ABSTRACT
OBJETIVO: mapear os cuidados de enfermagem empregados aos pacientes adultos com drenagem torácica internados em terapia intensiva. MÉTODO: scoping review a ser conduzida conforme o Joanna Briggs Institute, com a seguinte questão de pesquisa: "quais são os cuidados de enfermagem indicados aos pacientes adultos com drenagem torácica internados em terapia intensiva?". A busca será desenvolvida em cinco bases de dados: Pubmed, Scopus, Embase, BVS e Web of Science, e os achados serão geridos com o auxílio do software Rayyan. Serão incluídos estudos quantitativos e qualitativos, artigos de revisão, dissertações, teses, diretrizes clínicas e protocolos terapêuticos sobre a temática, incluindo a literatura cinzenta. Será descrito o número total de fontes de evidência encontradas e selecionadas. Através de uma narrativa, será detalhado o processo de decisão da inclusão dos estudos. Os principais achados deverão estar descritos em consonância com o objetivo e os resultados relacionados à questão de pesquisa.
OBJECTIVE: to map nursing care employed to adult patients with chest drainage admitted to intensive care. METHOD: scoping review to be conducted according to the Joanna Briggs Institute, with the following research question: "What are the nursing cares indicated to adult patients with chest drainage admitted to intensive care?". The search will be developed in five databases: Pubmed, Scopus, Embase, BVS and Web of Science, and the findings will be managed with the support of Rayyan software. Quantitative and qualitative studies, review articles, dissertations, theses, clinical guidelines and therapeutic protocols on the subject will be included, including gray literature. The total number of sources of evidence found and selected will be described. Through a narrative, the decision-making process of the inclusion of the studies will be detailed. The main findings must be described in line with the objective and the results related to the research question.
Subject(s)
Humans , Adult , Drainage/nursing , Thoracic Surgical Procedures , Pleural Cavity , Intensive Care Units , Nursing CareABSTRACT
Lung cancer is the highest cancer-related mortality rate in the world, and is one of the most common malignancies. The standard treatment for early-stage non-small cell lung cancer (NSCLC) is radical lobectomy, while recent studies have found that sub-lobectomy of pulmonary nodules (≤2 cm) is not inferior to lobectomy and even improve the prognosis of the patients. These important findings will effectively and positively promote the formation of consensus and principles of wedge resection of pulmonary nodules (≤2 cm) in the field of thoracic surgery. The purpose of this study is to present a national expert consensus on wedge resection of pulmonary nodules (≤2 cm) in the field of thoracic surgery. The experts from Editorial Committee of Consensus on Wedge Resection of Lung Nodules (≤2 cm) (2023 Edition) jointly participated in the revision work. According to the clinical progress about the wedge resection of pulmonary nodules (≤2 cm) at home and abroad during recent years, experts jointly wrote Wedge Resection of Pulmonary Nodules (≤2 cm): a Consensus Statement by Specialists of Thoracic Surgery (2023 Edition), in combination with the homogeneous treatment principles of wedge resection in the field of thoracic surgery in China. This consensus was summarized from the following aspects: (1) Indications of wedge resection of pulmonary nodules (≤2 cm); (2) Resection range of pulmonary nodules (≤2 cm) required for wedge resection; (3) Excisable pulmonary nodules (≤2 cm) for wedge resection. This consensus finally put forward 8 recommended opinions, and sorted out 5 opinions which were still controversial and needed more evidence. The integrated opinions were generated through the discussion held among the experts of thoracic surgery from all over the country, making wedge resection of pulmonary nodules (≤2 cm) more appropriate for China and more standardized and homogeneous for clinical practice. In the future, more relevant researches should be accumulated based on the characteristics of lung cancer and its diagnosis and treatment in China, optimizing the treatment of pulmonary nodules (≤2 cm).
