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Article in English | WPRIM | ID: wpr-880626


With the advancement of disease treatments, the number of patients undergoing surgery worldwide is increasing. However, many patients still experience severe perioperative complications. Perioperative hypotension is one of the common side effects during surgery. Physiologically, perioperative hypotension can lead to insufficient perfusion of important organs and result in acute and chronic irreversible organ injury, which cause serious consequences for the patient's postoperative hospitalization and even the long-term outcome. Therefore, in order to optimize perioperative circulation management and improve the quality of life for patients after surgery, it is of great importance to investigate the relationship between perioperative hypotension and postoperative myocardial injury, ischemic stroke, postoperative delirium, acute kidney injury, and postoperative mortality. Individualized circulation management and reasonable application of vasoactive drugs may be the key point to early prevention and correct treatment of perioperative hypotension, which is of great significance for reducing perioperative related morbidity and mortality and improving the prognosis for the surgical patients.

Acute Kidney Injury/etiology , Humans , Hypotension/etiology , Postoperative Complications/etiology , Quality of Life
Chinese Medical Journal ; (24): 1043-1051, 2021.
Article in English | WPRIM | ID: wpr-878147


BACKGROUND@#Hypotension is a common complication caused by spinal anesthesia (SA), which may have adverse impacts on the condition of the parturient and fetus. Liquid infusion was found to be relatively effective for reducing the incidence of hypotension. However, the question of whether colloid preload can optimize hemodynamic variables in the cesarean section remains controversial. This study aims to determine the effects of colloid preload on the incidence of hypotension induced by SA in elective cesarean section.@*METHODS@#Related keywords were searched on PubMed, EMBASE, and Cochrane Library from inception dates to May 2020. Studies included were evaluated for eligibility and quality. The primary outcome was the intra-operative incidence of hypotension and severe hypotension. The secondary outcomes included the lowest intra-operative systolic blood pressure, the maximal intra-operative heart rate, the intra-operative needs of ephedrine and phenylephrine, the incidence of maternal nausea and/or vomiting, and neonatal outcomes (umbilical artery pH and Apgar scores). Apart from the above, RevMan 5.3 was used for the data analysis.@*RESULTS@#Altogether nine randomized controlled trials were included in the meta-analysis. There were no significant differences in the incidence of intra-operative hypotension, severe hypotension, or neonatal outcomes between the colloid preload group and control group, except for the umbilical artery pH.@*CONCLUSION@#This meta-analysis suggests that colloid preload does not significantly reduce the incidence of hypotension associated with SA in elective cesarean section.

Anesthesia, Spinal/adverse effects , Cesarean Section/adverse effects , Colloids , Female , Humans , Hypotension/etiology , Incidence , Infant, Newborn , Pregnancy , Vasoconstrictor Agents/therapeutic use
Rev. bras. anestesiol ; 69(2): 200-203, Mar.-Apr. 2019. graf
Article in English | LILACS | ID: biblio-1003410


Abstract Background and objectives: A prompt and effective management of trauma patient is necessary. The aim of this case report is to highlight the importance of intraoperative echocardiography as a useful tool in patients suffering from refractory hemodynamic instability no otherwise explained. Case report: A 41 year-old woman suffered a car accident. At the emergency department, no abnormalities were found in ECG or chest X-ray. Abdominal ultrasound revealed the presence of abdominal free liquid and the patient was submitted to urgent exploratory laparotomy. Nevertheless, she persisted suffering arterial hypotension and metabolic acidosis. Looking for the reason of her hemodynamic instability, intraoperative transthoracic echocardiography was performed, finding out the presence of pericardial effusion. Once the cardiac surgeon extracted pericardial clots, patient's situation improved clinically and analytically. Conclusion: Every anesthesiologist should be able to use the intraoperative echocardiography as an effective tool in order to establish the appropriate measures to promote the survival of patients suffering severe trauma.

Resumo Justificativa e objetivos: O atendimento rápido e eficaz do paciente de trauma é necessário. O objetivo deste relato de caso foi destacar a importância do ecocardiograma intraoperatório como uma ferramenta útil em pacientes que sofrem de instabilidade hemodinâmica refratária sem explicação aparente. Relato de caso: Uma mulher de 41 anos sofreu um acidente de automóvel. No departamento de emergência, nenhuma anormalidade foi encontrada no ECG ou na radiografia de tórax. Uma ultrassonografia abdominal revelou a presença de líquido livre no abdome, e a paciente foi submetida à laparotomia exploradora de urgência. No entanto, a paciente continuou apresentando hipotensão arterial e acidose metabólica. Na busca pelo motivo de sua instabilidade hemodinâmica, um ecocardiograma transtorácico foi realizado no período intraoperatório e constatou a presenc¸a de derrame pericárdico. Após a remoção dos coágulos pericárdicos pelo cirurgião cardíaco, a condição da paciente melhorou clínica e analiticamente. Conclusão: Todo anestesiologista deve saber utilizar o ecocardiograma intraoperatório como ferramenta eficaz para estabelecer as medidas adequadas para promover a sobrevida de pacientes com traumatismos graves.

