jueves, 1 de marzo de 2018

Complicaciones en anestesia regional / Regional anesthesia complications

Febrero 28, 2018. No. 3008
La anestesia general epidural combinada se asoció con un menor riesgo de complicaciones postoperatorias en pacientes sometidos a cirugía abdominal abierta por feocromocitoma: un estudio de cohortes retrospectivo.
Combined epidural-general anesthesia was associated with lower risk of postoperative complications in patients undergoing open abdominal surgery for pheochromocytoma: A retrospective cohort study.
Li N1, Kong H1, Li SL1, Zhu SN2, Wang DX1.
PLoS One. 2018 Feb 21;13(2):e0192924. doi: 10.1371/journal.pone.0192924. eCollection 2018.
Abstract
BACKGROUND: Current evidences show that regional anesthesia is associated with decreased risk of complications after major surgery. However, the effects of combined regional-general anesthesia remain controversial. The purpose of our study was to analyze the impact of anesthesia (combined epidural-general anesthesia vs. general anesthesia) on the risk of postoperative complications in patients undergoing open surgery for pheochromocytoma. METHODS: This was a retrospective cohort study. 146 patients who underwent open surgery for pheochromocytoma (100 received combined epidural-general anesthesia and 46 received general anesthesia) in Peking University First Hospital from January 1, 2002 to December 31, 2015 were enrolled. The primary outcome was the occurrence of postoperative complications during hospital stay after surgery. Multivariate Logistic regression models were used to analyze the association between the choice of anesthetic method and the risk of postoperative complications. RESULTS: 17 (11.6%) patients developed complications during postoperative hospital stay. The incidence of postoperative complications was lower in patients with combined epidural-general anesthesia than in those with general anesthesia (6% [6/100] vs. 23.9% [11/46], P = 0.006). Multivariate Logistic regression analysis showed that use of combined epidural-general anesthesia (OR 0.219, 95% CI 0.065-0.741; P = 0.015) was associated with lower risk, whereas male gender (OR 5.213, 95% CI 1.283-21.177; P = 0.021) and perioperative blood transfusion (OR 25.879; 95% CI 3.130-213.961; P = 0.003) were associated with higher risk of postoperative complications. CONCLUSIONS: For patients undergoing open surgery for pheochromocytoma, use of combined epidural-general anesthesia may decrease the occurrence of postoperative complications.
Tratamiento con emulsiones lipídicas para el mioclono posterior a la anestesia espinal
Lipid Emulsion Treatment for Post Spinal Anesthesia Myoclonus
Nguyen TA, Phan DV, Dang TT, Joseph Eldor.
J Health Sci Development 2018; 1:1 (19-24).
Abstract
Two case reports of myoclonus of legs post spinal anesthesia treated successfully by IV lipid emulsion are first described in the medical literature. A review of cases of myoclonus post regional anesthesia (spinal or epidural) are discussed with the hypothesis that the Lipid Emulsion effects are on the mitochondria and the intracellular calcium. Keywords: Myoclonus; Post spinal anesthesia myoclonus; Post epidural anesthesia myoclonus; Intralipid; Lipidem; Fat emulsion; Mitochondria; Intracellular calcium
Fallas y complicaciones en la Anestesia Regional Obstétrica
Dr. Francisco J Cisneros-Rivas,* Dr. Israel Chávez-Ruiz*
Rev Mex Anestiol Vol. 40. Supl. 1 Abril-Junio 2017 pp S150-S154
Introducción
La anestesia neuroaxial es la técnica preferida en la paciente embarazada debido a que reduce o inhibe el dolor en las diferentes fases del trabajo de parto, el alumbramiento, así como en caso de requerirse en la cesárea, además de disminuir el uso de medicamentos que atraviesen la barrera placentaria que pudieran afectar al producto. Como cualquier otro procedimiento, la anestesia regional no se encuentra libre de fallas y complicaciones, debiendo tener en cuenta alternativas como la anestesia general y en caso de complicaciones saber cuáles son, con qué frecuencia se presentan, cuál es su sintomatología, saber cómo prevenirlas y en su caso cómo tratarlas, para evitar lesiones permanentes que puedan ser causa de una acción legal en contra de nosotros, independientemente de la seguridad y calidad que brindemos a nuestros pacientes.