Subject(s)
Humans , Thoracic Surgery , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms/surgery , Thoracic Surgical Procedures , Multiple Pulmonary Nodules , Small Cell Lung CarcinomaABSTRACT
We present the case report of one of the co-authors for the closure of her atrial septal defect under neuraxial anesthesia. The influence of the Cardiovascular Anesthesiologist on the response to perioperative stress in the context of cardiac surgery with the choice and application of the best anesthetic technique adjusted to a high-risk patient, has a positive impact on the main objectives of high-value care in the critical area of medicine and in the immediate postoperative evolution after a heart surgery. The safety of neuraxial anesthesia in cardiac surgery is a subject in wide debate in Mexico, even in hospitals with high volume of cardiac surgery it is a controversial subject, we present the first clinical case in Mexico of a 21-year-old female patient under- going closure of Atrial septal defect (ASD) via median sternotomy with extracorporeal circulation under neuraxial anesthesia and sedoanalgesia without orotracheal intubation.
Presentamos el reporte de caso de una de las coautoras para el cierre de su comunicación interatrial bajo anestesia neuroaxial. La influencia del Anestesiologo Cardiovascular en la respuesta al estres perioperatorio en el contexto de cirugía cardíaca con la elección y aplicación de la mejor tecnica anestesica ajustada a un paciente de alto riesgo, tiene un impacto positivo en los principales obejtivos del cuidado de alto valor en el área de la medicina critica y en la evolución posoperatoria inmediata tras una cirugía caridaca. La seguridad de la anestesia neuroaxial en cirugía cardíaca es un tema en amplio debate en México, aun en hospitales con alto volumen de cirugía cardíaca es un tema controversial. Presentamos el primer caso clínico en México de una paciente femenino de 21 años sometida a cierre de comunicación interauricular (CIA) vía esternotomia media con circulación extracorporea bajo anestesia neuroaxial y sedoanalgesia sin intubación orotraqueal.
Subject(s)
Humans , Female , Young Adult , Conscious Sedation/methods , Thoracic Surgical Procedures/methods , Heart Septal Defects, Atrial/surgery , Anesthesia, Conduction/methods , Extracorporeal Circulation , Sternotomy , Anesthesia, Epidural , Anesthesia, SpinalABSTRACT
OBJECTIVE: This study aimed to determine with electrical impedance tomography (EIT) the distribution of lung volume during spontaneous breathing, between the preoperative and postoperative state of cardiac surgery. MATERIAL AND METHODS: This was a cross-sectional study carried out with 38 adult patients who underwent elective cardiac surgery. The distribution of global and regional pulmonary ventilation was determined through EIT, during spontaneous breathing and in a sitting position, before and after cardiac surgery. The global minute tidal variation (MTVo) and the regional minute tidal variation (MTV) were compared between these two moments, accepting p < 0.05 as a significant difference. RESULTS: In the settings of our study, MTVdecreased without statistical significance (p = 0.74). Preoperative and postoperative regional showed substantial differences in ventilation distribution (p = 0.05), being ROI3 the most and ROI2 the least ventilated at both times. When evaluating the change from preoperative to postoperative a decrease in the left zone (ROI2 and ROI4; p = 0.049) and posterior zone (ROI3 and ROI4; p = 0.001) was observed. CONCLUSIONS: The EIT findings after cardiac surgery allowed the detection of zones of low ventilation (posterior and left) at risk for pulmonary complications.