Humans , Female , Adult , Pericardial Effusion/diagnostic imaging , Echocardiography/methods , Ultrasonography/methods , Hemodynamics , Acidosis/etiology , Accidents, Traffic , Hypotension/etiology , Intraoperative Care/methods
Rev. bras. anestesiol ; 68(6): 657-660, Nov.-Dec. 2018. graf
Article in English | LILACS | ID: biblio-977396


Abstract Background and objectives: Bilateral quadratus lumborum block has been described for major abdominal procedures when sepsis is present, because risks associated to epidural are considered elevated. In an open aortic surgery, a single-shot bilateral quadratus lumborum block type 1 may be an alternative to thoracic epidural block for post-operative analgesia in a patient having an increased cumulative risk for thoracic epidural hematoma. Case report: A 56-year-old female patient presenting controlled hypertension, chronic renal disease stage 3b, dyslipidemia and a platelet count of 102,000/µl, and taking aspirin, was scheduled for bilateral aortoiliac endarterectomy. She was submitted to a sole general anesthesia plus, at end of the surgery, a bilateral quadratus lumborum block type 1 for post-operative analgesia with 20 mL of ropivacaine 0.5%, per side, before extubation. Immediately after post anesthesia care unit admission, patient developed moderate hypotension (dopamine infusion was needed during 18 h), concomitantly with a rapid reduction in the pain scores. Low numeric rating scale and opioid consumption were noted, particularly in the first 24 h post-operatively. Conclusions: Quadratus lumborum block was an effective analgesic technique for open aortic surgery in this case, although hypotension associated to bilateral quadratus lumborum block type 1 may occur. Associated sympathetic block probably related to the bilateral paravertebral extension of the block, may contribute for post-operative hypotension associated to reperfusion-ischemia syndrome in a patient that had long-lasting intraoperative aortic cross-clamping. The use of high concentration of local anesthetic to obtain longer duration of action of a single-shot quadratus lumborum block to avoid thoracic epidural or bilateral quadratus lumborum block catheterization should be used judiciously.

Resumo Justificativa e objetivos: O bloqueio bilateral do quadrado lombar foi descrito para procedimentos abdominais de grande porte quando há presença de sepse, uma vez que os riscos associados à peridural são considerados altos. Em uma cirurgia aórtica aberta, um único bloqueio bilateral do quadrado lombar tipo 1 (QL tipo 1) pode ser uma opção ao bloqueio peridural torácico para analgesia pós-operatória em paciente com risco cumulativo aumentado de hematoma epidural torácico. Relato de caso: Paciente feminina de 56 anos, portadora de hipertensão arterial controlada, doença renal crônica (estágio 3 b), dislipidemia, plaquetopenia de 102.000/µl e tomava aspirina, estava programada para endarterectomia aortoilíaca bilateral. A paciente foi submetida à anestesia geral e, no fim da cirurgia, a bloqueio do quadrado lombar tipo 1 bilateralmente para analgesia pós-operatória com 20 mL de ropivacaína a 0,5%, para cada lado, antes da extubação. Imediatamente após a internação na sala de recuperação pós-anestésica, a paciente evoluiu com hipotensão moderada (necessidade de infusão de dopamina durante 18 horas), concomitante à rápida redução dos escores de dor. Escore numérico para dor baixo e consumo de opioides foram observados, especialmente nas primeiras 24 horas de pós-operatório. Conclusões: O bloqueio do quadrado lombar foi uma técnica analgésica eficaz nesse caso de cirurgia aórtica aberta, embora a hipotensão associada ao bloqueio bilateral do quadrado lombar possa ocorrer. O bloqueio simpático associado, causado pelo bloqueio do QL tipo 1, provavelmente relacionado à extensão paravertebral bilateral do bloqueio, pode contribuir para a hipotensão pós-operatória associada à síndrome de isquemia-reperfusão em paciente submetido a pinçamento aórtico intraoperatório de longa duração. Alta concentração de anestésico local para prolongar a ação de uma injeção única no bloqueio do quadrado lombar, com o objetivo de evitar cateterização de ambas as anestesias peridural e do quadrado lombar bilateral, deve ser usada de modo criterioso.

Humans , Female , Pain, Postoperative/prevention & control , Postoperative Complications/etiology , Analgesia/methods , Hypotension/etiology , Nerve Block/adverse effects , Abdominal Muscles , Middle Aged , Nerve Block/methods
Rev. bras. ter. intensiva ; 30(1): 121-126, jan.-mar. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-899567


RESUMO A nicotina é uma substância perigosa, extraída das folhas de fumo. Quando absorvida em quantidade excessiva, ela pode levar à insuficiência respiratória e à parada cardíaca. A comercialização de cigarros eletrônicos (e-cigarros) permite que os usuários manuseiem diretamente o líquido, com consequente aumento do risco de exposição à nicotina líquida. Descrevemos nossa experiência no tratamento do caso de um paciente que ingeriu elevada concentração de nicotina líquida contida em líquido para e-cigarros. O paciente apresentava bradicardia e hipotensão, que são sintomas de estimulação parassimpática, além de comprometimento da consciência. O paciente teve recuperação após tratamento com atropina e vasopressor.

