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1.
Rev. chil. anest ; 49(1): 160-167, 2020.
Artigo em Inglês | LILACS | ID: biblio-1510408

RESUMO

OBJETIVES: 100 mcg intrathecal morphine (ITM) for hip arthroplasty provides adequate functional recovery and reduces associated complications but is not exempt from opioid-related adverse effects. We evaluate efficacy of a reduced dose of ITM (80 mcg) in terms of anesthetic quality, postoperative analgesia, complication rates and early recovery. METHODS: Case-control study. Patients under hip arthroplasty were treated on a specific protocol, using neuraxial anesthesia with hyperbaric bupivacaine 10.5-13.5 mg plus 80 mcg ITM versus controls with 100 mcg ITM. Demographic variables, intra and perioperative course were extracted from medical records. Pain severity and morphine associated complications were blindly assessed at regular intervals postoperatively. p < 0.01 were considered significant. RESULTS: 82 patients were analyzed. Mean age was 64.21 years, 62.20% women and 70.73% ASA-2. Main endoprosthesis indication was arthrosis (58.53%). No statistically significant differences in demographic and operative data were found between groups, including surgical time, ambulation time, length of stay, and patient satisfaction for pain management. Mean VAS for pain during first 24 hours was 0.24 for the low ITM group and 0.22 for control. Rescue intravenous morphine was the same between groups. Compared to 80 mcg ITM, 100 mcg showed trends for higher complication rates for respiratory depression (OR 2.58, CI 95% 0.45-14.54, p = 0.28), nausea without vomiting (OR 1.82, CI 95% 0.82-4.01, p = 0.13), urinary retention (OR 2.02, CI 95% 0.88-4.61, p = 0.09) and significantly higher rates of pruritus (OR 3.55, CI 95% 1.61-7.82, p < 0.01). CONCLUSIONS: 80 mcg ITM during spinal anesthesia for hip arthroplasty provided comparable postoperative analgesia and lower incidence of opioid-related adverse effects.


OBJETIVOS: 100 mcg morfina intratecal (ITM), en artroplastia de cadera, proporciona una recuperación funcional adecuada y reduce complicaciones asociadas, pero no está exento de efectos adversos conocidos asociados a opioides. Evaluamos eficacia de reducir dosis (80 mcg ITM) en términos de calidad anestésica, analgesia, complicaciones y recuperación postoperatoria. MÉTODOS: Estudio de casos y controles. Pacientes sometidos a artroplastia de cadera fueron tratados con anestesia espinal con bupivacaína hiperbárica 10,5-13,5 mg más 80 mcg ITM y controles de manera similar pero con 100 mcg ITM. Variables demográficas, así como intra y perioperatorio, se extrajeron de registros médicos. Severidad del dolor, y complicaciones asociadas a ITM, se evaluaron a ciegas según protocolo, p < 0,01 fue considerado significativo. RESULTADOS: 82 pacientes analizados. Edad promedio fue 64,21 años, 62,20% fueron mujeres y 70,73% ASA-2. Principal indicación de prótesis fue artrosis (58,53%). No se encontraron diferencias estadísticas entre variables demográficas, tiempo quirúrgico, tiempo deambulación, duración hospitalización y satisfacción paciente. EVA promedio dolor, primeras 24 horas, fue 0,24 para grupo 80 mcg ITM y 0,22 para control (100 mcg ITM). Morfina intravenosa de rescate fue similar entre grupos. En comparación con 80 mcg, 100 mcg presentó mayores tasas de complicaciones para depresión respiratoria (OR 2,58, IC95% 0,45-14,54, p = 0,28), náuseas y vómitos (OR 1,82, CI95% 0,82-4,01, p = 0,13), retención urinaria (OR 2,02, CI95% 0,88-4,61, p = 0,09) y prurito (OR 3,55, CI95% 1,61-7,82, p < 0,01). CONCLUSIONES: 80 mcg ITM, en anestesia espinal para artroplastia cadera, proporciona analgesia postoperatoria comparable a 100 mcg pero con menor incidencia de efectos adversos relacionados a opioides.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Artroplastia de Quadril/métodos , Analgésicos Opioides/administração & dosagem , Raquianestesia/métodos , Morfina/administração & dosagem , Estudos de Casos e Controles , Resultado do Tratamento
2.
Rev. chil. anest ; 49(4): 548-559, 2020. ilus
Artigo em Inglês | LILACS | ID: biblio-1511829

