Analgesia epidural en pacientes quirúrgicos de alto riesgo cardiaco
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Epidural analgesia in high risk cardiac surgical patients.
Mehta Y, Arora D, Vats M.
Medanta Institute of Critical Care and Anaesthesiology, Medanta The Medicity, Gurgaon, Haryana, India.
HSR Proc Intensive Care Cardiovasc Anesth. 2012;4(1):11-4.
Abstract
Cardiac surgery is associated with high morbidity and mortality in patients with renal, hepatic or pulmonary dysfunction, advanced age and morbid obesity. Thoracic epidural analgesia is associated with decreased morbidity in these patients. Thoracic epidural analgesia in cardiac surgery is associated with haemodynamic stability, decreased catecholamine response, good pulmonary function, early extubation and discharge from intensive care unit. It is an important component of fast tracking in cardiac surgery as well. Its use has significantly increased over the years and has been used as an adjuvant to general anaesthesia as well as the sole anaesthetic technique in selected groups of patients. Proper selection of patients for thoracic epidural analgesia is mandatory. Timing of epidural catheter insertion and removal should be judiciously selected. The risk of epidural hematoma secondary to anticoagulation or residual effects of antiplatelet drug that can be reduced by taking standard precautions. In conclusion thoracic epidural analgesia in high risk cardiac surgery might decrease pulmonary, cardiovascular or renal complications, provide excellent analgesia and allow early extubation.
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| Oxigenación tisular en pacientes obesos y no obesos durante laparoscopía |
Tissue oxygenation in obese and non-obese patients during laparoscopy.
Fleischmann E, Kurz A, Niedermayr M, Schebesta K, Kimberger O, Sessler DI, Kabon B, Prager G.
Department of Anesthesia and Intensive Care, Medical University Vienna, Austria.
Obes Surg. 2005 Jun-Jul;15(6):813-9.
Abstract
BACKGROUND: Wound infection risk is inversely related to subcutaneous tissue oxygenation, which is reduced in obese patients and may be reduced even more during laparoscopic procedures. METHODS: We evaluated subcutaneous tissue oxygenation (PsqO(2)) in 20 patients with a body mass index (BMI) > or=40 kg/m(2) (obese group) and 15 patients with BMI <30 kg/m(2) (non-obese group) undergoing laparoscopic surgery with standardized anaesthesia technique and fluid administration. Arterial oxygen tension was maintained near 150 mmHg. PsqO(2) was measured from a surrogate wound on the upper arm. RESULTS: A mean FIO(2) of 51% (13%) was required in obese patients to reach an arterial oxygen tension of 150 mmHg; however, a mean FIO(2) of only 40% (7%) was required to reach the same oxygen tension in non-obese patients (P=0.007). PsqO(2) was significantly less in obese patients: 41 (10) vs 57 (15) mmHg (P<0.001). CONCLUSION: Obese patients having laparoscopic surgery require a significantly greater FIO(2) to reach an arterial oxygen tension of about 150 mmHg than non-obese patients; they also have significantly lower subcutaneous oxygen tensions. Both factors probably contribute to an increased infection risk in obese patients.
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Predicción de laringoscopía difícil en obesos mediante cuantificación por ultrasonido de tejido blando anterior del cuello.
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Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue.
Ezri T, Gewürtz G, Sessler DI, Medalion B, Szmuk P, Hagberg C, Susmallian S.
Department of Anaesthesia, Wolfson Medical Centre, Holon, Israel. tezri@netvision.net.il
Anaesthesia. 2003 Nov;58(11):1111-4.
Abstract
In 50 morbidly obese patients, we quantified the soft tissue of the neck from the skin to the anterior aspect of the trachea at the vocal cords using ultrasound. Thyromental distance, mouth opening, limited neck mobility, modified Mallampati score, abnormal upper teeth, neck circumference and sleep apnoea were assessed as predictors of difficult laryngoscopy. Of the nine (18%) cases of difficult laryngoscopy, seven (78%) had a history of obstructive sleep apnoea, compared with two of the 41 patients (5%) in whom laryngoscopy was easy (p < 0.001). Patients in whom laryngoscopy was difficult had more pretracheal soft tissue (mean (SD) 28 (2.7) mm vs. 17.5 (1.8) mm; p < 0.001) and a greater neck circumference (50 (3.8) vs. 43.5 (2.2) cm; p < 0.001). None of the other predictors correlated with difficult laryngoscopy. We conclude that an abundance of pretracheal soft tissue at the level of the vocal cords is a good predictor of difficult laryngoscopy in obese patients.
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