OBJETIVO: Este estudio tuvo como objetivo determinar con la tomografía de impedancia eléctrica (TIE) la distribución del volumen pulmonar durante la respiración espontánea, entre el estado preoperatorio y posoperatorio de la cirugía cardíaca. MATERIALES Y MÉTODOS: Se trata de un estudio transversal realizado con 38 pacientes adultos sometidos a cirugía cardíaca electiva. Se determinó la distribución de la ventilación pulmonar global y regional mediante TIE, durante la respiración espontánea y en posición sentada, antes y después de la cirugía cardíaca. Se comparó la variación tidal global por minuto (MTVo) y la variación tidal regional por minuto (MTV ROI) entre estos dos momentos, aceptando p < 0,05 como diferencia significativa. RESULTADOS: En los escenarios de nuestro estudio, la MTVglobal disminuyó sin significación estadística (p = 0,74). Las regiones preoperatoria y posoperatoria mostraron diferencias significativas en la distribución de la ventilación (p = 0,05), siendo el ROI3 el más ventilado y el ROI2 el menos ventilado en ambos momentos. Al evaluar el cambio del preoperatorio al postoperatorio se observó una disminución en la zona izquierda (ROI2 y ROI4; p = 0,049) y posterior (ROI3 y ROI4; p = 0,001). CONCLUSIONES: Los hallazgos de la TIE tras la cirugía cardíaca permitieron detectar zonas de baja ventilación (posterior e izquierda) con riesgo de complicaciones pulmonares.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Tomography/methods , Pulmonary Ventilation/physiology , Thoracic Surgical Procedures/methods , Postoperative Care , Respiratory Physiological Phenomena , Preoperative Care , Cross-Sectional Studies , Electric Impedance , Elective Surgical Procedures , Intensive Care Units , Lung Volume MeasurementsABSTRACT
Abstract Thoracic aortic diseases contribute to a major part of cardiac surgeries. The severity of pathologies varies significantly from emergency and life-threatening to conservatively managed conditions. Life-threatening conditions include type A aortic dissection and rupture. Aortic aneurysm is an example of a conservatively managed condition. Pathologies that affect the arterial wall can have a profound impact on the presentation of such cases. Several risk factors have been identified that increase the risk of emergency presentations such as connective tissue disease, hypertension, and vasculitis. The understanding of aortic pathologies is essential to improve management and clinical outcomes.
Subject(s)
Humans , Aortic Aneurysm , Aortic Aneurysm, Thoracic/surgery , Thoracic Surgical Procedures , Aortic Dissection/surgery , AortaABSTRACT
Abstract Background Cardiac surgery causes pathophysiological changes that favor the occurrence of pulmonary and functional complications. Objective To investigate the effects of inspiratory muscle training (IMT) with an electronic device on patients undergoing cardiac surgery. Methods A randomized controlled trial was conducted with 30 adult patients undergoing elective cardiac surgery. A control group (CG) received conventional physical therapy care, and an intervention group (IG) received IMT using the POWERbreathe K5® electronic device. Two daily sessions of physical therapy were performed at the intensive care unit and one daily session at the ward until the sixth postoperative day. The following variables were measured preoperatively and on the sixth postoperative day, in both groups: inspiratory muscle strength, dynamic inspiratory muscle strength, and peak inspiratory flow. Data distribution was evaluated by the Shapiro-Wilk test. Analysis of variance was used, and the results were considered statistically significant when p < 0.05. Results Maximal inspiratory pressure (71.7 ± 17.1 cmH2O vs 63.3 ± 21.3 cmH2O; p = 0.11], S-index (52.61 ± 18.61 vs 51.08 ± 20.71), and peak inspiratory flow [(2.94 ± 1.09 vs 2.79 ± 1.26)] were maintained in the IG but had a significant reduction in the CG. Conclusion IMT performed with an electronic device was effective at maintaining inspiratory muscle strength, dynamic inspiratory muscle strength, and peak inspiratory flow when compared to conventional physical therapy. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Breathing Exercises/methods , Physical Therapy Modalities/instrumentation , Thoracic Surgical Procedures/rehabilitation , Postoperative Complications , Respiratory Tract Diseases/complications , Total Lung Capacity , Thoracic Surgical Procedures/adverse effects , Muscle Strength , Maximal Respiratory PressuresABSTRACT
Surgical neuromodulation therapies are still considered a last resort when standard therapies have failed for patients with progressive heart failure (HF). Although a number of experimental studies have provided robust evidence of its effectiveness, the lack of strong clinical evidence discourages practitioners. Thoracic unilateral sympathectomy has been extensively studied and has failed to show significant clinical improvement in HF patients. Most recently, bilateral sympathectomy effect was associated with a high degree of success in HF models, opening the perspective to be investigated in randomized controlled clinical trials. In addition, a series of clinical trials showed that bilateral sympathectomy was associated with a decreased risk of sudden death, which is an important outcome in patients with HF. These aspects indicates that bilateral sympathectomy could be an important alternative in the treatment of HF wherein pharmacological treatment barely reaches the target dose.
