RESUMO
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyzes, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
Assuntos
Anestesia , Cirurgia Torácica , Humanos , Pulmão , Dor , Estudos Retrospectivos , Procedimentos Cirúrgicos VascularesRESUMO
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyses, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
Assuntos
Anestesia/métodos , Anestésicos/efeitos adversos , Pulmão/efeitos dos fármacos , Estresse Fisiológico , Procedimentos Cirúrgicos Torácicos , Anestesia/efeitos adversos , Anestésicos/farmacologia , Hiper-Reatividade Brônquica/induzido quimicamente , Humanos , Hipnóticos e Sedativos/efeitos adversos , Sistema Imunitário/efeitos dos fármacos , Inflamação/induzido quimicamente , Pulmão/fisiopatologia , Pulmão/cirurgia , Músculo Liso/efeitos dos fármacos , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial/efeitos adversos , Sistema Respiratório/efeitos dos fármacos , Estresse Fisiológico/efeitos dos fármacos , Estresse Fisiológico/fisiologiaRESUMO
BACKGROUND: Recent studies report the immunomodulatory lung-protective role of halogenated anaesthetics during lung resection surgery (LRS) but have not investigated differences in clinical postoperative pulmonary complications (PPCs). The main goal of the present study was to compare the effect of sevoflurane and propofol on the incidence of PPCs in patients undergoing LRS. The second aim was to compare pulmonary and systemic inflammatory responses to LRS. METHODS: Of 180 patients undergoing LRS recruited, data from 174 patients were analysed. Patients were randomized to two groups (propofol or sevoflurane) and were managed otherwise using the same anaesthetic protocol. Bronchoalveolar lavage (BAL) was performed in both lungs before and after one-lung ventilation for analysis of cytokines. Arterial blood was drawn for measurement of the cytokines analysed in the BAL fluid at five time points. Intraoperative haemodynamic and respiratory parameters, PPCs (defined following the ARISCAT study), and mortality during the first month and yr were recorded. RESULTS: More PPCs were detected in the propofol group (28.4% vs 14%, OR 2.44 [95% CI, 1.14-5.26]). First-yr mortality was significantly higher in the propofol group (12.5% vs 2.3%, OR 5.37 [95% CI, 1.23-23.54]). Expression of lung and systemic pro-inflammatory cytokines was greater in the propofol group than in the sevoflurane group. Pulmonary and systemic IL-10 release was less in the propofol group. CONCLUSIONS: Our results suggest that administration of sevoflurane during LRS reduces the frequency of the PPCs recorded in our study and attenuates the pulmonary and systemic inflammatory response. CLINICAL TRIAL REGISTRATION: NCT 02168751; EudraCT 2011-002294-29.
Assuntos
Anestésicos Inalatórios/farmacologia , Anestésicos Intravenosos/farmacologia , Pneumopatias/epidemiologia , Pulmão/cirurgia , Ventilação Monopulmonar/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Líquido da Lavagem Broncoalveolar , Comorbidade , Citocinas/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/metabolismo , Propofol/farmacologia , Sevoflurano/farmacologia , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Tempo , Adulto JovemRESUMO
OBJECTIVE: To determine the end-tidal desflurane concentration required for tracheal extubation in anaesthetised adults. MATERIAL AND METHODS: After hospital Ethics Committee approval, eighteen ASA I-II adult patients (19-65 years of age), who had been scheduled for elective ambulatory surgery were included in the study. Anaesthesia was induced with propofol 2.5mg.kg-1, fentanyl 2µg.kg-1, and rocuronium 0.6mg.kg-1 for intubation. Maintenance of anaesthesia was provided by desflurane in oxygen and air (40:60), and remifentanil at 0.05-0.25µg.kg-1.min1. Neuromuscular function was monitored with train-of-four (TOF) nerve stimulation and acceleromyography. At the end of the surgery neuromuscular blockade was reversed with sugammadex 2-4mg.kg-1 in accordance with the TOF ratio. The concentration of desflurane at which extubation was attempted was determined by using Dixon's up-and-down method with 0.5% as a step size. Smooth extubation was defined as one without coughing, teeth clenching, gross purposeful movements, and no breath-holding or laryngospasm within 1min of tracheal extubation. RESULTS: It was found that the end-tidal concentration of desflurane was 3.17±0.18% (95% CI: 3%-3.35%) for successful extubation in 50% of adults. CONCLUSION: Extubation in patients receiving desflurane may be feasible at 0.62 minimum alveolar concentration.
Assuntos
Extubação , Anestésicos Inalatórios/análise , Testes Respiratórios , Isoflurano/análogos & derivados , Adulto , Idoso , Extubação/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios , Tosse/prevenção & controle , Estudos Cross-Over , Desflurano , Feminino , Hemodinâmica , Humanos , Isoflurano/análise , Laringismo/prevenção & controle , Masculino , Pessoa de Meia-Idade , Monitoração Neuromuscular , Piperidinas , Complicações Pós-Operatórias/prevenção & controle , Remifentanil , Adulto JovemRESUMO
Horner's syndrome is a rare complication of epidural analgesia for labor. Much more uncommon is trigeminal nerve palsy. Both complications may be attributed to a subdural localization of the catheter, as we demonstrated clinically by a repeat injection and patchy sympathetic block and with the typical image on epidurography.
Assuntos
Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Cateterismo/efeitos adversos , Síndrome de Horner/induzido quimicamente , Dor do Parto/tratamento farmacológico , Doenças do Nervo Trigêmeo/induzido quimicamente , Adulto , Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Bupivacaína/administração & dosagem , Bupivacaína/efeitos adversos , Meios de Contraste/administração & dosagem , Feminino , Fentanila/administração & dosagem , Fentanila/efeitos adversos , Humanos , Iohexol , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Complicações do Trabalho de Parto/etiologia , Gravidez , Canal Medular/diagnóstico por imagem , Espaço Subdural/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodosRESUMO
A 28-year-old woman, 20 weeks pregnant, was diagnosed with aortic coarctation and postcoarctation mycotic aneurysm. After anesthetic induction, blood pressure was monitored in the radial artery of the right arm and the femoral artery of the right leg for two purposes: to verify hemodynamic stability as required in this type of operation and to determine the pressure gradient between the upper and lower limbs, which was approximately 40 mm Hg. To prevent spinal cord ischemia, an intradural catheter was inserted into the fourth and fifth lumbar space for spinal fluid drainage. A double lumen tube was used for intubation so that the left lung could be blocked, and a centrifugal pump was used instead of extracorporeal circulation. The aneurysm was resected through a left thoracotomy and an aortic prosthesis was placed. Satisfactory outcome was indicated by resolution of the pressure gradient, and fetal viability was verified by ultrasound. The mother suffered no neurological complications and the pregnancy continued to term uneventfully. We review the anesthetic procedure to follow in such cases.