RESUMO
La intubación traqueal ha sido considerada históricamente la técnica ideal en el manejo de la vía aérea en procedimientos quirúrgicos laparoscópicos. La introducción de este tipo intervenciones en los circuitos de cirugía mayor ambulatoria exige el empleo de técnicas anestésicas que ofrezcan una recuperación postoperatoria óptima y un alta precoz bajo unas condiciones de seguridad estrictas. La mascarilla laríngea se plantea como opción adecuada a la intubación traqueal, incluso en pacientes de mayor riesgo gracias a los nuevos modelos con modificaciones orientadas a mejorar sus características, lo que las convierten en dispositivos de gran proyección dentro del manejo total de la vía aérea. Presentamos el primer caso de funduplicatura de Nissen laparoscópica realizado con mascarilla laríngea Baska Mask® en un paciente con riesgo alto de regurgitación por reflujo gastroesofágico (AU)
Tracheal intubation has historically been considered the ideal technique to handle the airway in laparoscopic surgical procedures. The introduction of such procedures in ambulatory surgery requires the use of anesthetic techniques that offer optimal and early postoperative recovery under strict security conditions. Laryngeal mask is proposed as a suitable alternative to tracheal intubation, even in high risk patients due to new devices which have been modified to improve their characteristics, becoming great alternatives in the overall management of the airway. We report the first case of laparoscopic Nissen fundoplication performed with a laryngeal Baska Mask in patient with high risk of regurgitation due to its gastroesophageal reflux (AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Máscaras Laríngeas/tendências , Máscaras Laríngeas , Fundoplicatura/instrumentação , Fundoplicatura/métodos , Fundoplicatura , Laparoscopia/métodos , Laparoscopia , Asma/complicações , Propofol/uso terapêutico , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Refluxo Laringofaríngeo/tratamento farmacológico , Refluxo Laringofaríngeo/prevenção & controle , Fentanila/uso terapêuticoRESUMO
Tracheal intubation has historically been considered the ideal technique to handle the airway in laparoscopic surgical procedures. The introduction of such procedures in ambulatory surgery requires the use of anesthetic techniques that offer optimal and early postoperative recovery under strict security conditions. Laryngeal mask is proposed as a suitable alternative to tracheal intubation, even in high risk patients due to new devices which have been modified to improve their characteristics, becoming great alternatives in the overall management of the airway. We report the first case of laparoscopic Nissen fundoplication performed with a laryngeal Baska Mask in patient with high risk of regurgitation due to its gastroesophageal reflux.
Assuntos
Fundoplicatura , Intubação Intratraqueal , Máscaras Laríngeas , Refluxo Gastroesofágico , Humanos , LaparoscopiaRESUMO
Desde la introducción de la mascarilla laríngea, su uso se ha expandido especialmente en el contexto de la cirugía ambulatoria. La mascarilla laríngea representa el patrón oro de los dispositivos supraglóticos, y es la referencia con la que los nuevos dispositivos deben ser comparados. La presente revisión es una actualización de las principales indicaciones de la mascarilla laríngea en usos avanzados, incluyendo el abordaje de la vía aérea difícil en el paciente intervenido de forma ambulatoria. Así mismo se incluye una revisión de las indicaciones, aportaciones, y ventajas de la mascarilla laríngea Supreme aplicadas al contexto de la cirugía sin ingreso (AU)
Since the introduction of the original laryngeal mask airway(LMA) in the nineties in our country, its use has expanded especially in the context of outpatient surgery. The LMA remains the gold standard of the supraglotic devices and the standard by which all other devices should be compared. This review is an update of the main indications of the LMA in advanced applications, including addressing the difficult airway in the patient operated on an outpatient basis. Also includes a review of the information, contributions, and advantages of the LMA supreme applied to the context of day surgery (AU)
Assuntos
Humanos , Máscaras Laríngeas , Anestesia/métodos , Procedimentos Cirúrgicos Ambulatórios/métodos , Anestesia Endotraqueal/instrumentaçãoAssuntos
Manuseio das Vias Aéreas/métodos , Anestesia Intravenosa/métodos , Cateterismo Cardíaco , Ecocardiografia Transesofagiana , Forame Oval Patente/cirurgia , Máscaras Laríngeas , Monitorização Intraoperatória/métodos , Implantação de Prótese/métodos , Respiração Artificial/instrumentação , Adulto , Fluoroscopia , Forame Oval Patente/diagnóstico por imagem , Humanos , Radiografia IntervencionistaRESUMO
No disponible
Assuntos
