RESUMO
Carbon dioxide (CO) embolism is a complication of laparoscopic surgery that, although often does not have adverse sequelae, can be fatal. This is due to the fact that when CO is injected into the blood vessels, the bubbles impede blood flow, which clinically expresses as: decreased stroke volume, hypoxemia, sudden fall or sudden increase in expired CO, bradycardia, hypotension, dyspnea, cyanosis, arrhythmias, bilateral mydriasis, murmur in a mill wheel at auscultation and cardiovascular collapse with cardiorespiratory arrest. In this article we will present physiology of venous embolism, diagnosis, syntoms, treatment and prevention.
La embolia por dióxido de carbono (CO) es una complicación de la cirugía laparoscópica que, aunque a menudo no presenta secuelas adversas, puede ser fatal. Esto se debe a que al inyectar CO en los vasos sanguíneos las burbujas impiden el flujo de sangre, lo que clínicamente se expresa como: disminución del volumen sistólico, hipoxemia, caída repentina o aumento súbito del CO espirado, bradicardia, hipotensión, disnea, cianosis, arritmias, midriasis bilateral, soplo en rueda de molino a la auscultación y al colapso cardiovascular con paro cardiorrespiratorio. En este trabajo presentaremos fisiología del embolismo venoso, cuadro clínico, diagnóstico, tratamiento y formas de prevenir que ocurra este evento.
Assuntos
Humanos , Dióxido de Carbono/efeitos adversos , Laparoscopia/efeitos adversos , Embolia Aérea/etiologia , Fatores de Risco , Embolia Aérea/diagnóstico , Embolia Aérea/terapiaRESUMO
The ERAS protocols (Enhanced Recovery After Surgery or in Spanish, Recuperación Acelerada Después de Cirugía) are a set of multimodal perioperative strategies that aim to reduce the time of hospitalization, recovery, perioperative complications and costs associated with different surgical procedures. Multiple interventions are required for its implementation: anesthetic, surgical, kinesiological, nutritional and nursing interventions. There is a strong body of evidence supporting its application in the daily practice, but there are multiple barriers that have limited its development nationally and internationally. This review intends to appraise the state of the art of this topic, focusing on the anesthesiologist' role.
Los protocolos ERAS (Enhanced Recovery After Surgery o en español, Recuperación Acelerada Después de Cirugía) son un conjunto de estrategias multimodales del perioperatorio que tienen como objetivos el disminuir los tiempos de hospitalización, de recuperación, complicaciones perioperatorias y costos asociados a distintos procedimientos quirúrgicos. Para su implementación, requieren intervenciones anestésicas, quirúrgicas, kinesiológicas, nutricionales y de enfermería. Pese a que existe una amplia evidencia que avala su uso en nuestra práctica anestésica diaria, existen múltiples barreras que han limitado su desarrollo a nivel nacional e internacional. Presentamos una revisión de sus principales componentes y nos enfocamos en el rol que el anestesiólogo puede tener en su implementación.
Assuntos
Humanos , Recuperação Pós-Cirúrgica Melhorada , Anestesia , Educação de Pacientes como Assunto , Assistência Perioperatória/métodosRESUMO
Background:The incidence and epidemiological profile of tuberculosis (TB) has changed significantly in the recent years in Chile. Aim: To evaluate the clinical and epidemiological characteristics of TB cases diagnosed in the last decade at a university hospital in Santiago. Material and Methods: The Mycobacterium tuberculosis culture registry of the microbiology laboratory was reviewed. Medical records of patients with a positive culture registered between 2000 and 2010 were retrieved and analyzed. Results: Two hundred forty positive Mycobacterium tuberculosis cultures were identified and the medical records of 158 of these patients were accessed for analysis. The median age was 53 years (range: 3 to 89), 55.1% were female and nearly 42% had extra-pulmonary TB. Among known risk factors, 32.9% of patients were older than 65 years, 4.4% were health care workers and 3.9% immigrants. Twenty eight percent (41/145) had some type of immunosuppression at diagnosis: 11.7% HIV infection and 16.6% were using immunosuppressive drugs. In this group, a previous tuberculin skin test was done in only 5 cases (12.2%). Adverse events related to TB treatment were reported in 21.3% of cases (17/80). No cases of fulminant hepatitis or death from this cause were identified. Four of 92 patients that had a complete follow up during treatment, died. Two of these patients were receiving steroids. Conclusions:Almost one third of TB cases occurred among immunosuppressed patients and 42% were extra-pulmonary forms. The prevention of TB reactivation in this group should be strengthened.