Subject(s)
Humans , Thoracic Surgical Procedures , Heart Failure/surgery , Hyperhidrosis/surgery , Sympathectomy , Treatment OutcomeABSTRACT
Introducción: Mantener una oxigenación adecuada durante la ventilación a un solo pulmón es el problema fundamental al que se enfrenta el anestesiólogo durante la cirugía torácica, es por ello que se mantiene una constante búsqueda del método anestésico ideal que ayude a lograr dicho objetivo. Objetivos: Evaluar los resultados de dos técnicas de anestesia total intravenosa con remifentanilo y fentanilo como base analgésica e identificar la aparición de complicaciones durante la intervención quirúrgica. Métodos: Se realizó un estudio causiexperimental prospectivo, en el Hospital Docente Clínico Quirúrgico Dr. Salvador Allende, entre enero 2013 a diciembre 2015 en 40 pacientes ASA II o III que requirieron procedimientos intratorácicos. Estos se dividieron en dos grupos. A (remifentanilo-propofol) y B (fentanilo-propofol). Se estudiaron variables hemodinámicas, de oxigenación durante la ventilación unipulmonar, el tiempo de recuperación anestésica (ventilación espontánea, apertura ocular, extubación) y la analgesia posoperatoria. Resultados: No existieron variaciones significativas en la hemodinamia, ni en la oxigenación de los enfermos con el empleo de ambas técnicas anestésicas; sin embargo, el despertar y recuperación posoperatoria a corto plazo fue mejor en el grupo A. La intensidad del dolor posoperatorio según la escala visual análoga fue menor en el grupo B. Conclusiones: Ambas técnicas son efectivas para procedimientos quirúrgicos torácicos. Con mínima interferencia en la hemodinámia y parámetros de oxigenación(AU)
Introduction: Maintaining adequate oxygenation during single-lung ventilation is a fundamental concern faced by the anesthesiologist during thoracic surgery; therefore, a constant search is maintained for the ideal anesthetic method that helps achieve this goal is maintained. Objectives: To evaluate the outcomes of two total intravenous anesthesia techniques with remifentanil and fentanyl as analgesic base and to identify the onset of complications during surgery. Methods: A prospective and quasi-experimental study was carried out at Dr. Salvador Allende Clinical-Surgical Hospital, between January 2013 and December, with 40 ASA II or III patients who required intrathoracic procedures. These were divided into two groups: A (remifentanil-propofol) and B (fentanyl-propofol). Hemodynamic variables and others of oxygenation during one-lung ventilation were studied, together with anesthetic recovery time (spontaneous ventilation, ocular opening, extubation) and postoperative analgesia. Results: There were no significant variations in the hemodynamics or oxygenation of patients with the use of both anesthetic techniques; however, awakening and short-term postoperative recovery was better in group A. Postoperative pain intensity, based on the analogue-visual scale, was lower in group B. Conclusion: Both techniques are effective for thoracic surgical procedures, with minimal effect in hemodynamics and oxygenation parameters(AU)
Subject(s)
Humans , Fentanyl/therapeutic use , Thoracic Surgical Procedures , One-Lung Ventilation , Anesthesia, Intravenous/methods , Prospective Studies , Remifentanil/therapeutic use , AnalgesiaABSTRACT
Resumen Introducción: Uno de los mayores avances de las últimas décadas en la cirugía de tórax ha sido el desarrollo de la cirugía mínimamente invasiva. Objetivos: Describir la experiencia en videotoracoscopía (VATS) Uniportal de miembros del equipo de Cirugía de Tórax de la Universidad de Chile en 2 campos clínicos, (Clínica Las Condes y Hospital Clínico de la Universidad de Chile). Materiales y Método: Se estudiaron 105 pacientes sometidos a VATS uniportal entre enero de 2016 y enero de 2019. Los datos se analizaron de manera retrospectiva considerando variables demográficas (edad, sexo) y clínicas (diagnóstico, cirugía, estadía hospitalaria, días de pleurostomía, conversión y complicaciones). Resultados: De las 105 cirugías realizadas, 28 (26,6%) correspondieron a cirugías mayores complejas lobectomías y segmentectomías anatómicas. En 4 pacientes se agregó un 2° puerto, uno se convirtió a minitoracotomía y uno a toracotomía (5,7% conversión global). La estadía hospitalaria fue en promedio 3,07 ± 3,1 días y el