Urología en el anciano / Geriatric urology

Marzo 22, 2017. No. 2636

Raquianestesia con Baja Dosis de la Combinación de Bupivacaina y Fentanilo: Una Buena Alternativa para la Cirugía de Resección Transuretral de Próstata en Pacientes Ancianos en Régimen Ambulatorial Akcaboy ZN, Akcaboy EY, Mutlu NM, Serger N, Aksu C, Gogus Revista Brasileira de Anestesiologia Vol. 62, No 6, Noviembre-Diciembre, 2012 Resumen: Justificativa y objetivos: Evaluar la eficacia, la duración del bloqueo, la permanencia en la sala de recuperación postanestésica y los efectos adversos del uso por vía intratecal de dosis bajas de bupivacaina en combinación con el Fentanilo, y compararlos con la dosis convencional de prilocaína y Fentanilo en cirugía de resección transuretral de próstata en pacientes ancianos en régimen ambulatorial. Materiales y métodos: Fueron designados aleatoriamente 60 pacientes para dos grupos: el Grupo B que recibió 4 mg de bupivacaina al 0,5% + 25 µg de Fentanilo y el Grupo P que recibió 50 mg de prilocaína al 2% + 25 µg de Fentanilo intratecal. Se compararon la calidad y la duración de los bloqueos, el tiempo de permanencia en la sala de recuperación postanestésica y los efectos adversos. Resultados: La duración del bloqueo y el tiempo de permanencia en la sala de recuperación postanestesia fueron menores en el Grupo B que en el Grupo P (p < 0,001 para ambos). La hipotensión y la bradicardia no se observaron en el Grupo B, que fue significativamente diferente del Grupo P (p = 0,024, p = 0,011, respectivamente). Conclusiones: La administración intratecal de 4 mg de bupivacaina + 25 µg de Fentanilo produjo una raquianestesia adecuada con menos tiempo de duración del bloqueo y permanencia en la sala de recuperación postanestésica, con el perfil hemodinámico estable que la administración intratecal de 50 mg de prilocaína + 25 µg de Fentanilo para la cirugía de resección transuretral de próstata en pacientes ancianos en régimen ambulatorial. Descriptores: ANESTESIA, Regional, raquianestesia; ANESTÉSICOS, Local, bupivacaina, prilocaína; CIRUGÍA, Urología PDF Masas renales pequeñas en los ancianos: enfoques de tratamiento contemporáneos y resultados oncológicos comparativos de estrategias quirúrgicas y no quirúrgicas. Small renal masses in the elderly: Contemporary treatment approaches and comparative oncological outcomes of nonsurgical and surgical strategies. Vetterlein MW1, Jindal T2, Becker A1, Regier M3, Kluth LA1, Tilki D4, Chun FK5. Investig Clin Urol. 2016 Jul;57(4):231-9. doi: 10.4111/icu.2016.57.4.231. Epub 2016 Jul 5. Abstract Over the last decades, there has been a significant stage migration in renal cell carcinoma and especially older patients are getting diagnosed more frequently with low stage disease, such as small renal masses ≤4 cm of size. Considering the particular risk profile of an older population, often presenting with a nonnegligible comorbidity profile and progressive renal dysfunction, treatment approaches beyond aggressive radical surgical procedures have come to the fore. We sought to give a contemporary overview of the available different treatment strategies for incidental small renal masses in an elderly population with the focus on comparative oncological outcomes of nonsurgical and surgical modalities. KEYWORDS: Ablation techniques; Aged; Kidney neoplasms; Nephrectomy; Watchful waitin PDF Cirugía urológica en mayores de 80 años. Estudio clínico retrospectivo de 30 años Urological surgery in patients aged 80 years and older: a 30-year retrospective clinical study. Takao T1, Tsujimura A, Kiuchi H, Komori K, Fujita K, Miyagawa Y, Takada S, Nonomura N, Okuyama A. Int J Urol. 2008 Sep;15(9):789-93. doi: 10.1111/j.1442-2042.2008.02110.x. Epub 2008 Jul 10. Abstract OBJECTIVES:To investigate changes in the management of cases over time, we undertook a retrospective analysis of urological surgeries carried out in patients aged 80 years and older in a single institution over the last 30 years. METHODS: Between 1975 and 2004, 402 patients aged 80 years and older underwent 412 surgeries in our department. We reviewed the clinical records and analyzed changes in clinical data over time. We evaluated the observed comorbidities and postoperative complications in selected patients for whom complete clinical records were available. We then identified risk factors for postoperative complications by means of multiple logistic regression analysis. RESULTS: The number of surgeries carried out in patients aged 80 years and older increased every 5 years. Over time, the number of endourological and laparoscopic surgeries increased. Of 255 patients, 225 (88.3%) had at least one comorbidity, and 51 patients had postoperative complications. The number of observed comorbidities, such as cardiovascular disorder, central nervous system disorder, and diabetes mellitus, increased over the most recent 10-year period. However, there were no differences in postoperative complications over time. Male sex and open surgery were found to be independent risk factors for postoperative complications. CONCLUSIONS: Although elderly patients had various comorbidities, the postoperative morbidity rate was acceptable in our selected cases. This study may provide useful detailed information for patients 80 years and older who will undergo urological surgery. PDF  Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología. Committee for European Education in Anaesthesiology (CEEA)  y el Colegio de Anestesiólogos de León A.C. Abril 7-9, 2017, León Guanajuato, México Informes  (477) 716 06 16, kikinhedz@gmail.com Congreso Latinoamericano de Anestesia Regional Asociación Latinoamericana de Anestesia Regional, Capítulo México Ciudad de México, Mayo 24-27, 2017 Informes / Information Vacante para Anestesiología Pediátrica Hospital de Especialidades Pediátrico de León, Guanajuato  México  Informes con la Dra Angélica García Álvarez  angy.coachanestped@gmail.com o al teléfono 477 101 8700 Ext 1028

