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viernes, 28 de abril de 2017

Craniotomía con paciente despierto / Awake craniotomy

Abril 25, 2017. No. 2670

Craniotomía con paciente despierto utilizando dexmedetomidina, propofol y remifentanil

Awake craniotomy anesthetic management using dexmedetomidine, propofol, and remifentanil.

Prontera A1, Baroni S2, Marudi A2, Valzania F3, Feletti A1, Benuzzi F4, Bertellini E2, Pavesi G1.

Drug Des Devel Ther. 2017 Mar 3;11:593-598. doi: 10.2147/DDDT.S124736. eCollection 2017.

Abstract

INTRODUCTION: Awake craniotomy allows continuous monitoring of patients' neurological functions during open surgery. Anesthesiologists have to sedate patients in a way so that they are compliant throughout the whole surgical procedure, nevertheless maintaining adequate analgesia and anxiolysis. Currently, the use of α2-receptor agonist dexmedetomidine as the primary hypnotic-sedative medication is increasing. METHODS: Nine patients undergoing awake craniotomy were treated with refined monitored anesthesia care (MAC) protocol consisting of a combination of local anesthesia without scalp block, low-dose infusion of dexmedetomidine, propofol, and remifentanil, without the need of airways management. RESULTS: The anesthetic protocol applied in our study has the advantage of decreasing the dose of each drug and thus reducing the occurrence of side effects. All patients had smooth and rapid awakenings. The brain remained relaxed during the entire procedure. CONCLUSION: In our experience, this protocol is safe and effective during awake brain surgery. Nevertheless, prospective randomized trials are necessary to confirm the optimal anesthetic technique to be used.

KEYWORDS: anesthesia; awake surgery; dexmedetomidine

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Craniotomía con paciente despierto. Una revisión cualitativa y desafíos futuros.

Awake craniotomy: A qualitative review and future challenges.

Ghazanwy M1, Chakrabarti R2, Tewari A2, Sinha A3.

Saudi J Anaesth. 2014 Oct;8(4):529-39. doi: 10.4103/1658-354X.140890.

Abstract

Neurosurgery in awake patients incorporates newer technologies that require the anesthesiologists to update their skills and evolve their methodologies. They need effective communication skills and knowledge of selecting the right anesthetic drugs to ensure adequate analgesia, akinesia, along with patient satisfaction with the anesthetic conduct throughout the procedure. The challenge of providing adequate anesthetic care to an awake patient for intracranial surgery requires more than routine vigilance about anestheticmanagement.

KEYWORDS: Awake craniotomy; neuroanesthesiology

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Anestesia para craneotomía en el paciente despierto: una actualización

Jason Chui

Rev Colomb Anestesiol 2 0 1 5;43(S1):22-28

Resumen

La craneotomía en el paciente despierto se ha generalizado y su aplicación ha evolucionado continuamente. La anestesia para este procedimiento plantea un reto singular para los anestesiólogos. Los objetivos de este artículo son revisar, bajo la perspectiva crítica del autor, la evidencia actual y la aplicación de la craneotomía en el paciente despierto, y describir brevemente los principios del manejo anestésico durante el procedimiento.

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Foro Internacional de Medicina Crítica

Ciudad de México, Julio 13-15, 2017

Información / Information

Anestesiología y Medicina del Dolor

52 664 6848905

vwhizar@anestesia-dolor.org

anestesia-dolor.org

Tiroidectomía ambulatoria / Outpatient thyroidectomy

Abril 28, 2017. No. 2673

Tiroidectomía ambulatoria. ¿Es segura?

Outpatient Thyroidectomy: Is it Safe?

Balentine CJ¹, Sippel RS².

Surg Oncol Clin N Am. 2016 Jan;25(1):61-75. doi: 10.1016/j.soc.2015.08.003. Epub 2015 Oct 31.

Abstract

Outpatient thyroid surgery is controversial because of concerns over life-threatening cervical hematoma. Despite this concern, outpatient thyroidectomy is becoming increasingly common, especially among high-volume endocrine surgeons. Multiple studies have now demonstrated that careful patient selection combined with surgeon experience can result in successful and safe surgery without a full inpatient admission. This article reviews the data on safety and outcomes for outpatient thyroidectomy and discusses several techniques used to minimize risk to patients.

KEYWORDS: Hematoma; Outpatient thyroidectomy; Safety; Same day thyroidectomy; Short stay thyroidectomy

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Tiroidectomía ambulatoria. Perspectiva del anestesiólogo

Ambulatory thyroidectomy: an anesthesiologist's perspective.

Murray B1, Tandon S2, Dempsey G1.

Local Reg Anesth. 2017 Apr 5;10:31-39. doi: 10.2147/LRA.S111554. eCollection 2017.

Abstract

Thyroidectomy has been performed on an inpatient basis because of concerns regarding postoperative complications. These include cervical hematoma, bilateral recurrent laryngeal nerve injury and symptomatic hypocalcemia. We have reviewed the current available evidence and aimed to collate published data to generate incidence of the important complications. We performed a literature search of Medline, EMBASE and the Cochrane database of randomized trials. One hundred sixty papers were included. Twenty-one papers fulfilled inclusion criteria. Thirty thousand four hundred fifty-three day-case thyroid procedures were included. Ten papers were prospective and 11 retrospective. The incidences of complications were permanent vocal cord paralysis 7/30259 (0.02%), temporary hypocalcemia 129/4444 (2.9%), permanent hypocalcemia 405/29203 (1.39%), cervical hematoma 145/30288 (0.48%) and readmission rate 105/29609 (0.35%). Analysis of cervical hematoma data demonstrated that in only 3/14 cases the hematoma presented as an inpatient, and in the remaining 11/14, it occurred late, with a range of 2-9 days. There is a paucity of data relating to anesthetic techniques associated with ambulatory thyroidectomy. Cost comparison between outpatient and inpatient thyroidectomy was reported in three papers. Cost difference ranged from $676 to $2474 with a mean saving of $1301 with ambulatory thyroidectomy. There is a body of evidence that suggests that ambulatory thyroidectomy in the hands of experienced operating teams within an appropriate setting can be performed with acceptable risk profile. In most circumstances, this will be limited to hemithyroidectomies to reduce or avoid the potential for additional morbidity. We have found little evidence to support the use of one anesthetic technique over another. The rates of hospital admission and readmission related to anesthetic factors appear to be low and predominantly related to pain and postoperative nausea and vomiting. A balanced anesthetic technique incorporating appropriate analgesic and antiemetic regimens is essential to avoid unnecessary hospital admission/readmission.

KEYWORDS: ambulatory; day case; hemithyroidectomy; same day; thyroidectomy

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Riesgos de para complicaciones postoperatorias en tiroidectomía total

Risk factors for postoperative complications in total thyroidectomy: A retrospective, risk-adjusted analysis from the National Surgical Quality Improvement Program.

Caulley L¹, Johnson-Obaseki S, Luo L, Javidnia H.

Medicine (Baltimore). 2017 Feb;96(5):e5752. doi: 10.1097/MD.0000000000005752.

Abstract

Thyroid cancer incidence is increasing, and with it, an increase in total thyroidectomy. There are limited studies comparing outcomes in total thyroidectomy performed in the inpatient versus outpatient setting.The objective of this study was to perform a comparative analysis of risk factors and outcomes of postoperative morbidity and mortality in total thyroidectomy performed as an inpatient versus outpatient surgery.

Recommendations for patient selection for outpatient total thyroidectomies should be modified to account for pre-existing conditions that increase the risk of postoperative morbidity.

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