promedio de mantención de pleurostomía de 2,67 ± 1,61 días. Siete pacientes (6,6%) presentaron complicaciones postoperatorias. Un paciente falleció por progresión de su enfermedad, no hubo mortalidad relacionada a la cirugía. Discusión: Las contraindicaciones de la VATS uniportal son las mismas que en la VATS multipuerto. En manos experimentadas, las complicaciones en cirugía por puerto único son bajas. Impresiona tener menos dolor postoperatorio, menor estadía hospitalaria y reintegración precoz a las actividades diarias comparado con la VATS tradicional. Conclusiones: Se presenta la primera serie de VATS uniportal publicada en Chile. Los resultados obtenidos son comparables a los observados en la literatura. Su implementación y desarrollo requiere de una curva de aprendizaje similar a cualquier nueva técnica quirúrgica.
Objective: To describe the initial results with uniportal Video-Thoracoscopic Surgery (VATS) performed in two campuses by members of the Section of Thoracic Surgery of the University of Chile ("Clínica Las Condes" and University of Chile Clinical Hospital). Materials and Method: Between January 2016 and January 2019, a total of 105 patients underwent uniportal VATS. Clinical data was collected retrospectively from digital records including demographic (age, sex) and clinical variables (diagnosis, surgery, duration of the chest tube, length of stay, conversion rate and postoperative complications). Results: Uniportal VATS was performed on 105 patients during the study period. Twenty-eight cases (26.6%) corresponded to lobectomy or anatomic segmentectomy. In 4 cases a 2nd port was required, 1 patient had to be converted to mini-thoracotomy and 1 to thoracotomy (5.8% global conversion). Overall, the median length of stay was 3.07 ± 3.1 days and the median duration of chest tube drainage was 2.67 ± 1.61 days. Seven patients (6.6%) presented complications. One patient died due to progression of his disease, there were no deaths related to the procedures. Discussion: Uniportal VATS has similar indications than multiportal VATS. On experienced hands, uniportal VATS has a low morbidity rate. Uniportal VATS appears to produce less post-operative pain, with shorter hospital stay and a faster return to normal life compared to standard VATS. Conclusion: We present the first uniportal VATS series in Chile. Results were similar to published series. Implementation and development of uniportal VATS requires a learning curve similar to any new surgical procedure.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Thoracic Surgery, Video-Assisted/adverse effects , Thoracic Surgery, Video-Assisted/methods , Chile , Retrospective Studies , Minimally Invasive Surgical Procedures , Thoracic Surgical Procedures/methods , Thoracic Surgery, Video-Assisted/instrumentationABSTRACT
Selective bronchial intubation (SBI) to ventilate a single lung (one-lung ventilation, OLV) or to apply separate lung ventilation (independent-lung ventilation, ILV) can be frequently required under general anesthesia in pediatrics, mainly in video assisted thoracoscopy surgery, in the postoperative care of cardio-thoracic surgery, and for the treatment of lung pathologies with unilateral prevalence in intensive care. In children over 6-8 years of age SBI, OLV and ILV can be performed using marketed double-lumen tubes (DLTs). In neonates, infants and younger children the application of ILV is limited due to the lack of DLTs. For children of this age, a specific DLT for ILV was developed (Marraro Paediatric Endobronchial Bilumen Tube®) but is currently available only as a special product. The DLT represents the device of choice for OLV and ILV while the use of bronchial blocker is suggested as an alternative to achieve the SBI and the OLV when suitable DLTs are not available. Different catheters types can be used as bronchial blocker. If SBI is not possible using DLT or bronchial blocker, a conventional single-lumen tube of adequate length can allow SBI in all pediatric ages. Using the bronchial blocker and single lumen tube it is possible to perform OLV but it is impossible to apply ILV. The main complications of SBI and DLT are largely due to limited operator experience. Airway trauma, dislodgment and obstruction of the devices are quite frequent and can lead to severe hypoxia if not recognized and treated early.