RESUMO

OBJECTIVES: 100 mcg intrathecal morphine (ITM) for hip arthroplasty provides adequate functional recovery and reduces associated complications but is not exempt from opioid-related adverse effects. We evaluate efficacy of a reduced dose of ITM (80 mcg) in terms of anesthetic quality, postoperative analgesia, complication rates and early recovery. METHODS: Case control study. Patients under hip arthroplasty were treated on a specific protocol, using neuraxial anesthesia with hyperbaric bupivacaine 10.5-13.5 mg plus 80 mcg ITM versus controls with 100 mcg ITM. Demographic variables, intra and perioperative course were extracted from medical records. Pain severity and morphine associated complications were blindly assessed at regular intervals postoperatively. p < 0.01 were considered significant. RESULTS: 82 patients were analyzed. Mean age was 64.21 years, 62.20% women and 70.73% ASA-2. Main endoprosthesis indication was arthrosis (58.53%). No statistically significant differences in demographic and operative data were found between groups, including surgical time, ambulation time, length of stay, and patient satisfaction for pain management. Mean VAS for pain during first 24 hours was 0.24 for the low ITM group and 0.22 for control. Rescue intravenous morphine was the same between groups. Compared to 80 mcg ITM, 100 mcg showed trends for higher complication rates for respiratory depression (OR 2.58, CI 95% 0.4514.54, p = 0.28), nausea without vomiting (OR 1.82, CI 95% 0.82-4.01, p = 0.13), urinary retention (OR 2.02, CI95% 0.88-4.61, p = 0.09) and significantly higher rates of pruritus (OR 3.55, CI 95% 1.61-7.82, p < 0.01). CONCLUSIONS: 80 mcg ITM during spinal anesthesia for hip arthroplasty provided comparable postoperative analgesia and lower incidence of opioid-related adverse effects.


OBJETIVOS: 100 mcg morfina intratecal (ITM), en artroplastía de cadera, proporciona una recuperación funcional adecuada y reduce complicaciones asociadas, pero no está exento de efectos adversos conocidos asociados a opioides. Evaluamos eficacia de reducir dosis (80 mcg ITM) en términos de calidad anestésica, analgesia, complicaciones y recuperación postoperatoria. MÉTODOS: Estudio de casos y controles. Pacientes sometidos a artroplastía de cadera fueron tratados con anestesia espinal con bupivacaína hiperbárica 10,5-13,5 mg más 80 mcg ITM y controles de manera similar, pero con 100 mcg ITM. Variables demográficas, así como intra y perioperatorio, se extrajeron de registros médicos. Severidad del dolor, y complicaciones asociadas a ITM, se evaluaron a ciegas según protocolo. p < 0,01 fue considerado significativo. RESULTADOS: 82 pacientes analizados. Edad promedio fue 64,21 años, 62,20% fueron mujeres y 70,73% ASA-2. Principal indicación de prótesis fue artrosis (58,53%). No se encontraron diferencias estadísticas entre variables demográficas, tiempo quirúrgico, tiempo deambulación, duración hospitalización y satisfacción paciente. EVA promedio dolor, primeras 24 horas, fue 0,24 para grupo 80 mcg ITM y 0,22 para control (100 mcg ITM). Morfina intravenosa de rescate fue similar entre grupos. En comparación con 80 mcg, 100 mcg presentó mayores tasas de complicaciones para depresión respiratoria (OR 2,58, IC 95% 0,45-14,54, p = 0,28), náuseas y vómitos (OR 1,82, CI 95% 0,82-4,01, p = 0,13), retención urinaria (OR 2,02, CI 95% 0,88-4,61, p = 0,09) y prurito (OR 3,55, CI 95% 1,61-7.82, p < 0,01). CONCLUSIONES: 80 mcg ITM, en anestesia espinal para artroplastía cadera, proporciona analgesia postoperatoria comparable a 100 mcg, pero con menor incidencia de efectos adversos relacionados a opioides.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Artroplastia de Quadril/métodos , Analgésicos Opioides/administração & dosagem , Morfina/administração & dosagem , Injeções Espinhais , Período de Recuperação da Anestesia , Bupivacaína/administração & dosagem , Estudos de Casos e Controles , Satisfação do Paciente , Recuperação de Função Fisiológica , Analgésicos Opioides/efeitos adversos , Morfina/efeitos adversos
3.
Rev. otorrinolaringol. cir. cabeza cuello ; 78(1): 110-120, mar. 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-902823

