seem to indicate a dose considered effective, for each block, in a definitive way; but it is true that, through the use of ultrasound guidance, it is possible to reduce the dose of anesthetic in the performance of anesthetic blocks.


Resumo O uso de ultrassom em anestesia regional permite visualizar a colocação da agulha e a propagação dos anestésicos locais. Nos últimos anos houve um grande interesse em determinar o volume mínimo eficaz de anestésico necessário para fazer a anestesia cirúrgica. A visualização precisa e em tempo real da difusão dos anestésicos locais com o uso de ultrassom pode ser o melhor requisito para reduzir a dose e os efeitos relacionados aos anestésicos locais. Revisamos uma série de estudos que relataram a eficácia de bloqueios guiados por ultrassom para reduzir o uso de anestésicos locais e obter anestesia cirúrgica, em comparação com bloqueios feitos com a técnica às cegas e de estimulação elétrica de nervos. Infelizmente, os resultados dos estudos são muito divergentes e não parecem indicar uma dose considerada eficaz para cada bloqueio de modo definitivo, mas é verdade que, com o auxílio do ultrassom, é possível reduzir a dose dos anestésicos em bloqueios.


Subject(s)
Humans , Ultrasonography, Interventional/methods , Anesthesia, Conduction/methods , Anesthetics/administration & dosage , Randomized Controlled Trials as Topic
15.
Rev. bras. anestesiol ; 66(4): 423-425,
Article in English | LILACS | ID: lil-787627

ABSTRACT

Abstract Nephrectomies are usually performed under general anesthesia alone or in combination with regional anesthesia and rarely under regional anesthesia alone. We report the management of a patient with chronic obstructive pulmonary disease with a history of recurrent spontaneous pneumothorax undergoing nephrectomy under regional anesthesia alone.


Resumo Geralmente, as nefrectomias são feitas sob anestesia geral, isoladamente ou em combinação com anestesia regional, e raramente sob anestesia regional sozinha. Relatamos o tratamento de um paciente com doença pulmonar obstrutiva crônica e história de pneumotórax espontâneo recorrente submetido à nefrectomia sob anestesia regional isolada.


Subject(s)
Humans , Male , Pneumothorax/complications , Pulmonary Disease, Chronic Obstructive/complications , Hydronephrosis/surgery , Hydronephrosis/complications , Anesthesia, Conduction/methods , Nephrectomy/methods , Recurrence , Kidney/surgery , Middle Aged
16.
Rev. bras. anestesiol ; 66(2): 183-193, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-777417

ABSTRACT

ABSTRACT BACKGROUND AND OBJECTIVES: Neuraxial anesthesia (NA) has been used in association with general anesthesia (GA) for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. METHODS: Mortality, arrhythmias, cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stay (LHS), length of ICU stay (ICUS), reoperations, blood transfusion (BT), quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD) was estimated for continuous variables, and relative risk (RR) and risk difference (RD) for categorical variables. RESULTS: 17 original articles analyzed. Meta-analysis of mortality (RD = -0.01, 95% CI = -0.03 to 0.01), CVA (RR = 0.79, 95% CI = 0.32-1.95), MI (RR = 0.96, 95% CI = 0.52-1.79) and LHS (MD = -1.94, 95% CI = -3.99 to 0.12) were not statistically significant. Arrhythmia was less frequent with NA (RR = 0.68, 95% CI = 0.50-0.93). ICUS was lower in NA (MD = -2.09, 95% CI = -2.92 to -1.26). CONCLUSION: There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS.


RESUMO INTRODUÇÃO E OBJETIVOS: A anestesia neuroaxial (AN) vem sendo utilizada em associação com a anestesia geral (AG) para revascularização miocárdica, entretanto a anticoagulação durante a cirurgia torna questionável a viabilidade dos benefícios mediante o risco de hematoma de espaço peridural. O objetivo deste estudo foi executar metanálises analisando a efetividade da AN associada à AG comparada à AG isolada para a cirurgia de revascularização miocárdica relativa à redução da mortalidade. MÉTODOS: Foram analisados mortalidade, arritmias, acidente vascular cerebral (AVC), infarto miocárdico (IM), tempo de internação hospitalar (TIH), tempo de internação em unidade de terapia intensiva (TUTI), reoperações, transfusão sanguínea (TS), qualidade de vida, grau de satisfação e disfunção cognitiva pós-opertória. A diferença média (DM) ponderada foi estimada para as variáveis contínuas e risco relativo (RR) e a diferença de risco (DR) para variáveis categóricas. RESULTADOS: Analisados 17 artigos originais. Metanálise da mortalidade (DR = -0,01; IC 95% = -0,03 a 0,01), AVC (RR = 0,79; IC 95% = 0,32 a 1,95), IM (RR = 0,96; IC 95% = 0,52 a 1,79) e TIH (DM = -1,94; IC 95% = -3,99 a 0,12) não demonstraram significância estatística. Arritmia foi menos frequente com AN (RR = 0,68; IC 95% = 0,50 a 0,93). O TUTI foi menor no com AN (DM = -2,09; IC 95% = -2,92 a -1,26). CONCLUSÃO: Não se observaram diferenças estatisticamente significantes quanto a mortalidade. A combinação de AN e AG mostrou menor incidência de arritmias e menor TUTI.