Subject(s)
Child , Humans , Infant , Infant, Newborn , Intubation, Intratracheal , Lung , One-Lung Ventilation , Thoracic Surgical ProceduresABSTRACT
The clinical characteristics of the pediatric population infected with the SARS-CoV-2 virus in general are not as severe as in the adult population, so they can be considered asymptomatic carriers. The pediatric patient with congenital heart disease are considered a high risk group of contagion in the SARS-CoV-2 pandemic, so healthcare personnel who interact with patients must have established guidelines to avoid transmission and spread of the disease. Each country is commanded by the central guidelines established by its health system considering operative definitions and protocols, but in certain places these guidelines do not fulfill international standards, as those proposed by the World Health Organization. In this communication we have done a current literature review and adaptation of the recommendations to face the infectious outbreak due to the SARS-CoV-2 virus in pediatric cardiovascular surgery programs, specifically in the ââanesthesiology area. We also analyze the type of personal protective equipment that should be used in each area of ââpatient management, changes in the environment of work areas, shift times of health personnel, the protection of personnel performing transesophageal echocardiography, modification of the airway management algorithms, proper placement and withdrawal of personal protective equipment, patients transfer between wards or other services, and adequate disinfection of airway equipment used.
Las características clínicas de la población pediátrica contagiada del virus SARS-CoV-2 en general no son tan severas como en la población adulta, por lo que pueden ser considerados portadores asintomáticos. El paciente pediátrico con cardiopatía congénita pertenece a un grupo de alto riesgo de contagio dentro de la pandemia producida por el SARS-CoV-2, por lo que el personal sanitario que interactúe con los pacientes debe tener lineamientos establecidos para evitar la transmisión y propagación de la enfermedad. Cada país se rige por las guías centrales establecidas por su sistema de salud en cuanto a definiciones operativas y protocolos, pero en algunos lugares estas directrices no cumplen las metas internacionales, como las propuestas por la Organización Mundial de la Salud. En este comunicado hemos realizado una revisión de la literatura actual y adaptación de las recomendaciones para enfrentar el brote infeccioso por el virus SARS-CoV-2 en los programas de cirugía cardiovascular pediátrica, específicamente en el área de anestesiología. También analizamos el tipo de equipo de protección personal que debe ser utilizado en cada área del manejo de pacientes, cambios del ambiente de las áreas de trabajo, rotación de personal, la protección del personal que realiza ecocardiografía transesofágica, modificación de los algoritmos de manejo de la vía aérea, colocación y retiro correctos del equipo de protección personal, traslado de los pacientes entre servicios, y adecuada desinfección del equipo utilizado en el manejo de la vía aérea.