RESUMO

RESUMEN Paciente de 36 años en tratamiento de leucemia mieloide crónica con nilotinib a quien se le diagnostica hipertiroidismo por síntomas clínicos y exámenes de laboratorio. Se inicia tratamiento con metimazol más propanolol. Los estudios imagenológicos muestran un tejido ectópico tiroideo cervical infrahiodeo lateralizado a la izquierda y un nódulo en la base de la lengua. Presentó toxicidad hepática atribuida al tratamiento por lo que se decide extirpación quirúrgica de tiroides ectópica dual. Por la edad de la paciente y preocupación acerca del resultado estético, se realiza una tiroidectomía videoasistida por via axilar de la tiroides ectópica cervical y una resección transoral de la tiroides ectópica lingual. La patología confirma tejido tiroideo en ambas localizaciones sin signos de malignidad. La paciente se recuperó sin complicaciones y sin cicatriz cervical.


ABSTRACT A 36-year-old female patient with chronic myeloid leukemia being treated with nilotinib who was diagnosed with hyperthyroidism both on clinical and laboratory examination is presented. Imaging studies found left lateralized ectopic thyroid tissue of infrahyoid localization and a nodule at the base of the tongue. Hepatic toxicity was attributed to medical treatment, surgical removal of the dual thyroid ectopia was proposed. Due to the patients age and cosmetical concerns, a minimally invasive surgery was undertaken thru a video assisted transaxillary thyroidectomy for the cervical thyroid ectopia and a video assisted trans oral approach for the lingual thyroid ectopia. Post op pathology confirmed thyroid tissue at both locations and also excluded malignancy. The patient fully recovered without any complicaction and witout a residual cervical scar.


Assuntos
Humanos , Feminino , Adulto , Tireoidectomia/métodos , Cirurgia Vídeoassistida , Disgenesia da Tireoide/cirurgia , Nódulo da Glândula Tireoide/cirurgia , Tireoide Lingual/cirurgia , Disgenesia da Tireoide/diagnóstico , Disgenesia da Tireoide/diagnóstico por imagem , Hipertireoidismo
4.
Bol. Hosp. Viña del Mar ; 73(1): 28-30, 2017.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1397400

RESUMO

Las endoprotesis de vía biliar son dispositivos utilizados para aumentar el calibre de las vías biliares, y son implementadas en el alivio sintomático de neoplasias de la vía biliar; sin embargo en el último tiempo se ha diversificado su uso en el manejo de los casos de coledocolitiasis que no se resuelven con los métodos convencionales. Sus complicaciones más comunes son la colangitis y la obstrucción de la endoprótesis; las menos frecuentes son la pancreatitis, hemorragia digestiva, perforación intestinal y migración de la endoprótesis. Se presenta el caso de una paciente con dolor abdominal secundario a la migración distal de la endoprótesis biliar. Caso clínico: Mujer de 93 años, colecistectomizada, con antecedentes de colocación de endoprotesis biliar. Consulta por dolor abdominal, sin signos de irritación peritoneal. Exámenes de laboratorio con parámetros inflamatorios elevados. Tomografía computada (TC) de abdomen y pelvis muestra neumobilia y presencia de cuerpo extraño tubular enclavado en divertículo sigmoideo. Se interpretan los hallazgos como migración distal de endoprótesis biliar, con enclavamiento en divertículo sigmoideo. Se hospitaliza para extracción de endoprótesis mediante colonoscopía la cual fue realizada con éxito. Luego es dada de alta indicándose manejo con ácido ursodeoxicólico y control en policlínico para control de litiasis de la vía biliar. Conclusión: La migración de endoprótesis biliar es una complicación poco frecuente del uso de estos dispositivos, que puede debutar con dolor abdominal. Su diagnóstico se basa en los antecedentes de colocación de la endoprótesis, la forma de presentación clínica y los hallazgos radiológicos encontrados.


