ABSTRACT
BACKGROUND: Cancer patients configure a risk group for complications or death by COVID-19. For many of them, postponing or replacing their surgical treatments is not recommended. During this pandemic, surgeons must discuss the risks and benefits of treatment, and patients should sign a specific comprehensive Informed consent (IC). OBJECTIVES: To report an IC and an algorithm developed for oncologic surgery during the COVID-19 outbreak. METHODS: We developed an IC and a process flowchart containing a preoperative symptoms questionnaire and a PCR SARS-CoV-2 test and described all perioperative steps of this program. RESULTS: Patients with negative questionnaires and tests go to surgery, those with positive ones must wait 21 days and undergo a second test before surgery is scheduled. The IC focused both on risks and benefits inherent each surgery and on the risks of perioperative SARS-CoV-2 infections or related complications. Also, the IC discusses the possibility of sudden replacement of medical staff member(s) due to the pandemic; the possibility of unexpected complications demanding emergency procedures that cannot be specifically discussed in advance is addressed. CONCLUSIONS: During the pandemic, specific tools must be developed to ensure safe experiences for surgical patients and prevent them from having misunderstandings concerning their care.
Subject(s)
COVID-19/epidemiology , Informed Consent , Neoplasms/surgery , SARS-CoV-2 , Algorithms , Humans , Surgical OncologyABSTRACT
Objetivos: Verificar a efetividade do Protocolo Prevenção de Lesão de Pele, por meio do levantamento de ocorrências causadas pelo posicionamento cirúrgico em pacientes oncológicos submetidos às cirurgias urológicas robóticas e demonstrar a importância da simulação como estratégia educativa no treinamento da equipe de enfermagem. Método: Trata-se de uma pesquisa descritiva, retrospectiva, abordagem quantitativa, referente ao ano de 2015. O estudo foi feito no centro cirúrgico de um hospital oncológico que realiza em média 1.000 cirurgias/mês. Resultados: Em 2015, foram realizados 359 procedimentos urológicos robóticos, sendo 298 casos de prostatectomia. Não houve nenhuma lesão de pele por posicionamento no período observado. Conclusão: A ocorrência de lesões de pele em pacientes oncológicos submetidos a cirurgias urológicas robóticas, associada ao posicionamento cirúrgico, neste estudo, foi zero. Esse resultado comprova a efetividade do protocolo institucional demonstrando a importância da simulação como estratégia educativa de melhoria para garantir o sucesso do posicionamento cirúrgico robótico.
Objectives: To verify the effectiveness of the Skin Lesion Prevention Protocol by analyzing the occurrence of lesions caused by surgical positioning in cancer patients undergoing robotic urological surgeries; to demonstrate the importance of simulations as educational strategies for training nursing teams. Method: This study includes a descriptive, retrospective, quantitative approach, and refers to the year of 2015. The study was performed at the surgery center of a cancer hospital that performs on average 1,000 surgeries per month. Results: In 2015, 359 robotic urological procedures were performed, of which 298 cases were prostatectomies. There were no skin lesions caused by positioning in the observed period. Conclusion: In this study, the occurrence of skin lesions associated with the surgical positioning of cancer patients undergoing robotic urological surgeries was zero. This result proves the effectiveness of the institutional protocol and demonstrates the importance of simulation as an educational improvement strategy to guarantee the success of robotic surgical positioning.
Objetivos: Verificar la efectividad del Protocolo Prevención de Lesión de Piel, por medio del levantamiento de ocurrencias causadas por el posicionamiento quirúrgico en pacientes oncológicos sometidos a las cirugías urológicas robóticas e demostrar la importancia de la simulación como estrategia educativa en la capacitación del equipo de enfermería. Método: Se trata de un estudio descriptivo, retrospectivo, abordaje cuantitativo, referente al año 2015. El estudio fue hecho en el centro quirúrgico de un hospital oncológico que realiza en promedio 1.000 cirugías/mes. Resultados: En 2015, fueron realizados 359 procedimientos urológicos robóticos, siendo 298 casos de prostatectomía. No hubo ninguna lesión de piel por posicionamiento en el período observado. Conclusión: La ocurrencia de lesiones de piel en pacientes oncológicos sometidos a cirugías urológicas robóticas, asociada al posicionamiento quirúrgico, en este estudio, fue cero. Ese resultado comprueba la efectividad del protocolo institucional demostrando la importancia de la simulación como estrategia educativa de mejoría para garantizar el éxito del posicionamiento quirúrgico robótico.
Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Aged, 80 and over , Prostatectomy , Urologic Neoplasms , Video-Assisted Surgery , General Surgery , Education, Nursing , Simulation TrainingABSTRACT
JUSTIFICATIVA E OBJETIVOS: A miastenia gravis (MG) é doença auto-imune rara, caracterizada pela redução de receptores nicotínicos na junção neuromuscular, com incidência de 14/100.000. O objetivo deste relato foi descrever o caso de paciente portador de miastenia gravis submetido à anestesia geral balanceada, para tratamento radioterápico de carcinoma espinocelular de parótida, em regime ambulatorial. RELATO DO CASO: Paciente do sexo masculino, 87 anos, 87 kg, estado físico ASA III, com história de miastenia gravis; acidente vascular encefálico prévio (AVE); marca-passo por bloqueio atrioventricular total; hipertensão arterial sistêmica (HAS). Foram programadas sete sessões de radioterapia de 20 minutos para tratamento de tumor de parótida, sob anestesia geral. Na sala de radioterapia foi monitorizado com cardioscópio, monitor de pressão arterial não-invasiva, oxímetro de pulso, e submetido à anestesia geral com propofol e sevoflurano. Após a indução, foi mantido em ventilação espontânea com cânula de Guedel e cateter nasofaríngeo com O2 /sevoflurano, para acomodação da máscara imobilizadora. Na sala de recuperação pós-anestésica, não apresentou complicações. CONCLUSÕES: A escolha dos anestésicos e o acompanhamento clínico criterioso permitiram a boa evolução do paciente, com AVE prévio, cardiopata e idoso, submetido à anestesia geral balanceada para procedimento de aplicação de radioterapia, em regime ambulatorial.
Subject(s)
Male , Aged , Humans , Anesthesia , Monitoring, Physiologic , Myasthenia Gravis/radiotherapy , Outpatient Clinics, HospitalABSTRACT
BACKGROUND AND OBJECTIVES: Myasthenia Gravis (MG) is a rare autoimmune disease, characterized by the reduction in the number of nicotinic receptors in the neuromuscular junction, with an incidence of 14/100,000. The objective of this report is to describe the case of a patient with myasthenia gravis who underwent balanced general anesthesia for radiotherapy of a spinocellular carcinoma of the parotid gland as an outpatient. CASE REPORT: Male patient, 87 years old, 87 kg, physical status ASA III, with a prior history of myasthenia gravis; stroke; pacemaker for a third-degree AV block; and hypertension. He was scheduled for seven 20-minutes radiotherapy sessions under general anesthesia. In the radiotherapy room he was monitored with a cardioscope, noninvasive blood pressure, pulse oxymeter, and underwent general anesthesia with propofol and sevoflurane. After the induction, he maintained spontaneous ventilation with a Guedel canula and nasopharyngeal catheter with O2 /sevoflurane for proper fitting of the immobilizing mask. He did not present any complications in the post-anesthetic recovery room. CONCLUSIONS: The choice of anesthetics and strict clinical follow-up allowed an elderly patient, with prior stroke and cardiopathy, to be submitted to balanced general anesthesia for radiotherapy, as an outpatient, with good response.
ABSTRACT
Background and objectives - The epidural or intrathecal administration of the association of local anesthetics with opioids has been commonly used for postoperative oain control. Mepedirine 1mg/Kg-1 association with local anesthetics has shown to improve the quality of intraoperative and postoperative analgesia. The purpose of this study is to evaluated the quality of intra and postoperative analgesia and the adverse effects folowing the epidural administration of the association of 0.5 per cent bupivacaine and meperidine for patients undergoing C-section. Methods - Thirty pregnant patients were randomly allocated into two groups: Group I patients (n=17) received 50mg of meperidine and 110mg of bupivacaine ang Group II patients (n=13) received only 110mg of bupivacaine, both epidurally. The studied variables were the latency period (sensory block in T10), the degree of motor block (Bromage scale), the level of sensory block after 60 minutes, the quality of the anesthesia, the presence of shivering, the neonatal conditions (apgar score), the during of analgesia and the side effects. Results - The latency period was shrter and the sensory block was appropriate for the surgical prosedure in Group I. The degree of motor block was not different between the two groups. There were no differences between gorups as higher shivering and Apgar score. The duration of postoperative analgesia was longer in Group I. Three patients had nausea, two of them belonging to Group I. Conclusions - The association of meperidine and bupivacaine provides good quality anesthesia, with shorter latency period, low incidence of side effects and prolonged postoperative analgesia
