ABSTRACT
Preoperative anemia in patients with cancer is highly prevalent, is associated with increased perioperative morbidity and is a risk factor for transfusion. There is evidence that patients who undergo transfusions have higher morbidity, increased cancer recurrence and poorer survival. The pathophysiology of anemia is multifactorial, with an inflammatory component to which chronic blood loss and nutritional deficiencies can be associated. Therefore, preoperative anemia in patients with cancer should be treated appropriately, given that there is sufficient time in the preoperative period. Of the currently available options, parenteral iron is an effective alternative, especially for those types of cancer that have an associated hemorrhagic component.
Subject(s)
Anemia/therapy , Hemoglobins/analysis , Neoplasms/surgery , Preoperative Care/methods , Anemia/diagnosis , Anemia/etiology , Anemia/physiopathology , Biomarkers , Blood Loss, Surgical , C-Reactive Protein/analysis , Erythropoietin/therapeutic use , Ferritins/blood , Forecasting , Hematinics/therapeutic use , Humans , Iron/administration & dosage , Iron/therapeutic use , Medical Errors/prevention & control , Neoplasms/blood , Neoplasms/complications , Recombinant Proteins/therapeutic use , Transfusion ReactionABSTRACT
La anemia preoperatoria en los pacientes oncológicos es muy prevalente, se asocia a mayor morbilidad perioperatoria y es un factor de riesgo de transfusión. Existe evidencia de que los pacientes transfundidos tienen mayor morbilidad, mayor recurrencia del cáncer y peor supervivencia. La fisiopatología de la anemia es multifactorial, con un componente inflamatorio al que se puede asociar pérdidas hemáticas crónicas y deficiencias nutricionales. Por ello, la anemia preoperatoria en pacientes con cáncer debería tratarse adecuadamente, ya que se dispone de tiempo suficiente en el preoperatorio. De las opciones disponibles actualmente, el hierro parenteral es una alternativa eficaz, sobre todo en los tipos de cáncer que asocian un componente hemorrágico (AU)
Preoperative anemia in patients with cancer is highly prevalent, is associated with increased perioperative morbidity and is a risk factor for transfusion. There is evidence that patients who undergo transfusions have higher morbidity, increased cancer recurrence and poorer survival. The pathophysiology of anemia is multifactorial, with an inflammatory component to which chronic blood loss and nutritional deficiencies can be associated. Therefore, preoperative anemia in patients with cancer should be treated appropriately, given that there is sufficient time in the preoperative period. Of the currently available options, parenteral iron is an effective alternative, especially for those types of cancer that have an associated hemorrhagic component (AU)
Subject(s)
Neoplasms/surgery , Neoplasms/drug therapy , Neoplasms/radiotherapy , Anemia/diagnosis , Anemia/epidemiology , Anemia/physiopathology , Iron/therapeutic use , Iron/administration & dosage , Iron/deficiency , Iron/metabolism , Preoperative Period , Perioperative Period , Blood Transfusion , Erythrocyte Transfusion , Erythropoiesis , Hemoglobins/analysis , Administration, Intravenous , Administration, Oral , Thromboembolism/prevention & controlABSTRACT
The patient was a 26-year-old primipara diagnosed in the first trimester with aortic stenosis and coarctation of the descending aorta. She had remained stable until the 37th week, when she developed dyspnea, edema in the lower extremities, crepitations, oliguria, hypotension, and mild sinus tachycardia consistent with left ventricular insufficiency. A cesarean was performed under general anesthesia with remifentanil, with good outcomes for mother and infant. Aortic stenosis causes left ventricular hypertrophy that increases the risk of myocardial ischemia and left ventricular insufficiency in combination with the physiological changes that pregnancy produces in the cardiovascular system. An emergency cesarean section in such patients requires preservation of hemodynamic stability, which is difficult to achieve with epidural or subarachnoid techniques. Remifentanil is an alternative to drugs used until now in this context.