Bile duct stents are devices used to increase the caliber of the bile ducts and are used in the symptomatic relief of biliary tract neoplasias; However, lately their use has been extended into the management of choledocholithiasis cases not amenable to conventional treatment. The most common complications are cholangitis and stent obstruction, and the least common are pancreatitis, gastrointestinal bleeding, intestinal perforation, and stent migration. We present the case of a patient with abdominal pain secondary to the distal migration of a biliary stent. Case report: 93 year old female, cholecystectomy, with a history of biliary stent, admitted for abdominal pain with no signs of peritoneal irritation. Laboratory tests showed elevated inflammatory parameters. Abdomen and pelvis CT-scan showed pneumobilia and presence of a tubular foreign body embedded in the sigmoid diverticulum. These findings were interpreted as distal migration of a biliary stent which embedded in the sigmoid diverticulum. She was hospitalized for stent extraction by colonoscopy, which was performed successfully. She was then discharged, prescribed ursodeoxycholic acid and sent to follow-up in the outpatients´ clinic in order to monitor biliary tract lithiasis. Conclusion: Biliary endoprosthesis migration is a rare complication of the use of these devices, and may present as abdominal pain. Its diagnosis is based on the history of stent placement, clinical presentation and radiological findings.

5.
Biosalud ; 15(2): 106-115, jul.-dic. 2016. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-950982

RESUMO

Los alimentos funcionales contienen componentes activos que con un consumo habitual favorecen la salud de consumidor. Dentro del concepto de funcional se encuentran los alimentos con microorganismos probióticos, los cuales al ser ingeridos en dosis adecuadas confieren diversos beneficios, estos microorganismos son sensibles a factores tecnológicos y ambientales que pueden reducir su viabilidad, estabilidad y su capacidad funcional. Existen tecnologías como la encapsulación, las cuales permiten mejorar la estabilidad de los probióticos al protegerlos mediante un material de recubrimiento. En este trabajo se realizó una búsqueda sistemática en diversas bases de datos sobre los probióticos más empleados en la industria de alimentos, su capacidad catalítica en matrices alimenticias, métodos de encapsulación, tipos de matrices en la encapsulación, estabilidad bajo condiciones gastrointestinales y los mecanismos de liberación. Se encontró que la encapsulación, además de favorecer la estabilidad de los microorganismos probióticos frente a factores adversos, condiciona según sus características, su aplicación e incorporación en matrices alimenticias de diversas cualidades.


Functional foods contain active components, which under their regular use favor consumers' health. Within the functional concept food with probiotics are found, which when ingested in adequate doses confer various benefits. These microorganisms are sensitive to technological and environmental factors that can reduce their viability, stability, and functional capacity. There are some technologies such as encapsulation, which allow improving the stability of probiotics by protecting them with a coating material. This a systematic search in several databases on the most widely used probiotics in the food industry, their catalytic capacity in food matrices, encapsulation methods, types of matrices in encapsulation, stability in gastrointestinal conditions and release mechanisms. It was found that encapsulation, besides favoring the stability of probiotic microorganisms against adverse factors, conditions, according to their characteristics, their application and incorporation in food matrices of different qualities.

6.
Rev. chil. obstet. ginecol ; 81(3): 223-228, jun. 2016. ilus
Artigo em Espanhol | LILACS | ID: lil-788913

RESUMO

El síndrome de Hallermann-Streiff es una rara entidad asociada a hipoplasia del tercio inferior de la cara, determinando así una vía aérea de difícil manejo. Se presenta el caso de una mujer de 21 años con ese síndrome, acondroplasia, escoliosis severa e infección respiratoria los días previos a la interrupción exitosa de su embarazo mediante cesárea. El manejo requirió una cuidadosa evaluación preoperatoria y disponibilidad inmediata de dispositivos alternativos para el manejo de la vía aérea en caso necesario. La gravidez, así como ciertas comorbilidades asociadas, aumentan la posibilidad de una intubación fallida con morbi-mortalidad secundaria importante, dado ello, es necesaria la preparación e implementación de algoritmos atingentes para el manejo de la vía aérea en casos como el presentado.


