28 de março de 2013

Artigo recomendado: Adult–Child Interactions in the Postanesthesia Care Unit - Behavior Matters

Jill MacLaren Chorney, R.Psych., Edwin T. Tan, Zeev N. Kain

Anesthesiology 2013; 118:834-41, MacLaren Chorney et al.

ABSTRACT

Background: Many children experience significant distress before and after surgery. Previous studies indicate that healthcare providers’ and parents’ behaviors may influence children’s outcomes. This study examines the influence of adults’ behaviors on children’s distress and coping in the postanesthesia care unit.

Methods: Children aged 2–10 yr were videotaped during their postanesthesia care unit stay (n = 146). Adult and child behaviors were coded from video, including the onset, duration, and order of behaviors. Correlations were used to examine relations between behaviors, and timewindow sequential statistical analyses were used to examine whether adult behaviors cued or followed children’s distress and coping.

Results: Sequential analysis demonstrated that children were significantly less likely to become distressed after an adult used empathy, distraction, or coping/assurance talk than they were at any other time. Conversely, if a child was already distressed, children were significantly more likely to remain distressed if an adult used reassurance or empathy than they were at any other time. Children were more likely to display coping behavior (e.g., distraction, nonprocedural talk) after an adult used this behavior.

Conclusions: Adults can influence children’s distress and coping in the postanesthesia care unit. Empathy, distraction, and assurance talk may be helpful in keeping a child from becoming distressed, and nonprocedural talk and distraction may cue children to cope. Reassurance should be avoided when a child is already distressed.

Caso queira, deixe seu e-mail nos comentários abaixo desta postagem ou solicite pelo e-mail anestesiasegura@sma.com.br e lhe enviaremos o artigo completo.

26 de março de 2013

Artigo recomendado: Preoperative Stroke and Outcomes after Coronary Artery Bypass Graft Surgery


Alex Bottle, Abdul Mozid, Hilary P. Grocott, Matthew R. Walters, Kennedy R. Lees, Paul Aylin, Robert D. Sanders

Anesthesiology 2013; 118:885-93, Bottle et al.

ABSTRACT

Background: Data are lacking on the optimal scheduling of coronary artery bypass grafting (CABG) surgery after stroke. The authors investigated the preoperative predictors of adverse outcomes in patients undergoing CABG, with a focus on the importance of the time interval between prior stroke and CABG.

Methods: The Hospital Episode Statistics database (April 2006–March 2010) was analyzed for elective admissions for CABG. Independent preoperative patient factors influencing length of stay, postoperative stroke, and mortality, were identified by logistic regression and presented as adjusted odds ratios (OR).

Results: In all, 62,104 patients underwent CABG (1.8% mortality). Prior stroke influenced mortality (OR 2.20 [95% CI 1.47–3.29]), postoperative stroke (OR 1.99 [1.39–2.85]), and prolonged length of stay (OR 1.31 [1.11– 1.56]). The time interval between stroke and CABG did not influence mortality or prolonged length of stay. However, a longer time interval between stroke and CABG surgery was associated with a small increase in risk of postoperative stroke (OR per month elapsed 1.02 [1.00–1.04]; P = 0.047). An interaction was evident between prior stroke and myocardial infarction for death (OR 5.50 [2.84–10.8], indicating the importance of the combination of comorbidities. Prominent effects on mortality were also exerted by liver disease (OR 20.8 [15.18–28.51]) and renal failure (OR 4.59 [3.85–5.46]).

Conclusions: The authors found no evidence that more recent preoperative stroke predisposed patients undergoing CABG surgery to suffer postoperative stroke, death, or prolonged length of stay. The combination of prior stroke and myocardial infarction substantially increased perioperative risk.


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22 de março de 2013

Artigo recomendado: Postoperative Respiratory Muscle Dysfunction - Pathophysiology and Preventive Strategies


Nobuo Sasaki, Matthew J. Meyer, Matthias Eikermann

Anesthesiology 2013; 118:961-78, Sasaki et al.

ABSTRACT

Postoperative pulmonary complications are responsible for significant increases in hospital cost as well as patient morbidity and mortality; respiratory muscle dysfunction represents a contributing factor. Upper airway dilator muscles functionally resist the upper airway collapsing forces created by the respiratory pump muscles. Standard perioperative medications (anesthetics, sedatives, opioids, and neuromuscular blocking agents), interventions (patient positioning, mechanical ventilation, and surgical trauma), and diseases (lung hyperinflation, obesity, and obstructive sleep apnea) have differential effects on the respiratory muscle subgroups.

These effects on the upper airway dilators and respiratory pump muscles impair their coordination and function and can result in respiratory failure. Perioperative management strategies can help decrease the incidence of postoperative respiratory muscle dysfunction. Such strategies include minimally invasive procedures rather than open surgery, early and optimal mobilizing of respiratory muscles while on mechanical ventilation, judicious use of respiratory depressant anesthetics and neuromuscular blocking agents, and noninvasive ventilation when possible.

Caso queira, deixe seu e-mail nos comentários abaixo desta postagem ou solicite pelo e-mail anestesiasegura@sma.com.br e lhe enviaremos o artigo completo.