Humanos , Feminino , Gravidez , Adulto , Ecocardiografia Transesofagiana/métodos , Ecocardiografia Transesofagiana , Forame Oval , Forame Oval/cirurgia , Forame Oval , Anestesia Geral/métodos , Fluoroscopia/métodos , Ecocardiografia Transesofagiana/instrumentação , Anestesia Geral/tendências , Anestesia Geral , Fluoroscopia/tendências , Fluoroscopia , Sonda de ProspecçãoRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Procedimentos Cirúrgicos Ambulatórios/instrumentação , Procedimentos Cirúrgicos Ambulatórios/métodos , Dispositivos de Proteção Respiratória/classificação , Dispositivos de Proteção Respiratória , Assistência Ambulatorial/métodos , Assistência Ambulatorial/tendências , Procedimentos Cirúrgicos Ambulatórios/tendências , Procedimentos Cirúrgicos AmbulatóriosAssuntos
Obstrução das Vias Respiratórias , Anestesiologia/métodos , Guias de Prática Clínica como Assunto , Algoritmos , Anestesiologia/instrumentação , Ensaios Clínicos como Assunto , Humanos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Máscaras Laríngeas , Laringoscopia , Máscaras , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Gravação em VídeoRESUMO
No disponible
Assuntos
Humanos , Doenças Respiratórias/complicações , Doenças Respiratórias/epidemiologia , Anestesiologia/educação , Doenças Respiratórias/prevenção & controle , Doenças Respiratórias/reabilitação , Doenças Respiratórias/cirurgia , Anestesia/estatística & dados numéricos , Anestesia/tendências , Anestesiologia/instrumentaçãoRESUMO
BACKGROUND: We have prospectively evaluated the incidence and characteristics of awareness with recall (AWR) during general anaesthesia in a tertiary care hospital. METHODS: This study involves a prospective observational investigation of AWR in patients undergoing general anaesthesia. Blinded structured interviews were conducted in the postanaesthesia care unit, on postoperative day 7 and day 30. Definition of AWR was 'when the patient stated or remembered that he or she had been awake at a time when consciousness was not intended'. Patient characteristics, perioperative, and drug-related factors were investigated. Patients were classified as not awake during surgery, AWR, AWR-possible, AWR-not evaluable. The perceived quality of the awareness episode, intraoperative dreaming, and sequelae were investigated. The anaesthetic records were reviewed to search for data that might explain the awareness episode. RESULTS: The study included 4001 patients. Incidence of AWR was 1.0% (39/3921 patients). If high risk for AWR patients were excluded, the incidence was 0.8%. After the interview on the seventh day, six patients denied having been conscious during anaesthesia; hence, the incidence of AWR in elective surgery was 0.6%. Factors associated with AWR were: anaesthetic technique incidence of 1.1% TIVA-propofol vs 0.59% balanced anaesthesia vs 5.0% O2/N2O-based anaesthesia vs 0.9% other anaesthetic techniques (mainly propofol boluses for short procedures), P=0.008; age (AWR 42.3 yr old vs 50.6 yr old, P=0.041), absence of i.v. benzodiazepine premedication (P=0.001), Caesarean section (C-section) (P=0.019), and surgery performed at night (P=0.013). More than 50% of patients reported intraoperative dreaming in the early interview, mainly pleasant. Avoidable human factors were detected from the anaesthetic records of most patients. Subjective auditory perceptions prevailed, together with trying to move or communicate, and touch or pain perception. CONCLUSIONS: A relatively high incidence of AWR and dreams during general anaesthesia was found. Techniques without halogenated drugs showed more patients. The use of benzodiazepine premedication was associated with a lower incidence of AWR. Age, C-section with general anaesthesia, and surgery performed at night are risk factors.
Assuntos
Anestésicos Gerais/farmacologia , Conscientização/efeitos dos fármacos , Rememoração Mental/efeitos dos fármacos , Adulto , Idoso , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Sonhos/efeitos dos fármacos , Emoções , Feminino , Humanos , Incidência , Complicações Intraoperatórias/epidemiologia , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Pré-Medicação/métodos , Estudos Prospectivos , Espanha/epidemiologiaRESUMO
No disponible
Assuntos
Humanos , Máscaras Laríngeas , Decúbito Ventral , Anestesia/métodos , Fatores de RiscoRESUMO
Introducción: Se ha realizado un estudio retrospectivo con el objetivo de demostrar la disminución en la morbilidad de los pacientes con insuficiencia renal crónica, a los que se les implantó un catéter para diálisis peritoneal en el servicio de cirugía mayor ambulatoria, frente a una etapa anterior en la que se realizó de forma no reglada en urgencias. Material y métodos: Los 87 pacientes se distribuyeron en dos grupos: I (julio 1997-abril 2000): 42 intervenidos en urgencias y por personal quirúrgico no específico y II (mayo 2000-noviembre 2004): 45 operados en el servicio de CMA. Se han colocado un total de 94 catéteres, 47 en el grupo I y 47 en el II; consumiendo ingreso sólo en el 10% de los pacientes del grupo I. Resultados: En el seguimiento realizado durante las 4 primeras semanas, la infección del orificio de salida del catéter se redujo del 54,75% (grupo I) al 4,5% (grupo II). En cuanto a la incidencia de peritonitis en los primeros 6 meses del implante, se pasó del 28,6% (grupo I) al 2,25% (grupo II). Los desplazamientos del catéter disminuyeron del 21% (grupo I) al 2% (grupo II), así como las hemorragias postcirugía, que del 24% (grupo I) se situaron en un 7% (grupo II). Algo similar sucedió con las fugas de líquido pericatéter, del 11,9% en el I al 4,45% del grupo II, y el desarrollo de eventraciones paraumbilicales, del 19% en el I al 8,9% en el II. Discusión: La UCMA contribuye al bienestar de nuestros pacientes y a la consecución de una adecuada técnica dialítica (AU)
