RESUMO
The anaesthetic plan for liver transplantation focuses on maintaining central blood volume and thereby cerebral oxygenation. Normovolaemia represents a central blood volume that establishes a maximal venous oxygen saturation, and a value of 85% (78-90%) is maintained during the operation by administration of blood components. Treatment quality is expressed as a maintained central blood volume evaluated by transthoratic electrical impedance and a stable cerebral oxygenation (71% (67-82%)) as determined by near-infrared spectroscopy.
Assuntos
Anestesia , Transplante de Fígado , Anestesia/métodos , Circulação Sanguínea/fisiologia , Volume Sanguíneo/fisiologia , Encéfalo/irrigação sanguínea , Encéfalo/metabolismo , Impedância Elétrica , Humanos , Transplante de Fígado/instrumentação , Transplante de Fígado/métodos , Transplante de Fígado/fisiologia , Monitorização Intraoperatória/métodos , Oxigênio/sangue , Consumo de Oxigênio/fisiologia , Pressão Parcial , Substitutos do Plasma/administração & dosagem , Transfusão de Plaquetas , Postura , Espectroscopia de Luz Próxima ao InfravermelhoRESUMO
For patients with kidney disease it is particularly important to secure normovolaemia before anaesthesia. By providing the volume that secures a maximal venous oxygen saturation or a maximal cardiac output, such a volume can be defined with an accuracy of 100-200 ml. Surgical procedures for the kidney patient are dominated by providing an i.v. access. The internal jugular vein is preferred after identification of its lumen by ultrasound.
Assuntos
Nefropatias/complicações , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Anestesia/efeitos adversos , Anestesia/métodos , Volume Sanguíneo , Cateterismo Venoso Central , Humanos , Infusões Intravenosas , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Nefropatias/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Diálise Renal , Fatores de Risco , Equilíbrio HidroeletrolíticoRESUMO
BACKGROUND: Recent studies have shown a high incidence of postoperative residual curarization (PORC). The reason for this is unclear. The purpose of this study was to evaluate whether the methods used by Danish anaesthetists to exclude PORC are evidence-based and, if they are not, to determine the reasons why. METHODS: 251 anaesthetists (nurses and physicians) from eight different hospital anaesthetic departments completed a questionnaire concerning their knowledge about and clinical practice of residual curarization. RESULTS: All of the 251 participants filled in the questionnaire. 91% underestimated the incidence of PORC after the administration of intermediate-acting muscle relaxants, and 27% incorrectly believed that it is always possible to exclude PORC using clinical tests. Only 45% knew that the train-of-four ratio must exceed 0.9 to exclude residual curarization, and only 25% knew that clinically significant residual curarization cannot be excluded by tactile/visual evaluation of the response to train-of-four nerve stimulation. 91% had access to a nerve stimulator, 85% with the option of objective monitoring. 13% used a nerve stimulator seldom or never. The overall attitude toward using nerve stimulators was positive. CONCLUSION: The results indicate that Danish anaesthetists" clinical practice regarding residual curarization is often not evidence-based. The reason for this seems to be a lack of knowledge, rather than lack of resources and/or a negative attitude toward neuromuscular monitoring.
