RESUMO
Venous congestion is the most critical complication following microsurgical finger replantation and can present within the first postoperative days or even in the immediate postoperative period. This is a case series of three patients who underwent digit replantation. The postoperative complication was venous congestion, and immediately, negative pressure wound therapy (NPWT) was applied to reduce the risk of failure. Three patients with a range of 35 years of age were included. One index finger, one thumb, and one ring finger were the fingers amputated; the surgical technique was described; our anticoagulant protocol was demonstrated; and finally, standardization of the NPWT was established. At the end of the therapy, all fingers survived. We concluded that NPWT is an excellent treatment option following the identification of venous congestion in digit replantation.
RESUMO
BACKGROUND: Usable real-time displays of intravenous anesthetic concentrations and effects could significantly enhance intraoperative clinical decision-making. Pharmacokinetic models are available to estimate past, present, and future drug effect-site concentrations, and pharmacodynamic models are available to predict the drug's associated physiologic effects. METHODS: An interdisciplinary research team (bioengineering, architecture, anesthesiology, computer engineering, and cognitive psychology) developed a graphic display that presents the real-time effect-site concentrations, normalized to the drugs' EC(95), of intravenous drugs. Graphical metaphors were created to show the drugs' pharmacodynamics. To evaluate the effect of the display on the management of total intravenous anesthesia, 15 anesthesiologists participated in a computer-based simulation study. The participants cared for patients during two experimental conditions: with and without the drug display. RESULTS: With the drug display, clinicians administered more bolus doses of remifentanil during anesthesia maintenance. There was a significantly lower variation in the predicted effect-site concentrations for remifentanil and propofol, and effect-site concentrations were maintained closer to the drugs' EC(95). There was no significant difference in the simulated patient heart rate and blood pressure with respect to experimental condition. The perceived performance for the participants was increased with the drug display, whereas mental demand, effort, and frustration level were reduced. In a post-simulation questionnaire, participants rated the display to be a useful addition to anesthesia monitoring. CONCLUSIONS: The drug display altered simulated clinical practice. These results, which will inform the next iteration of designs and evaluations, suggest promise for this approach to drug data visualization.