The Hallermann-Streiff syndrome is a rare entity associated to hypoplasia of the lower third of the face, determining a difficult airway management. We report the case of a 21 years female with this syndrome, achondroplasia, severe scoliosis and respiratory infection at the days prior to the interruption of her preg-nancy by cesarean section. Her management required a carefully preoperative evaluation and availability of alternative devices to secure her airway. Pregnancy and certain comorbidities increase the chance of a failed intubation with severe secondary morbidity and mortality, given this, the correct preparation and implementation of difficult airway algorithms in pregnancy if it’s necessary.


Assuntos
Humanos , Feminino , Gravidez , Adulto Jovem , Complicações na Gravidez/cirurgia , Síndrome de Hallermann/complicações , Complicações na Gravidez/etiologia , Resultado da Gravidez , Cesárea , Gravidez de Alto Risco , Manuseio das Vias Aéreas , Intubação
7.
Rev. méd. Chile ; 143(6): 759-766, jun. 2015. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-753516

RESUMO

Surgical resection of lung cancer, the only available curative option today, is strongly associated with mortality. The goal during the perioperative period is to identify and evaluate appropriate candidates for lung resection in a more careful way and reduce the immediate perioperative risk and posterior disability. This is a narrative review of perioperative risk assessment in lung cancer resection. Instruments designed to facilitate decision-making have been implemented in recent years but with contradictory results. Cardiovascular risk assessment should be the first step before a potential lung resection, considering that most of these patients are old, smokers and have atherosclerosis. Respiratory mechanics determined by postoperative forced expiratory volume in the first second (FEV1), the evaluation of the alveolar-capillary membrane by diffusing capacity of carbon monoxide and cardiopulmonary function measuring the maximum O2 consumption, will give clues about the patient s respiratory and cardiac response to stress. With these assessments, the patient and its attending team can reach a treatment decision balancing the perioperative risk, the chances of survival and the pulmonary long-term disability.


Assuntos
Humanos , Neoplasias Pulmonares/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Neoplasias Pulmonares/cirurgia , Consumo de Oxigênio , Valor Preditivo dos Testes , Testes de Função Respiratória , Fatores de Risco
8.
Bol. Hosp. Viña del Mar ; 70(2): 67-70, jun.2014. ilus
Artigo em Espanhol | LILACS | ID: lil-779175

RESUMO

Las manifestaciones neurológicas en pacientes con endocarditis infecciosa pueden ser muy frecuentes. Presentamos un caso clínico cuya manifestación cardinal fue un accidente cerebrovascular isquémico, y revisamos la epidemiología de este fenómeno, así como algunos aspectos terapéuticos y diagnósticos a considerar en este tipo de pacientes. Se otorga énfasis a la controversia en torno a la indicación de anticoagulación, la evaluación precoz con neuroimagen en pacientes asintomáticos, y la decisión de intervención quirúrgica precoz para pacientes seleccionados...


The neurological manifestations of patients with infectious endocarditis can be very common. We present a case report in which the cardinal manifestation was a stroke, and we review the epidemiology of this phenomenon, as well as some diagnostic and therapeutic aspects to consider in this type of patients. We put emphasis on the controversy around the anticoagulation therapy, initial evaluation with neuroimaging in asymptomatic patients, and the decision of surgical intervention in selected patients...


Assuntos
Humanos , Feminino , Idoso , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/tratamento farmacológico , Anticoagulantes/uso terapêutico , Endocardite Bacteriana/etiologia
9.
Rev. méd. Chile ; 138(12): 1539-1543, dic. 2010. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-583052

RESUMO

We report a 46-year-old woman, subjected to a laparoscopic sleeve gastrectomy, that had to be converted to open surgery due to the presence of adherences. She required an immediate new intervention due to a hemoperitoneum caused by a liver tear and venous bleeding from the splenic hilus. Both lesions were successfully repaired. In the postoperative period the patient had fever, leukocytosis and sialorrhea. A CAT scan showed a splenic infarction and a huge intra abdominal collection that communicated with the stomach. Streptococcus anginosus was isolated from the collection. The patient was managed with antimicrobials and percutaneous drainage with a favourable evolution and closure of the communication with the stomach.


Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Abscesso Abdominal/microbiologia , Gastrectomia/efeitos adversos , Infarto do Baço/patologia , Infecções Estreptocócicas/microbiologia , Streptococcus anginosus/isolamento & purificação , Gangrena , Gastrectomia/métodos , Obesidade Mórbida/cirurgia , Fatores de Risco
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