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1.
Anesth Analg ; 128(3): 494-501, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29697506

RESUMO

BACKGROUND: Neuraxial anesthesia improves components of the Virchow's triad (hypercoagulability, venous stasis, and endothelial injury) which are key pathogenic contributors to venous thrombosis in surgical patients. However, whether neuraxial anesthesia reduces the incidence of venous thromboembolism (VTE) remain unclear. We therefore tested the primary hypothesis that neuraxial anesthesia reduces the incidence of 30-day VTE in adults recovering from orthopedic surgery. Secondarily, we tested the hypotheses that neuraxial anesthesia reduces 30-day readmission, 30-day mortality, and the duration of postoperative hospitalization. METHODS: Inpatient orthopedic surgeries from American College of Surgeons National Surgical Quality Improvement Program database (2011-2015) in adults lasting more than 1 hour with either neuraxial or general anesthesia were included. Groups were matched 1:1 by propensity score matching for appropriate confounders. Logistic regression model was used to assess the effect of neuraxial anesthesia on 30-day VTE, 30-day mortality, and readmission, while Cox proportional hazard regression model was used to assess its effect on length of stay. RESULTS: Neuraxial anesthesia decreased odds of 30-day VTE (odds ratio 0.85, 95% confidence interval, 0.78-0.95; P = .002) corresponding to number-needed-to-treat of 500. Although there was no difference in 30-day mortality, neuraxial anesthesia reduced 30-day readmission (odds ratio 0.90, 98.3% confidence interval, 0.85-0.95; P < .001) corresponding to number-needed-to-treat of 250 and had a shortened hospitalization (2.87 vs 3.11; P < .001). CONCLUSIONS: Neuraxial anesthesia appears to provide only weak VTE prophylaxis, but can be offered as an adjuvant to current thromboprophylaxis in high-risk patients.


Assuntos
Anestesia Epidural/tendências , Procedimentos Ortopédicos/tendências , Complicações Pós-Operatórias/diagnóstico , Pontuação de Propensão , Melhoria de Qualidade/tendências , Tromboembolia Venosa/diagnóstico , Idoso , Anestesia Epidural/efeitos adversos , Bases de Dados Factuais/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Sociedades Médicas/tendências , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/mortalidade
2.
World Neurosurg ; 111: 22-25, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29229347

RESUMO

BACKGROUND: Parkinson disease (PD), a neurodegenerative disorder characterized by loss of dopaminergic neurons in the substantia nigra of the midbrain, is commonly thought of as a motion disorder, but it can have significant effect on the respiratory system. Respiratory failure is the most common cause of death in these patients, but it can also affect laryngeal function causing dysphonia, dysphagia, and dysarthric speech. Acute upper airway obstruction is a rare finding in PD, especially in the perioperative settings. In this article we report a PD patient who developed upper respiratory obstruction postoperatively. We also review the literature and highlight the importance of preoperative evaluation to identify patients who may be at risk of this complication. CASE DESCRIPTION: We describe a PD patient presenting for brain stimulation electrode implantation under general anesthesia, who postoperatively developed stridor and near complete upper airway obstruction despite maintenance of oral anti-Parkinson medication regimen intraoperatively. The patient was reintubated in post-anesthesia-care unit, and tracheostomy was performed after 1 week due to persistent vocal cord dysfunction. CONCLUSIONS: Baseline vocal cord impairment in PD patients can be acutely aggravated perioperatively. Symptoms such as dysphagia and dysarthria, which can indicate susceptibility to postoperative upper airway obstruction, may not be well recognized by the patient and family. Surgical candidates should be carefully interviewed preoperatively, and watchful monitoring of respiratory function intraoperatively and postoperatively is of paramount importance. Neurosurgical and neuroanesthesia team should be aware of, and prepared to manage, this potentially life-threatening airway obstruction in PD patients.


Assuntos
Estimulação Encefálica Profunda/métodos , Doença de Parkinson/cirurgia , Complicações Pós-Operatórias/terapia , Implantação de Prótese/efeitos adversos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Sons Respiratórios/etiologia , Idoso , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/terapia , Anestesia Geral , Antiparkinsonianos/efeitos adversos , Antiparkinsonianos/uso terapêutico , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Implantação de Prótese/métodos , Traqueostomia , Disfunção da Prega Vocal/etiologia , Disfunção da Prega Vocal/terapia
4.
Rio de Janeiro; Interamericana; 4.ed; 1978. xv,230 p. ilus, tab.
Monografia em Português | Coleciona SUS | ID: biblio-925314
5.
Rio de Janeiro; Interamericana; 4 ed; 1978. 230 p. ilus, tab.
Monografia em Português | Sec. Munic. Saúde SP, AHM-Acervo, TATUAPE-Acervo | ID: sms-10154
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