Introduction: A retrospective study has been carried out, having as an objective the demonstration of the decrease in morbidity of patients with chronic renal failure, to whom a catheter for peritoneal dialysis was implanted in the ambulatory major surgery service, against a previous stage in which it was made in anonregulated way in urgencies. Material and methods: The 87 patients were distributed in two groups: I (July 1997-April 2000): 42 persons being operated upon in urgencies by nonspecific surgical personnel and II (May 2000-November 2004): 45 patients operated in the ambulatory major surgery service. A total of 94 catheters have been placed, 47 in group I and 47 in group II; having the need to be hospitalized by only the 10% of the patients from group I. Results: Throughout the monitoring done during the first four weeks, the catheters exit orifices infection reduced from 54.75% (group I) to 4.5% (group II). According to peritonitis incidence in the first 6 months after the implant, it passed from 28.06% (group I) to 2.25% (group II). The catheters displacements decreased from 21% (group I) to 2% (group II), as so did the post surgery haemorrhages, which from 24% (group I) went to 7% (group II). A similar situation happened with the pericatheter liquid leaks, from 11.9% in I to 4.45% from group II, and the development of paraumbilical eventrations, from 19% in group I to 8.9% in group II. Discussion: The ambulatory major surgery service contributes to our patients wellbeing and to an adequate dialitic technique achievement (AU)
Assuntos
Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Humanos , Procedimentos Cirúrgicos Ambulatórios , Insuficiência Renal Crônica/cirurgia , Insuficiência Renal Crônica/terapia , Diálise Peritoneal , Cateteres de Demora , Estudos Retrospectivos , SeguimentosRESUMO
Contiene: principios de la anestesia ambulatoria, selección de pacientes y procedimientos, valoración y preparación preoperatoria, premedicación, anestesia loco-regional (ALR), cuidados anestésicos monitorizados (CAM), anestesia general, anestesia ambulatoria por especialidades, la anestesia en consultorio y la anestesia fuera de quirófano (AFQ) en pacientes ambulatorios, la anestesia ambulatoria en pediatría, el dolor postoperatorio en cirugía ambulatoria, técnicas analgésicas invasivas en cirugía ambulatoria, las náuseas y vómitos postoperatorios en cirugía ambulatoria, criterios de recuperación y alta domiciliaria en cirugía ambulatoria, eficiencia y efectividad del programa ambulatorio. Estándares de calidad, morbilidad diferida en cirugía ambulatoria, docencia de anestesiología para cirugía ambulatoria.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Anestesia e Analgesia , Anestesiologia , Anestesia por Condução , Anestesia Local , Anestesia Geral , Adulto , Pediatria , Criança , Dor Pós-Operatória , Período de Recuperação da Anestesia , Pré-MedicaçãoRESUMO
Uno de los objetivos en Cirugía Ambulatoria es conseguir el mayor confort perioperatorio para el paciente minimizando las complicaciones y con la mayor seguridad posible. En la práctica de la anestesia ambulatoria moderna, los Cuidados Anestésicos Monitorizados y la Anestesia General ofrecen a los pacientes elevada calidad al utilizar fármacos que permiten una rápida inducción, un rápido despertar y una recuperación precoz de los parámetros de recuperación con mínimos efectos indeseables. En anestesia ambulatoria la combinación de propofol y remifentanilo junto con el manejo de la vía aérea mediante mascarilla laríngea ofrece los mejores resultados. Sin embargo, para garantizar el éxito de los procedimientos sin ingreso es necesario diseñar estrategias multimodales para prevenir el Dolor Postoperatorio y las Náuseas y/o Vómitos. En este trabajo se realiza una revisión bibliográfica sobre Cuidados Anestésicos Monitorizados y Anestesia General en Cirugía Ambulatoria (AU)
One of the objectives of Ambulatory Surgery is to achieve the best and safest peri-operative comfort for patients with a minimum of complications. In modern ambulatory anaesthesic practice, Monitorized Anesthesic Care and General Anaesthesia offer high quality to patients if we use drugs that allow fast induction and awakening, early post-anaesthesia recovery and minimal adverse effects. In ambulatory anaesthesia, the combination of propofol and remifentanil and the management of the airway using a laryngeal mask offer the best results. However, it is necessary to design multimodal strategies for prevention of postoperative pain and nausea and/or vomiting to ensure the success of the ambulatory procedure. This communication is a bibliographic review of Monitorized Anaesthesic Care and General Anaesthesia in Ambulatory Surgery (AU)