Subject(s)
Humans , Child , Thoracic Surgical Procedures/methods , COVID-19/prevention & control , Anesthesia/methods , Pediatrics , Personnel Turnover , Thoracic Surgery/methods , Algorithms , Clinical Protocols , Patient Transfer , Echocardiography, Transesophageal/methods , Airway Management/methods , Pandemics , Personal Protective Equipment , SARS-CoV-2 , COVID-19/surgery , COVID-19/diagnosisSubject(s)
Humans , Pneumonia, Viral/prevention & control , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Surgeons/standards , Betacoronavirus , Hospitals, Special/standards , Brazil , Tracheostomy/standards , Thoracic Surgical Procedures/standards , Surgeons/education , Personal Protective Equipment , SARS-CoV-2 , COVID-19ABSTRACT
ABSTRACT Objective: To evaluate the results of resection of tumors of the thymus by robotic thoracic surgery, analyzing the extent of resection, postoperative complications, time of surgery, and length of stay. Methods: Retrospective study from a database involving patients diagnosed with a tumor of the thymus and undergoing robotic thoracic surgery at one of seven hospitals in Brazil between October of 2015 and June of 2018. Results: During the study period, there were 18 cases of resection of tumors of the thymus: thymoma, in 12; carcinoma, in 2; and carcinoid tumor, in 1; high-grade sarcoma, in 1; teratoma, in 1; and thymolipoma, in 1. The mean lesion size was 60.1 ± 32.0 mm. Tumors of the thymus were resected with tumor-free margins in 17 cases. The median (interquartile range) for pleural drain time and hospital stay, in days, was 1 (1-3) and 2 (2-4), respectively. There was no need for surgical conversion, and there were no major complications. Conclusions: Robotic thoracic surgery for resection of tumors of the thymus has been shown to be feasible and safe, with a low risk of complications and with postoperative outcomes comparable to those of other techniques.
RESUMO Objetivo: Avaliar os resultados da ressecção de tumores tímicos por cirurgia torácica robótica, verificando a radicalidade da ressecção, complicações pós-operatórias, tempo de cirurgia e tempo de internação. Métodos: Estudo retrospectivo a partir de um banco de dados envolvendo pacientes com diagnóstico de tumor tímico e submetidos à cirurgia torácica robótica em sete hospitais no Brasil entre outubro de 2015 e junho de 2018. Resultados: Durante o período estudado, houve 18 casos de ressecção de tumores tímicos (timomas, em 12; carcinoma tímico, em 2; e tumor carcinoide tímico, sarcoma tímico de alto grau, teratoma tímico e timolipoma, em 1 cada). A média do tamanho das lesões foi de 60,1 ± 32,0 mm. Tumores tímicos foram ressecados com margens livres em 17 casos. As medianas (intervalos interquartis) de tempo de dreno pleural e de internação, em dias, foram 1 (1-3) e 2 (2-4), respectivamente. Não houve necessidade de conversão cirúrgica nem complicações maiores. Conclusões: A cirurgia torácica robótica para a ressecção de tumores tímicos demonstrou ser factível e segura, com baixo risco de complicações e desfechos pós-operatórios comparáveis aos de outras técnicas.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Thymoma/surgery , Thymus Neoplasms/surgery , Thoracic Surgical Procedures/methods , Robotic Surgical Procedures/methods , Tomography, X-Ray Computed , Retrospective Studies , Treatment OutcomeABSTRACT
Abstract Background: Hemodilution, transoperative bleeding and cardiopulmonary bypass (CPB) are some of the factors associated with high transfusion rates in cardiac surgery. Objective: To analyze the incidence of blood transfusion and early postoperative outcomes in cardiac surgery patients. Methods: Cohort study of patients undergoing cardiac surgery in a university hospital, consecutively enrolled from May 2015 to February 2017. Data were prospectively collected and comparisons were made between two patients' groups: transfused and not transfused. Student's t-test, chi-square test, and logistic regression were used, and a p-value < 0.05 was considered significant. Results: Among the 271 patients evaluated, 100 (37%) required transfusion in the transoperative (32.1%) and/or postoperative periods (19.5%). The following predictors of transfusion were identified by multivariate analysis: EuroScore II (OR 1.2); chronic kidney disease (CKD) (OR 3.2); transoperative bleeding ≥ 500 mL (OR 6.7); baseline hemoglobin (Hb) ≤ 10 g/dL (OR 11.5); activated partial thromboplastin time (aPTT) (OR 1.1) and CPB duration (OR 1.03). Transfusion was associated with prolonged mechanical ventilation (≥ 24h) (2.4% vs. 23%), delirium (5.9% vs. 18%), bronchopneumonia (1.2% vs. 16%), acute renal failure (3.5% vs. 25%), acute on CKD (0.6% vs. 8%), stroke or transient ischemic attack (1.8% vs. 8%), intensive care unit stay ≥ 72 h (36% vs. 57%), longer hospital stay (8 ± 4 days vs. 16 ± 15 days), as well as increased early mortality (1.75% vs. 15%). Conclusion: EuroScore II, CKD, major transoperative bleeding, preoperative Hb and aPTT values and CPB time were independent predictors of transfusion, which was associated with a higher rate of adverse outcomes, including early mortality.