Evaluación de la seguridad y eficacia de la anestesia regional en comparación con la anestesia general en el procedimiento de biopsia pulmonar toracoscópica en pacientes con fibrosis pulmonar idiopática.
Evaluation of safety and efficacy of regional anesthesia compared with general anesthesia in thoracoscopic lung biopsy procedure on patient with idiopathic pulmonary fibrosis.
Saudi J Anaesth. 2018 Jan-Mar;12(1):46-51. doi: 10.4103/sja.SJA_265_17.
Abstract
BACKGROUND: Interstitial lung diseases are diseases that need histology diagnosis or obtaining a lung biopsy to establish the diagnosis. Surgical biopsies are performed usually using the thoracoscopy technique under general anesthesia (GA) although this procedure is still associated with morbidity rate. The aim of this study is to determine the effectiveness and safety of regional anesthesia (RA) compared with GA in thoracoscopic lung biopsy procedures done on patients with idiopathic pulmonary fibrosis (IPF). SUBJECTS AND METHODS: This is a retrospective qualitative study based on adult cases of video-assisted thoracoscopy (VAT) lung biopsy on patients with IPF admitted in the division of Thoracic Surgery, Department of General Surgery, King Khalid University Hospital, Riyadh, KSA. We included 67 patients with IPF, 26 with RA, and 41 with GA, who underwent this procedure from January 2008 to December 2015. Procedures performed under RA were done using three different approaches, intercostal nerve blocks, extrapleural infusion, and paravertebral block while GA was performed using double-lumen endotracheal tube placement. For statistical analysis, SPSS program, version 21.0. Software used to analyze the obtained data. The statistical significance was defined as P < 0.05. RESULTS: Sixty-seven patients underwent the procedure of thoracoscopic lung biopsy. Twenty-six of them (38.8%) underwent the procedure under RA and 41 (61.2%) under GA. The cross tabulation of the intercostal chest tube duration showed that it was significantly longer in GA group (6.23 ± 5.1 days) compared to RA group (3.12 ± 1.5 days), P = 0.004. Furthermore, for the Intensive Care Unit (ICU) stay, it was significantly longer in GA group (3.38 ± 2.1 days) compared to RA group (1.09 ± 0.7 days), P = 0.019. Regarding the relation between the number of biopsies taken and type of anesthesia performed, the probability values for GA group as well as RA group come out to be >0.05 (statistically independent) and the results of risk estimate also show that there was no significant association found between them. The cross tabulation of the representation of biopsies taken by the two methods showed that all biopsies taken under both settings were representative of the disease. Of 41 procedures done under GA, 16 of the total showed a number of complications. Likewise, of 26 procedures under RA, five cases showed complications. The significant (two-sided) value was (P = 0.110), there was no statistical significance between the risks of complications and the two types of anesthesia. CONCLUSION: There was a significant decrease in chest tube duration and ICU stay in RA group compared to the GA group. There was no statistical difference between both types of anesthesia in the number of biopsy, representation, and postoperative complications although the rate of these complications was much less in the RA group. Based on this outcome, we can conclude that VAT lung biopsy procedure on patients with IPF under RA is safe, representative, and effective operation. In addition, high-risk patients for GA can go through this procedure under RA as an alternative and safe option with no added complications.
KEYWORDS: General anesthesia; idiopathic pulmonary fibrosis; regional anesthesia; thoracoscopic lung biopsy
Simposio Internacional de Emergencias Médicas y Paciente Crítico
Santiago de Chile
31 de Mayo al 1 de Junio, 2018
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