ABSTRACT Nicotine is a dangerous substance extracted from tobacco leaves. When nicotine is absorbed in excessive amounts, it can lead to respiratory failure and cardiac arrest. The commercialization of electronic cigarettes (e-cigarettes) has allowed users to directly handle e-cigarette liquid. Consequently, the risk of liquid nicotine exposure has increased. We describe our experience of managing the case of a patient who orally ingested a high concentration of liquid nicotine from e-cigarette liquid. The patient presented with bradycardia and hypotension, which are symptoms of parasympathetic stimulation, together with impaired consciousness. He recovered following treatment with atropine and a vasopressor.

Humans , Male , Bradycardia/etiology , Electronic Nicotine Delivery Systems , Nicotine/poisoning , Atropine/therapeutic use , Vasoconstrictor Agents/therapeutic use , Bradycardia/drug therapy , Hypotension/etiology , Hypotension/drug therapy , Middle Aged
Rev. bras. anestesiol ; 68(1): 96-99, Jan.-Feb. 2018. graf
Article in English | LILACS | ID: biblio-897810


Abstract Background and objectives Ischemic cardiomyopathy is characterized by imbalance between supply and demand of myocardial oxygen. Endoscopic transthoracic sympathectomy is a therapeutic option indicated in refractory cases. However, the patient's position on the operating table may favor ischemic coronary events triggering the Bezold-Jarisch reflex. Case report A female patient, 47 years old, with refractory ischemic cardiomyopathy, admitted to the operating room for endoscopic transthoracic sympathectomy, developed the Bezold- Jarisch reflex with severe bradycardia and hypotension after placement in semi-sitting position to the procedure. Conclusion Bradyarrhythmia, hypotension, and asystole are complications potentially associated with patient placement in a semi-sitting position, particularly in cases with previous ischemic heart disease.

Resumo Justificativa e objetivos A cardiomiopatia isquêmica caracteriza-se pelo desbalanço entre a oferta e o consumo de oxigênio pelo miocárdio. A simpatectomia transtorácica endoscópica é uma opção terapêutica indicada nos casos refratários. Contudo, a posição do paciente na mesa cirúrgica pode favorecer eventos coronarianos isquêmicos e deflagrar o reflexo de Bezold-Jarisch. Relato de caso Paciente do sexo feminino, 47 anos, portadora de cardiomiopatia isquêmica refratária, admitida na sala de cirurgia para simpatectomia transtorácica endoscópica, deflagrou o reflexo de Bezold-Jarisch e desenvolveu bradicardia e hipotensão graves logo após colocação em posição semissentada para o procedimento. Conclusão Bradiarritmia, hipotensão e assistolia são complicações potencialmente associadas à colocação do paciente em posição semissentada, especialmente nos casos em que há prévio comprometimento isquêmico do coração.

Humans , Female , Sympathectomy/methods , Bradycardia/etiology , Patient Positioning/adverse effects , Hypotension/etiology , Intraoperative Complications/etiology , Angina Pectoris/surgery , Reflex, Abnormal , Endoscopy , Respiratory Rate , Middle Aged
Rev. chil. anest ; 46(2): 80-85, 2017. tab
Article in Spanish | LILACS | ID: biblio-908247


Spinal anesthesia is the technique of choice for patients undergoing cesarean section. One of the most common adverse effects of this technique is arterial hypotension, which if severe, can result in serious maternal and fetal injury or death. Different alternatives exist to prevent and treat hypotension associated to spinal anesthesia; one of them is fluid therapy. The objective of this review is to evaluate the currently available evidence for different fluid therapy alternatives and assess their effectiveness. Nowadays, it does not seem advisable to use preload with crystalloids as evidence suggests its ineffectiveness. As for the other three alternatives (preload with colloids, coload with crystalloids and coload with colloids) there is no superiority among them and neither of them seems effective enough to be used as monotherapy. Due to its safety and ease of use, coload with crystalloids associated to alpha agonist vasopressor therapy seems to be the best management strategy. Further studies should aim at the best way to administer fluids in order to optimize vasopressor therapy.

La técnica anestésica de elección para operación cesárea es la anestesia subaracnoídea. Uno de los principales efectos adversos de esta técnica es la hipotensión arterial, que puede llegar a ocasionar graves complicaciones. Existen diversas alternativas para la prevención y manejo de la hipotensión arterial; una de ellas la fluidoterapia. El objetivo de esta revisión es evaluar la evidencia reciente disponible para las distintas alternativas de fluidoterapia y evaluar su efectividad. Actualmente no parece recomendable el utilizar precarga con cristaloides para la prevención de hipotensión arterial. En cuanto a las otras tres alternativas(precarga con coloides, cocarga con cristaloides o cocarga coloides) ninguna parece ser más efectiva que las otras previniendo hipotensión arterial y ninguna sería efectiva como monoterapia. Por su disponibilidad y seguridad de uso, al día de hoy la cocarga con cristaloides asociada a terapia vasopresora alfa agonista parece ser la mejor alternativa. Estudios futuros debieran apuntar a encontrar la forma de infusión que optimize la terapia con vasopresores.