Subject(s)
Humans , Male , Middle Aged , Aged , Postoperative Complications/prevention & control , Blood Transfusion/statistics & numerical data , Intraoperative Care/adverse effects , Prospective Studies , Risk Factors , Risk Assessment , Thoracic Surgical Procedures , Transfusion ReactionABSTRACT
Introducción: El dolor posoperatorio en la cirugía de tórax y hemiabdomen superior tiene un fuerte componente neuropático, por ello se le asocia con evolución hacia el dolor crónico. Sobre esta base se aplican los anticonvulsivantes como parte del tratamiento multimodal. Objetivos: Evaluar la efectividad analgésica y seguridad de la gabapentina en el tratamiento del dolor tras cirugía de tórax y abdomen superior. Método: Se realizó un estudio causiexperimental, comparativo y prospectivo con los pacientes anunciados para cirugía de abdomen superior y tórax, en el periodo de 2015 a 2017. Se incluyeron 30 pacientes divididos en 2 grupos. El grupo Grupo G: (n=14) recibió tratamiento con gabapentina 100 mg vía oral el día antes de la intervención y cada 12 h en el posoperatorio hasta las 24 h. El Grupo C: (n=16) recibió la analgesia convencional pautada para este tipo de intervención. Resultados: La muestra fue homogénea para la edad y el sexo. Los niveles de intensidad del dolor fueron menores en el grupo de gabapentina y esta diferencia se hace más significativa a las 24 h de la cirugía. Ello se corresponde con menor necesidad de analgesia de rescate (71 por ciento vs 100 por ciento). Las complicaciones asociadas resultaron más frecuentes en el grupo estudio a expensas de las náuseas, aunque sin diferencias significativas. Conclusiones: El empleo de gabapentina en el perioperatorio garantiza mejor control del dolor con escasas complicaciones(AU)
Introduction: Post-operative pain in upper thorax and hemiabdomen surgery has a solid neuropathic component; it is therefore associated with evolution towards chronic pain. On this basis, anticonvulsants are applied as part of the multimodal treatment. Objectives: To evaluate analgesic effectiveness and safety of gabapentin for management of pain after thorax and upper abdomen surgery. Method: A quasiexperimental, comparative and prospective study was conducted with the patients announced for surgery of the upper abdomen and thorax, in the period from 2015 to 2017. Thirty patients divided into 2 groups were included. The Group G (n=14) received treatment with gabapentin 100 mg orally the day before the intervention and every 12 h in the postoperative period until 24 h. The Group C (n=16) received the conventional analgesia prescribed for this type of intervention. Results: The sample was homogeneous regarding age and sex. Pain intensity levels were lower in the gabapentin group and this difference becomes more significant 24 hours after surgery. This corresponds to a lower need for rescue analgesia (71 percent vs. 100 percent). Associated complications were more frequent in the study group at the expense of nausea, although there were no significant differences. Conclusions: The use of gabapentin in the perioperative period guarantees better pain control with few complications(AU)