Subject(s)
Humans , Coronary Artery Bypass/methods , Anesthesia, Conduction/methods , Anesthesia, General/methods , Randomized Controlled Trials as Topic , Coronary Artery Bypass/mortality , Hematoma/prevention & control , Intensive Care Units/statistics & numerical data , Anesthesia, Conduction/adverse effects , Anesthesia, General/adverse effects , Length of Stay , Anticoagulants/administration & dosage
17.
Rev. bras. anestesiol ; 66(1): 44-49, Jan.-Feb. 2016. tab, graf
Article in Portuguese | LILACS | ID: lil-773490

ABSTRACT

BACKGROUND AND OBJECTIVES: Tourniquet pain is one of the major obstacles for intravenous regional anesthesia. We aimed to compare tramadol and lornoxicam used in intravenous regional anesthesia as regards their effects on the quality of anesthesia, tourniquet pain and postoperative pain as well. METHODS: After the ethics committee approval 51 patients of ASA physical status I-II aged 18-65 years were enrolled. The patients were divided into three groups. Group P (n = 17) received 3 mg/kg 0.5% prilocaine; group PT (n = 17) 3 mg/kg 0.5% prilocaine + 2 mL (100 mg) tramadol and group PL (n = 17) 3 mg/kg 0.5% prilocaine + 2 mL (8 mg) lornoxicam for intravenous regional anesthesia. Sensory and motor block onset and recovery times were noted, as well as tourniquet pains and postoperative analgesic consumptions. RESULTS: Sensory block onset times in the groups PT and PL were shorter, whereas the corresponding recovery times were longer than those in the group P. Motor block onset times in the groups PT and PL were shorter than that in the group P, whereas recovery time in the group PL was longer than those in the groups P and PT. Tourniquet pain onset time was shortest in the group P and longest in the group PL. There was no difference regarding tourniquet pain among the groups. Group PL displayed the lowest analgesic consumption postoperatively. CONCLUSION: Adding tramadol and lornoxicam to prilocaine for intravenous regional anesthesia produces favorable effects on sensory and motor blockade. Postoperative analgesic consumption can be decreased by adding tramadol and lornoxicam to prilocaine in intravenous regional anesthesia.


JUSTIFICATIVA E OBJETIVOS: A dor relacionada ao torniquete é um dos maiores obstáculos para a anestesia regional intravenosa (ARIV). Nosso objetivo foi comparar tramadol e lornoxicam usados em ARIV em relação aos seus efeitos sobre a qualidade da anestesia, dor relacionada ao torniquete e dor no pós-operatório. MÉTODOS: Após a aprovação do Comitê de Ética, 51 pacientes com estado físico ASA I-II entre 18-65 anos foram inscritos. Os pacientes foram divididos em três grupos. Grupo P (n = 17) recebeu 3 mg/kg de prilocaína a 0,5%; Grupo PT (n = 17) 3 mg/kg de prilocaína a 0,5% + 2 mL (100 mg) de tramadol e Grupo PL (n = 17) de 3 mg/kg de prilocaína a 0,5% + 2 mL (8 mg) de lornoxicam para ARIV. O início do bloqueio sensorial e motor e os tempos de recuperação foram registrados, bem como a dor relacionada ao torniquete e o consumo de analgésico no pós-operatório. RESULTADOS: Os tempos de início do bloqueio sensorial foram mais curtos nos grupos PT e PL, enquanto que os tempos de recuperação correspondentes foram mais longos do que os do Grupo P. Os tempos de início do bloqueio motor nos grupos PT e PL foram menores do que no Grupo P, enquanto que o tempo de recuperação do grupo PL foi maior do que os dos grupos P e PT. O tempo para início da dor relacionada ao torniquete foi menor no Grupo P e maior no Grupo PL. Não houve diferença em relação à dor relacionada ao torniquete entre os grupos. O Grupo PL apresentou o menor consumo de analgésicos no pós-operatório. CONCLUSÃO: A adição de tramadol e lornoxicam à prilocaína para ARIV produz efeitos favoráveis sobre o bloqueio sensorial e motor. O consumo de analgésicos no pós-operatório pode ser reduzido com a adição de tramadol e lornoxicam à prilocaína em ARIV.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Pain, Postoperative/prevention & control , Tourniquets/adverse effects , Tramadol/administration & dosage , Piroxicam/analogs & derivatives , Anesthesia, Conduction/methods , Pain/ethnology , Pain/prevention & control , Prilocaine/administration & dosage , Anesthesia Recovery Period , Piroxicam/administration & dosage , Anesthetics, Intravenous/administration & dosage , Analgesics/administration & dosage , Analgesics, Opioid/administration & dosage , Anesthetics, Local/administration & dosage , Middle Aged
18.
Rev. bras. anestesiol ; 66(1): 72-74, Jan.-Feb. 2016.
Article in Portuguese | LILACS | ID: lil-773482

ABSTRACT

The inclusion body myositis is an inflammatory myopathy that leads to chronic muscle inflammation associated with muscle weakness. It is characterized by a restrictive ventilatory syndrome requiring ventilatory support under non-invasive ventilation. The authors describe a clinical case and the anaesthetic management of a patient with inclusion body myopathy candidate for vertebroplasty, which highlights the importance of locoregional anaesthesia and of noninvasive ventilation and includes assisted cough techniques, maintained throughout the perioperative period.


A miosite por corpos de inclusão é uma miopatia inflamatória que cursa com inflamação crônica muscular associada à fraqueza muscular. Caracteriza-se por uma síndrome ventilatória restritiva com necessidade de suporte ventilatório sob ventilação não invasiva. Os autores descrevem caso clínico e respectivo manuseio anestésico de paciente com miopatia por corpos de inclusão proposta para vertebroplastia que realça a importância da anestesia locorregional e da ventilação não invasiva e inclui as técnicas de tosse assistida, mantidas durante todo o período perioperatório.


Subject(s)
Humans , Female , Aged , Myositis, Inclusion Body/physiopathology , Vertebroplasty/methods , Noninvasive Ventilation/methods , Anesthesia, Conduction/methods , Perioperative Care/methods , Anesthesia, Local/methods , Neuromuscular Diseases/physiopathology
19.
Rev. bras. anestesiol ; 65(4): 249-254, July-Aug. 2015. tab
Article in English | LILACS | ID: lil-755132

ABSTRACT

BACKGROUND:

Retrospective and prospective randomized studies have compared general and locoregional anesthesia for carotid endarterectomy, but without definitive results.

OBJECTIVES:

Evaluate the incidence of complications (medical, surgical, neurological, and hospital mortality) in a tertiary center in Portugal and review the literature.

METHODS:

Retrospective analysis of patients undergoing endarterectomy between 2000 and 2011, using a software for hospital consultation.

RESULTS:

A total of 750 patients were identified, and locoregional anesthesia had to be converted to general anesthesia in 13 patients. Thus, a total of 737 patients were included in this analysis: 74% underwent locoregional anesthesia and 26% underwent general anesthesia. There was no statistically significant difference between the two groups regarding per operative variables. The use of shunt was more common in patients undergoing general anesthesia, a statistically significant difference. The difference between groups of strokes and mortality was not statistically significant. The average length of stay was shorter in patients undergoing locoregional anesthesia with a statistically significant difference.

CONCLUSIONS:

We found that our data are overlaid with the literature data. After reviewing the literature, we found that the number of studies comparing locoregional and general anesthesia and its impact on delirium, cognitive impairment, and decreased quality of life after surgery is still very small and can provide important data to compare the two techniques. Thus, some questions remain open, which indicates the need for randomized studies with larger number of patients and in new centers.

.

JUSTIFICATIVA:

Estudos retrospectivos e prospectivos randomizados têm comparado a anestesia locorregional e geral para endarterectomia carotídea, mas sem resultados definitivos.

OBJETIVOS:

Avaliar a incidência de complicações (médicas, cirúrgicas, neurológicas e mortalidade intra-hospitalar) num centro terciário em Portugal e revisão da literatura.

MÉTODO:

Análise retrospectiva dos doentes submetidos a endarterectomia entre 2000 e 2011 com o software consulta hospitalar.

RESULTADOS:

Foram identificados 750 doentes, mas em 13 foi necessário converter a anestesia locorregional em anestesia geral. Dos 737 doentes incluídos nesta análise, 74% foram submetidos a anestesia locorregional e 26% a anestesia geral. Não foram encontradas diferenças estatisticamente significativas relativamente às variáveis estudadas no perioperatório entre os dois grupos. O uso de shunt foi mais frequente em doentes submetidos a anestesia geral, diferença estatisticamente significativa. A diferença entre grupos de acidentes vasculares cerebrais e mortalidade não foi estatisticamente significativa. O tempo médio de internamento foi mais curto nos doentes submetidos a anestesia locorregional, diferença estatisticamente significativa.

CONCLUSÕES:

Verificamos que os dados encontrados são sobreponíveis aos descritos na literatura. Após revisão da literatura constatamos que o número de estudos que comparam anestesia locorregional e anestesia geral e o seu impacto no delirium, nas alterações cognitivas e na diminuição da qualidade de vida no pós-operatório é ainda diminuto e pode fornecer dados importantes para a comparação das duas técnicas. Assim, permanecem algumas questões em aberto que obrigam à feitura de estudos randomizados com maior número de doentes e em novas áreas.

.

JUSTIFICACIÓN:

Estudios retrospectivos y prospectivos aleatorizados han comparado la anestesia locorregional y la general para la endarterectomía carotídea pero sin resultados definitivos.

OBJETIVOS:

Evaluar la incidencia de las complicaciones médicas, quirúrgicas, neurológicas y de la mortalidad intrahospitalaria en un centro terciario en Portugal y la revisión de la literatura.

MÉTODO:

Análisis retrospectivo de los enfermos sometidos a endarterectomía entre 2000 y 2011 con el software de consulta hospitalaria.

RESULTADOS:

Fueron identificados 750 enfermos pero en 13 de ellos fue necesario convertir la anestesia locorregional en anestesia general. De los 737 enfermos incluidos en este análisis, un 74% fueron sometidos a anestesia locorregional y un 26% a anestesia general. No fueron encontradas diferencias estadísticamente significativas relativas a las variables estudiadas en el perioperatorio entre los 2 grupos. El uso de shunt fue más frecuente en enfermos sometidos a anestesia general, con diferencia estadísticamente significativa. La diferencia de accidentes cerebrovasculares y mortalidad entre los grupos no fue estadísticamente significativa. El tiempo promedio de ingreso fue más corto en los enfermos sometidos a anestesia locorregional; diferencia estadísticamente significativa.

CONCLUSIONES:

Verificamos que los datos encontrados se sobreponen a los descritos en la literatura. Después de la revisión de la literatura constatamos que el número de estudios que compararon la anestesia locorregional con la anestesia general y su impacto en el delirium, en las alteraciones cognitivas y en la reducción de la calidad de vida en el postoperatorio es todavía pequeño y puede suministrar datos importantes para la comparación de las 2 técnicas. ...


Subject(s)
Humans , Male , Female , Aged , Postoperative Complications/epidemiology , Endarterectomy, Carotid/methods , Anesthesia, Conduction/methods , Anesthesia, General/methods , Portugal , Quality of Life , Incidence , Retrospective Studies , Hospital Mortality , Cognition Disorders/etiology , Cognition Disorders/epidemiology , Delirium/etiology , Delirium/epidemiology , Tertiary Care Centers , Length of Stay , Middle Aged
20.
Ann Card Anaesth ; 2015 Apr; 18(2): 231-233
Article in English | IMSEAR | ID: sea-158177

ABSTRACT

Current technique of airway management for impaled knife in the back includes putting the patient in lateral position and intubation. We present here a novel technique of anesthesia induction (intubation and central line insertion) in a patient with impaled knife in the back which is simple and easily reproducible. This technique can be used for single lung ventilation using double lumen tube or bronchial blocker also if desired.


Subject(s)
Adult , Airway Management/methods , Anesthesia, Conduction/methods , Anesthesia, Spinal/methods , Foreign Bodies/surgery , Humans , Male , Middle Aged , Supine Position
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