Humans , Anesthesia, Spinal/adverse effects , Cesarean Section/methods , Fluid Therapy/methods , Hypotension/etiology , Hypotension/prevention & control , Isotonic Solutions
Acta cir. bras ; 31(2): 84-91, Feb. 2016. graf
Article in English | LILACS | ID: lil-775564


PURPOSE : To describe video-assisted ovariohysterectomy (OHE) with two portals access in adult intact queens. METHODS Fifty-two females cats were used. A 4 mm cannula was positioned in the abdomen through an incision close to the umbilicus (first portal), and a pneumoperitoneum was established. A second portal was positioned in the midline of the pre-pubic region. Females were positioned in right lateral recumbency to locate the left ovarian pedicle, and the uterine horn was held by a transcutaneous suture. The pedicle was cauterized and incised. The procedure was then performed on the contralateral ovary. The ovaries were exteriorized from the abdomen, along with the uterus, through the second access point. The uterine body was exposed, fixed and sectioned, and the abdominal incisions were sutured. RESULTS Surgeries were performed in an average of 41.4±14.2 minutes. The main complications included hypotension (7.7%) and subcutaneous emphysema (7.7%), and 13.5% of the surgeries were converted to laparotomy. CONCLUSION Ovariohysterectomy using a video-assisted technique and two access portals is safe, has minimal risks and is effective for the spaying of queens.

Animals , Female , Cats , Postoperative Complications/veterinary , Ovariectomy/veterinary , Video-Assisted Surgery/veterinary , Hypotension/etiology , Hysterectomy/veterinary , Ovariectomy/methods , Video-Assisted Surgery/instrumentation , Operative Time , Hysterectomy/methods
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.1049-1066.
Monography in Portuguese | LILACS | ID: biblio-971581
Article in English | WPRIM | ID: wpr-218580


Transurethral resection has been the gold standard in the operative management of benign prostatic hyperplasia and bladder tumor; however, it is associated with several complications that may cause patient discomfort. We evaluated the usefulness of continuous infusion of dexmedetomidine on emergence agitation, hemodynamic status, and recovery profiles in patients undergoing elective surgery by a randomized clinical trial. Sixty patients aged 30 to 80 yr who were scheduled for elective transurethral resection under general anesthesia were included in this study. Participants were randomly assigned to two groups (control group, group C; dexmedetomidine group, group D). A total of 60 male patients were enrolled in this study and randomly assigned to group C (n=30) or group D (n=30). The quality of emergence in group D was marked by a significantly lower incidence of emergence agitation than in group C (P=0.015). Patients in group D therefore felt less discomfort induced by the indwelling Foley catheter than those in group C (P=0.022). No statistically significant differences were found between the two groups with respect to side effects including bradycardia (P=0.085), hypotension (P=0.640), and postoperative nausea and vomiting (P=0.389). Our study showed that intraoperative dexmedetomidine infusion effectively reduced the incidence and intensity of emergence agitation and catheter-induced bladder discomfort without delaying recovery time and discharge time, thus providing smooth emergence during the recovery period in patients undergoing transurethral resection (Clinical Trial Registry No. KT0001683).

Adult , Aged , Aged, 80 and over , Blood Pressure , Bradycardia/etiology , Dexmedetomidine/adverse effects , Hemodynamics , Humans , Hypnotics and Sedatives/adverse effects , Hypotension/etiology , Male , Middle Aged , Nausea/etiology , Prostatic Hyperplasia/surgery , Psychomotor Agitation/drug therapy , Transurethral Resection of Prostate , Vomiting/etiology
Clinics ; 69(2): 120-127, 2/2014. tab, graf
Article in English | LILACS | ID: lil-701380


OBJECTIVE: To evaluate whether the pathophysiology of shock syndromes can be better understood by comparing central hemodynamics with kinetic data on fluid and electrolyte shifts. METHODS: We studied the dilutional hyponatremic shock that developed in response to overhydration with electrolyte-free irrigating fluid - the so-called ‘transurethral resection syndrome' - by comparing cardiac output, arterial pressures, and volume kinetic parameters in 17 pigs that were administered 150 ml/kg of either 1.5% glycine or 5% mannitol by intravenous infusion over 90 minutes. RESULTS: Natriuresis appeared to be the key factor promoting hypovolemic hypotension 15-20 minutes after fluid administration ended. Excessive sodium excretion, due to osmotic diuresis caused by the irrigant solutes, was associated with high estimates of the elimination rate constant (k10) and low or negative estimates of the rate constant describing re-distribution of fluid to the plasma after translocation to the interstitium (k21). These characteristics indicated a high urinary flow rate and the development of peripheral edema at the expense of plasma volume and were correlated with reductions in cardiac output. The same general effects of natriuresis were observed for both irrigating solutions, although the volume of infused 1.5% glycine had a higher tendency to enter the intracellular fluid space. CONCLUSION: Comparisons between hemodynamics and fluid turnover showed a likely sequence of events that led to hypovolemia despite intravenous administration of large amounts of fluid. .