19 de março de 2013

11 a 14 de abril de 2013: 10º COPA - Congresso Paulista de Anestesiologia













10º COPA - NOVIDADES

Confira as novidades que trouxemos para a edição comemorativa de 10 anos do COPA:

10/04/2013
- Visita aos hospitais
Para você que tem interesse em conhecer as dependências e rotinas dos maiores hospitais de São Paulo, está é a oportunidade!




11/04/2013
- Refresher – Curso de atualização e reciclagem

Temas atuais, do cotidiano que merecem uma reflexão atualizada e com a possibilidade do participante levar um resumo para a revisão posterior.
Professores com um grande conhecimento teórico e uma forte atuação na prática clínica, uma combinação imbatível de atualização profissional.




12 e 13/04/2013 – 7h30 às 8h30
- Café da manhã com especialista
Venha tomar café da manhã com os especialistas!
Discussão de casos clínicos com uma revisão da literatura e uma visão prática da solução dos problemas com experts no assunto.
* Buffet completo de café da manhã montado dentro da sala




- Mini-workshop
Esta atividade prevê maior interatividade com o público. O palestrante fará uso, além de data-show e artigos, de outras ferramentas de aprendizagem, inclusive o uso de exemplos pessoais ou de sua empresa para trabalhar o tema proposposto.




Atenção: As atividades têm preços diferenciais e as vagas são limitadas!
Organize-se!!! O último prazo de inscrição antecipada é 31/03/13.
Evite filas no local e aproveite o valor com desconto.

Participe!



Fonte: http://www.saesp.org.br/home.php

15 de março de 2013

Artigo recomendado: Epidural versus Continuous Preperitoneal Analgesia during Fast-track Open Colorectal Surgery


Philippe Jouve, Jean-Etienne Bazin, Antoine Petit, Vincent Minville, Adeline Gerard, Emmanuel Buc, Aurelien Dupre, Fabrice Kwiatkowski, Jean-Michel Constantin, Emmanuel Futie

Anesthesiology 2013; 118:622-30, Jouve et al.

ABSTRACT

Background: Effective postoperative analgesia is essential for early rehabilitation after surgery. Continuous wound infiltration (CWI) of local anesthetics has been proposed as an alternative to epidural analgesia (EA) during colorectal surgery. This prospective, double-blind trial compared CWI and EA in patients undergoing elective open colorectal surgery.

Methods: Fifty consecutive patients were randomized to receive EA or CWI for 48 h. In both groups, patients were managed according to Enhanced Recovery After Surgery recommendations. The primary outcome was the dynamic pain score measured during mobilization 24 h after surgery (H24) using a 100-mm verbal numerical scale. Secondary outcomes were time to functional recovery, analgesic technique-related side effects, and length of hospital stay.

Results: Median postoperative dynamic pain score was lower in the EA than in the CWI group (10 [interquartile range: 1.6–20] vs. 37 [interquartile range: 30–49], P < 0.001) and remained lower until hospital discharge. The median times to return of gut function and tolerance of a normal, complete diet were shorter in the EA than in the CWI group (P < 0.01 each). Sleep quality was also better in the EA group, but there was no difference in urinary retention rate (P = 0.57). The median length of stay was lower in the EA than in the CWI group (4 [interquartile range: 3.4–5.3] days vs. 5.5 [interquartile range: 4.5–7] days; P = 0.006).

Conclusion: Within an Enhanced Recovery After Surgery program, EA provided quicker functional recovery than CWI and reduced length of hospital stay after open colorectal surgery.

Caso queira, deixe seu e-mail nos comentários abaixo desta postagem ou solicite pelo e-mail anestesiasegura@sma.com.br e lhe enviaremos o artigo completo.




11 de março de 2013

Artigo recomendado: Near-Miss Data Show Signs of Trouble Outside OR


by Michael Vlessides

Anesthesiology News, ISSUE: MARCH 2013 | VOLUME: 39:3

Washington—Although nearly 15% of hospital-based anesthesia occurs outside the operating room, clinicians have little data on rates of morbidity and mortality in these locations.

But the evidence that does exist points to a cause for concern. A new study by California researchers shows that near misses in non–operating room anesthesia (NORA) may be on the rise, a significant worry given that adverse events in these locations are associated with a higher severity of injury and are more likely to result in death than those occurring in operating rooms (Curr Opin Anaesthesiol 2006; 19:436-442).

“My clinical experience suggested that provision of anesthesia outside the operating room was becoming increasingly common, and that patients undergoing procedures in remote locations could be quite ill, with multiple comorbidities,” said Angela Lipshutz, MD, MPH, a critical care fellow at the University of California, San Francisco School of Medicine. “I was concerned that provision of anesthesia in remote locations may be associated with increased risk, and that patterns of failure may be different from those associated with the provision of anesthesia in the operating room.”

Visite o site do Anesthesiology News e leia o artigo completo: http://www.anesthesiologynews.com//ViewArticle.aspx?d=PRN&d_id=21&i=March+2013&i_id=937&a_id=22706



7 de março de 2013

Artigo recomendado: Situation Awareness in Anesthesia - Concept and Research

Christian M. Schulz, Mica R. Endsley, Eberhard F. