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Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management
Tedde, Miguel L.; Vasconcelos Filho, Paulo; Hajjar, Ludhmila Abrahão; Almeida, Juliano Pinheiro de; Flora, Gustavo Fagundes; Okumura, Erica Mie; Osawa, Eduardo A.; Fukushima, Julia Tizue; Teixeira, Manoel Jacobsen; Galas, Filomena Regina Barbosa Gomes; Jatene, Fabio Biscegli; Auler Jr., José Otávio Costa.
  • Tedde, Miguel L.; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Thoracic Surgery Department. São Paulo. BR
  • Vasconcelos Filho, Paulo; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Anaesthesia and Surgical Intensive Care Unit. São Paulo. BR
  • Hajjar, Ludhmila Abrahão; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Anaesthesia and Surgical Intensive Care Unit. São Paulo. BR
  • Almeida, Juliano Pinheiro de; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Anaesthesia and Surgical Intensive Care Unit. São Paulo. BR
  • Flora, Gustavo Fagundes; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Thoracic Surgery Department. São Paulo. BR
  • Okumura, Erica Mie; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Thoracic Surgery Department. São Paulo. BR
  • Osawa, Eduardo A.; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Anaesthesia and Surgical Intensive Care Unit. São Paulo. BR
  • Fukushima, Julia Tizue; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Anaesthesia and Surgical Intensive Care Unit. São Paulo. BR
  • Teixeira, Manoel Jacobsen; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Department of Neurosurgery and Laboratory of Experimental Surgery (LIM26). São Paulo. BR
  • Galas, Filomena Regina Barbosa Gomes; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Anaesthesia and Surgical Intensive Care Unit. São Paulo. BR
  • Jatene, Fabio Biscegli; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Thoracic Surgery Department. São Paulo. BR
  • Auler Jr., José Otávio Costa; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Anaesthesia and Surgical Intensive Care Unit. São Paulo. BR
Clinics ; 67(11): 1265-1269, Nov. 2012. ilus, tab
Article Dans Anglais | LILACS | ID: lil-656715
ABSTRACT

OBJECTIVE:

The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker.

METHODS:

Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov NCT01385384.

RESULTS:

The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day.

CONCLUSIONS:

The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.
Sujets)


Texte intégral: Disponible Indice: LILAS (Amériques) Sujet Principal: Pacemaker / Ventilation artificielle / Traumatismes de la moelle épinière / Muscle diaphragme / Électrothérapie / Implantation de prothèse / Anesthésie Type d'étude: Essai clinique contrôlé Limites du sujet: Adolescent / Adulte / Femelle / Humains / Mâle langue: Anglais Texte intégral: Clinics Thème du journal: Médicament Année: 2012 Type: Article Pays d'affiliation: Brésil Institution/Pays d'affiliation: Universidade de São Paulo/BR

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Texte intégral: Disponible Indice: LILAS (Amériques) Sujet Principal: Pacemaker / Ventilation artificielle / Traumatismes de la moelle épinière / Muscle diaphragme / Électrothérapie / Implantation de prothèse / Anesthésie Type d'étude: Essai clinique contrôlé Limites du sujet: Adolescent / Adulte / Femelle / Humains / Mâle langue: Anglais Texte intégral: Clinics Thème du journal: Médicament Année: 2012 Type: Article Pays d'affiliation: Brésil Institution/Pays d'affiliation: Universidade de São Paulo/BR