Animals , Hemodynamics/physiology , Hyponatremia/physiopathology , Hypotension/physiopathology , Therapeutic Irrigation/adverse effects , Transurethral Resection of Prostate/adverse effects , Cardiac Output/drug effects , Diuretics, Osmotic/administration & dosage , Electrolytes , Glycine Agents/administration & dosage , Glycine/administration & dosage , Hyponatremia/etiology , Hypotension/etiology , Hypovolemia/etiology , Hypovolemia/physiopathology , Infusions, Intravenous , Kinetics , Mannitol/administration & dosage , Postoperative Complications/physiopathology , Swine , Syndrome , Time Factors
Article in English | WPRIM | ID: wpr-163323


We conducted a study to determine whether the hemocontrol biofeedback system (HBS) can improve intradialytic hypotension (IDH) in hypotension-prone hemodialysis (HD) patients compared with conventional HD. In this multicenter prospective crossover study, 60 hypotension-prone patients were serially treated by conventional HD for 8 weeks (period A), by HD with hemoscan blood volume monitoring for 2 weeks (period B0), and by HBS HD for 8 weeks (period B1). The number of sessions complicated by symptomatic IDH during 24 HD sessions (14.9+/-5.8 sessions, 62.1% in period A vs 9.2+/-7.2 sessions, 38.4% in period B1, P<0.001) and the number of IDH-related nursing interventions in a session (0.96+/-0.66 in period A vs 0.56+/-0.54 in period B1, P<0.001) significantly decreased in period B1 than in period A. Recovery time from fatigue after dialysis was significantly shorter in period B1 than in period A. The patients with higher post-dialysis blood pressure, lower difference between pre- and post-dialysis blood pressure, less frequent IDH, and higher pre- and post-dialysis body weight in period A responded better to HBS in period B1 in regard to the reduction of IDH. In conclusion, HBS may improve the patient tolerability to HD by reducing the IDH frequency and promoting faster recovery from fatigue after dialysis.

Adolescent , Adult , Aged , Biofeedback, Psychology , Blood Pressure , Blood Volume , Body Weight , Cross-Over Studies , Fatigue , Female , Humans , Hypotension/etiology , Kidney Failure, Chronic/therapy , Male , Middle Aged , Prone Position , Prospective Studies , Renal Dialysis/adverse effects , Young Adult
Article in English | WPRIM | ID: wpr-109968


We report a case of pulmonary bone cement embolism in a female who presented with dyspnea following multiple sessions of vertebroplasty. She underwent spectral CT pulmonary angiography and the diagnosis was made based on enhanced visualization of radiopaque cement material in the pulmonary arteries and a corresponding decrease in the parenchymal iodine content. Here, we describe the CT angiography findings of bone cement embolism with special emphasis on the potential benefits of spectral imaging, providing additional information on the material composition.

Angiography/methods , Bone Cements/adverse effects , Dyspnea/etiology , Female , Humans , Hypotension/etiology , Lung/diagnostic imaging , Middle Aged , Pulmonary Artery/diagnostic imaging , Pulmonary Embolism/etiology , Tomography, X-Ray Computed/methods , Vertebroplasty
Rev. bras. ter. intensiva ; 25(4): 270-278, Oct-Dec/2013. tab, graf
Article in Portuguese | LILACS | ID: lil-701402


Objetivo: A definição atual de sepse grave e choque séptico inclui um perfil heterogêneo de pacientes. Embora o valor prognóstico de hiperlactatemia seja bem estabelecido, ela está presente em pacientes com ou sem choque. Nosso objetivo foi comparar o prognóstico de pacientes sépticos estratificando-os segundo dois fatores: hiperlactatemia e hipotensão persistente. Métodos: Este estudo é uma análise secundária de um estudo observacional conduzido em dez hospitais no Brasil (Rede Amil - SP). Pacientes sépticos com valor inicial de lactato das primeiras 6 horas do diagnóstico foram incluídos e divididos em 4 grupos segundo hiperlactatemia (lactato >4mmol/L) e hipotensão persistente: (1) sepse grave (sem ambos os critérios); (2) choque críptico (hiperlactatemia sem hipotensão persistente); (3) choque vasoplégico (hipotensão persistente sem hiperlactatemia); e (4) choque disóxico (ambos os critérios). Resultados: Foram analisados 1.948 pacientes, e o grupo sepse grave constituiu 52% dos pacientes, seguido por 28% com choque vasoplégico, 12% choque disóxico e 8% com choque críptico. A sobrevida em 28 dias foi diferente entre os grupos (p<0,001), sendo maior para o grupo sepse grave (69%; p<0,001 versus outros), semelhante entre choque críptico e vasoplégico (53%; p=0,39) e menor para choque disóxico (38%; p<0,001 versus outros). Em análise ajustada, a sobrevida em 28 dias permaneceu diferente entre os grupos (p<0,001), sendo a maior razão de risco para o grupo choque disóxico (HR=2,99; IC95% 2,21-4,05). Conclusão: A definição de pacientes com sepse inclui quatro diferentes perfis, se considerarmos a presença de hiperlactatemia. Novos estudos são necessários para melhor caracterizar pacientes sépticos e gerar conhecimento ...

Objective: The current definition of severe sepsis and septic shock includes a heterogeneous profile of patients. Although the prognostic value of hyperlactatemia is well established, hyperlactatemia is observed in patients with and without shock. The present study aimed to compare the prognosis of septic patients by stratifying them according to two factors: hyperlactatemia and persistent hypotension. Methods: The present study is a secondary analysis of an observational study conducted in ten hospitals in Brazil (Rede Amil - SP). Septic patients with initial lactate measurements in the first 6 hours of diagnosis were included and divided into 4 groups according to hyperlactatemia (lactate >4mmol/L) and persistent hypotension: (1) severe sepsis (without both criteria); (2) cryptic shock (hyperlactatemia without persistent hypotension); (3) vasoplegic shock (persistent hypotension without hyperlactatemia); and (4) dysoxic shock (both criteria). Results: In total, 1,948 patients were analyzed, and the sepsis group represented 52% of the patients, followed by 28% with vasoplegic shock, 12% with dysoxic shock and 8% with cryptic shock. Survival at 28 days differed among the groups (p<0.001). Survival was highest among the severe sepsis group (69%, p<0.001 versus others), similar in the cryptic and vasoplegic shock groups (53%, p=0.39), and lowest in the dysoxic shock group (38%, p<0.001 versus others). In the adjusted analysis, the survival at 28 days remained different among the groups (p<0.001) and the dysoxic shock group exhibited the highest hazard ratio (HR=2.99, 95%CI 2.21-4.05). Conclusion: The definition of sepsis includes four different profiles if we consider the presence of hyperlactatemia. Further studies are needed to better characterize septic patients, to understand the etiology and to design adequate targeted treatments. .

Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Hyperlactatemia/etiology , Hypotension/etiology , Sepsis/diagnosis , Shock, Septic/diagnosis , Brazil , Cohort Studies , Hospitals , Hyperlactatemia/diagnosis , Hypotension/diagnosis , Lactic Acid/blood , Prognosis , Retrospective Studies , Survival Rate , Sepsis/classification , Sepsis/physiopathology , Shock, Septic/classification , Shock, Septic/physiopathology , Vasoplegia/diagnosis , Vasoplegia/etiology , Vasoplegia/physiopathology
Rev. méd. Chile ; 140(8): 1046-1049, ago. 2012. ilus
Article in Spanish | LILACS | ID: lil-660058


Background: Systolic anterior motion describes the anterior displacement of one or both mitral valve leaflets, obstructing the outflow tract of the left ventricle. It can be a cause of severe hypotension during the intraoperative and postoperative period of non-cardiac surgery. The diagnosis is made with echocardiography. We report two patients with this problem. The first was a 74-year-old male subjected to an incisional hernia repair who presented severe hypotension in the intraoperative period. A transesophageal echocardiography revealed an anterior displacement of the mitral valve anterior leaflet. Epinephrine was discontinued and Norepinephrine and a volume expander were administered, with good response. The second patient was a 64-year-old male undergoing a right liver lobectomy. In the postoperative period, he suffered severe hypotension. A transesophageal echocardiography revealed an anterior displacement of the mitral valve anterior leaflet. Dobutamine was discontinued, volume was administered, and a Norepinephrine infusion was started with good response.

Aged , Humans , Male , Middle Aged , Hypotension/etiology , Intraoperative Complications , Mitral Valve Insufficiency , Postoperative Complications , Herniorrhaphy , Liver/surgery , Mitral Valve Insufficiency , Severity of Illness Index
Rev. bras. anestesiol ; 61(5): 574-581, set.-out. 2011. tab
Article in Portuguese | LILACS | ID: lil-600950


JUSTIFICATIVA E OBJETIVOS: As alterações cardiovasculares associadas aos bloqueios do neuroeixo apresentam interesse pela frequência com que ocorrem e porque algumas delas podem ser consideradas efeitos fisiológicos desencadeados pelo bloqueio do sistema nervoso simpático. O objetivo desta pesquisa foi avaliar as complicações cardiovasculares intraoperatórias e os fatores preditores associados aos bloqueios do neuroeixo em pacientes com idades > 18 anos submetidos a procedimentos não obstétricos, em um período de 18 anos, em hospital universitário de atendimento terciário-HCFMB-UNESP. MÉTODO: Foi realizada análise retrospectiva das seguintes complicações: hipertensão arterial, hipotensão arterial, bradicardia sinusal e taquicardia sinusal. Tais complicações foram correlacionadas com técnica anestésica, estado físico (ASA), idade, sexo e comorbidades pré-operatórias. Para a análise estatística, foram utilizadas o teste de Tukey para comparações entre proporções e regressão logística. RESULTADOS: Foram avaliados 32.554 pacientes submetidos a bloqueios do neuroeixo e houve 4.109 citações de hipotensão arterial, 1.107 de bradicardia sinusal, 601 de taquicardia sinusal e 466 de hipertensão arterial no período intraoperatório. Hipotensão foi mais frequente nos pacientes submetidos à anestesia subaracnoidea contínua (29,4 por cento, OR = 2,39), com idades > 61 anos e do sexo feminino (OR = 1,27). CONCLUSÕES: Hipotensão e bradicardia intraoperatórias foram complicações mais frequentes, sendo que a hipotensão arterial esteve relacionada à técnica anestésica (ASC), faixa etária elevada e sexo feminino. Taquicardia e hipertensão arterial podem não ter sido diretamente relacionadas aos bloqueios do neuroeixo.

BACKGROUND AND OBJECTIVES: Cardiovascular changes associated with neuraxial blocks are a cause of concern due to their frequency and because some of them can be considered physiological effects triggered by the sympathetic nervous system blockade. The objective of this study was to evaluate intraoperative cardiovascular complications and predictive factors associated with neuraxial blocks in patients > 18 years of age undergoing non-obstetric procedures over an 18-year period in a tertiary university hospital - HCFMB-UNESP. METHODS: A retrospective analysis of the following complications was undertaken: hypertension, hypotension, sinus bradycardia, and sinus tachycardia. These complications were correlated with anesthetic technique, physical status (ASA), age, gender, and preoperative co-morbidities. The Tukey test for comparisons among proportions and logistic regression was used for statistical analysis. RESULTS: 32,554 patients underwent neuraxial blocks. Intraoperative complications mentioned included hypotension (n = 4,109), sinus bradycardia (n = 1,107), sinus tachycardia (n = 601), and hypertension (n = 466). Hypotension was seen more often in patients undergoing continuous subarachnoid anesthesia (29.4 percent, OR = 2.39), > 61 years of age, and female (OR = 1.27). CONCLUSIONS: Intraoperative hypotension and bradycardia were the complications observed more often. Hypotension was related to anesthetic technique (CSA), increased age, and female. Tachycardia and hypertension may not have been directly related to neuraxial blocks.

JUSTIFICATIVA Y OBJETIVOS: Las alteraciones cardiovasculares asociadas a los bloqueos del neuro eje son de interés por la frecuencia con que ocurren y porque algunas de ellas pueden ser consideradas como efectos fisiológicos desencadenados por el bloqueo del sistema nervioso simpático. El objetivo de esta investigación, fue evaluar las complicaciones cardiovasculares intraoperatorias y los factores predictores asociados a los bloqueos del neuro eje, en pacientes con edades > 18 años, sometidos a procedimientos no obstétricos, en un período de 18 años, en un hospital universitario de atención terciario-HCFMB-UNESP. MÉTODO: Fue realizado un análisis retrospectivo de las siguientes complicaciones: hipertensión arterial, hipotensión arterial, bradicardia sinusal y taquicardia sinusal. Esas complicaciones se correlacionaron con la técnica anestésica, estado físico (ASA), edad, sexo y comorbilidades preoperatorias. Para el análisis estadístico, se usó el test de Tukey para las comparaciones entre las proporciones y la regresión logística. RESULTADOS: Fueron evaluados 32.554 pacientes sometidos a bloqueos del neuro eje y hubo 4.109 apariciones de hipotensión arterial, 1.107 de bradicardia sinusal, 601 de taquicardia sinusal y 466 de hipertensión arterial en el período intraoperatorio. La hipotensión fue más frecuente en los pacientes sometidos a la anestesia subaracnoidea continua (29,4 por ciento, OR = 2,39), con edades > 61 años y pertenecientes al sexo femenino (OR =1,27). CONCLUSIONES: La hipotensión y la bradicardia intraoperatorias fueron las complicaciones más frecuentes, siendo que la hipotensión arterial se relacionó con la técnica anestésica (ASC), franja etaria elevada y sexo femenino. La taquicardia y la hipertensión arterial pueden no haber sido directamente relacionadas con los bloqueos del neuro eje.

Humans , Male , Female , Young Adult , Middle Aged , Anesthesia, Epidural/adverse effects , Arrhythmias, Cardiac/etiology , Hypertension/etiology , Hypotension/etiology , Intraoperative Care , Intraoperative Complications , Risk Factors
Rev. bras. anestesiol ; 61(1): 25-30, jan.-fev. 2011. ilus, tab
Article in Portuguese | LILACS | ID: lil-599872


JUSTIFICATIVA E OBJETIVOS: Existem poucas publicações correlacionando hipotensão em gestantes obesas, principalmente em obesas mórbidas, após raquianestesia para cesárea. Objetivamos avaliar a incidência de hipotensão correlacionada ao IMC. MÉTODO: No grupo Eutrofia foram incluídas 49 pacientes com IMC pré-gestacional abaixo de 25 kg.m-2 e no grupo Sobrepeso, 51 pacientes com IMC igual ou acima de 25 kg.m-2. Após raquianestesia, foram anotadas as medidas de pressão arterial, volume de cristaloides infundidos e dose de vasopressores utilizada até o nascimento. Redução da pressão arterial sistólica abaixo de 100 mmHg ou 10 por cento da pressão arterial sistólica (PAS) inicial foi classificada como hipotensão e corrigida com vasopressor. RESULTADOS: Os episódios de hipotensão foram menores no grupo Eutrofia (5,89 ± 0,53 vs. 7,80 ± 0,66; p = 0,027), assim como a quantidade de cristaloides (1.298 ± 413,6 mL vs. 1.539 ± 460,0 mL; p = 0,007) e o uso de vasopressores (5,87 ± 3,45 bolus vs. 7,70 ± 4,46 bolus; p = 0,023). Quanto às doenças associadas, observamos maior incidência de diabetes entre as gestantes obesas (29,41 por cento vs. 9,76 por cento, RR 1,60; IC 95 por cento: 1,15-2,22; p = 0,036), porém não houve diferença entre os grupos em relação à incidência de doença hipertensiva específica da gestação (DHEG) (sobrepeso: 21,57 por cento, peso normal: 12,20 por cento, RR 1,30; IC 95 por cento: 0,88-1,94; p = 0,28). CONCLUSÕES: Na amostra estudada, IMC pré-gestacional maior ou igual a 25 kg.m-2 apresentou-se como fator de risco para hipotensão após raquianestesia em pacientes submetidas a cesáreas. O mesmo grupo de pacientes necessitou de um número de doses maior de vasopressores. A valorização desses achados implica aprimorar as técnicas anestésicas nessas pacientes a fim de diminuir as consequências da hipotensão pós-raquianestesia, tanto na gestante como no feto.