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Anestesia en cirugía urológica / Anesthesia for urology

Marzo 23, 2017. No. 2637

Retos anestésicos de pacientes con comorbilidades cardíacas sometidos a cirugía urológica mayor. Anesthetic challenges of patients with cardiac comorbidities undergoing major urologic surgery. Domi R1, Sula H1, Ohri I1, Beqiri A2, Kaci M2, Bodeci A2, Laho H3. Int Arch Med. 2014 Apr 29;7:17. doi: 10.1186/1755-7682-7-17. eCollection 2014. Abstract The cardiac patient undergoing major urologic surgery is a complex case requiring a great attention by the anesthesiologist. Number of this group of patients having to go through this procedure is constantly increasing, due to prolonged life, increased agressiveness of surgery and increased anesthesia's safety. The anesthesiologist usually has to deal with several problems of the patient, such as hypertension, chronic heart failure, coronary artery disease, rhythm disturbances, intraoperative hemodymanic changes, intraoperative bleeding, perioperative fluid imbalance, and metabolic disturbances. A cardiac patient undergoing major urologic surgery is a complex case requiring a great attention by the anesthesiologist. The scope of this review article is to present the most frequent issues encountered with this group of patients, and to synthetically discuss the respective strategies and maneuvers during perioperative period, which is the major challenge for the anesthesiologist. KEYWORDS: Anesthesia; Cardiac patient; Urological surgery PDF Aspectos anestésicos de la prostatectomía radical laparoscópica asistida por robot. Anesthetic concerns for robotic-assisted laparoscopic radical prostatectomy. Gainsburg DM1. Minerva Anestesiol. 2012 May;78(5):596-604. Epub 2012 Mar 13. Abstract The anesthetic concerns of patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP) are primarily related to the use of pneumoperitoneum in the steep Trendelenburg position. This combination will affect cerebrovascular, respiratory and hemodynamic homeostasis. Possible non-surgical complications range from mild subcutaneous emphysema to devastating ischemic optic neuropathy. The anesthetic management of RALP patients involves a thorough preoperative evaluation, careful positioning on the operative table, managing ventilation issues, and appropriate fluid management. Close coordination between the anesthesia and surgical teams is required for a successful surgery. This review will discuss the anesthetic concerns and perioperative management of patients presenting for RALP. PDF Anestesia para cirugía urológica Anesthesia for Urological Surgery Zeki Tuncel Tekgul et al. In: Current Topics in Anesthesiology InTech, Chapters published February 08, 2017 under CC BY 3.0 license Abstract Because of the variable techniques and patients' positions used in urological surgery, anesthesia for urologic surgery requires advanced knowledge and special transactions. In this matter, it is important to follow current approaches for anesthesiologists. Different surgical procedures and complications due to different positions or anesthesia were evaluated separately to be more concise. We have researched recent literature and created this chapter about new technologies in urological surgery and development in anesthesia for urological surgery. Keywords: urological anesthesia, anesthesia management, anesthesia complications, urological surgery complications PDF Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología. Committee for European Education in Anaesthesiology (CEEA)  y el Colegio de Anestesiólogos de León A.C. Abril 7-9, 2017, León Guanajuato, México Informes  (477) 716 06 16, kikinhedz@gmail.com Congreso Latinoamericano de Anestesia Regional Asociación Latinoamericana de Anestesia Regional, Capítulo México Ciudad de México, Mayo 24-27, 2017 Informes http://r.enviosgrupolahe.com/2e7l0th0feu87f.html  Vacante para Anestesiología Pediátrica Hospital de Especialidades Pediátrico de León, Guanajuato  México  Informes con la Dra Angélica García Álvarez  angy.coachanestped@gmail.com o al teléfono 477 101 8700 Ext 1028

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015