BACKGROUND AND OBJECTIVES: Very few publications correlate hypotension in obese pregnant women, and especially morbidly obese, after spinal anesthesia for cesarean section. The objective of the present study was to evaluate the incidence of hypotension according to the BMI. METHODS: Forty-nine patients with pregestational BMI below 25 kg.m-2 were included in the Eutrophia group, and 51 patients with BMI > 25 kg.m-2 were included in the Overweight group. After spinal anesthesia, blood pressure, volume of crystalloid infused, and dose of vasopressors used until delivery were recorded. A fall in systolic blood pressure below 100 mmHg or 10 percent reduction of the initial systolic blood pressure (SBP) was considered as hypotension and it was corrected by the administration of vasopressors. RESULTS: Episodes of hypotension were fewer in the Eutrophia group (5.89 ± 0.53 vs. 7.80 ± 0.66, p = 0.027), as well as the amount of crystalloid administered (1,298 ± 413.6 mL vs. 1,539 ± 460.0 mL; p = 0.007), and use of vasopressors (5.87 ± 3.45 bolus vs. 7.70 ± 4.46 bolus; p = 0.023). As for associated diseases, we observed higher incidence of diabetes among obese pregnant women (29.41 percent vs. 9.76 percent, RR 1.60, 95 percentCI: 1.15-2.22, p = 0.036), however, differences in the incidence of pregnancy-induced hypertension (PIH) were not observe between both groups (overweight: 21.57 percent, normal weight: 12.20 percent, RR 1.30, 95 percentCI: 0.88-1.94, p = 0.28). CONCLUSIONS: In the study sample, pregestational BMI > 25 kg.m-2 was a risk factor for hypotension after spinal anesthesia in patients undergoing cesarean section. The same group of patients required higher doses of vasopressors. Those results indicate that the anesthetic techniques in those patients should be improved to reduce the consequences of post-spinal anesthesia hypotension, both in pregnant women and fetuses.

JUSTIFICATIVA Y OBJETIVOS: Existen pocas publicaciones correlacionando la hipotensión en embarazadas obesas y principalmente obesas mórbidas, después de la raquianestesia para cesárea. Deseamos aquí evaluar la incidencia de la hipotensión correlacionada con el IMC. MÉTODO: En el grupo Eutrofia fueron incluidas 49 pacientes con IMC pregestacional por debajo de 25 kg.m-2 y en el grupo Sobrepeso 51 pacientes con IMC igual o por encima de 25 kg.m-2. Después de la raquianestesia fueron anotadas las medidas de presión arterial, volumen de cristaloides infundidos y dosis de vasopresores utilizadas hasta el nacimiento. La reducción de la presión arterial sistólica por debajo de 100 mmHg o 10 por ciento de la presión arterial sistólica (PAS) inicial, fue considerado como hipotensión y corregida con vasopresor. RESULTADOS: Los episodios de hipotensión fueron menores en el grupo Eutrofia (5,89 ± 0,53 vs 7,80 ± 0,66; p 0,027); como también la cantidad de cristaloides (1298 ± 413,6 mL vs. 1539 ± 460,0 mL; p 0,007) y el uso de vasopresores (5,87 ± 3,45 bolo vs. 7,70 ± 4,46 bolo; p 0,023). En lo concerniente a las enfermedades asociadas, observamos una mayor incidencia de diabetes entre las embarazadas obesas (29,41 por ciento vs. 9,76 por ciento, RR 1,60, IC 95 por ciento: 1,15-2,22, p 0,036), pero no hubo una diferencia entre los grupos con relación a la incidencia de enfermedad hipertensiva específica de la gestación (DHEG) (sobrepeso: 21,57 por ciento, peso normal: 12,20 por ciento, RR 1,30, IC 95 por ciento: 0,88-1,94, p 0,28). CONCLUSIONES: En la muestra en estudio, el IMC pregestacional mayor o igual a 25 kg.m-2 se presentó como un factor de riesgo para la hipotensión después de la raquianestesia en pacientes sometidas a la cesárea. El mismo grupo de pacientes necesitó un número de dosis mayor de vasopresores. La valoración de esos hallazgos nos hace perfeccionar las técnicas anestésicas en esas pacientes para reducir las consecuencias de la hipotensión postraquianestesia, tanto en la embarazada como en el feto.

Female , Humans , Pregnancy , Anesthesia, Obstetrical/adverse effects , Anesthesia, Spinal/adverse effects , Body Mass Index , Cesarean Section , Hypotension/etiology , Obesity , Pregnancy Complications , Hypotension/epidemiology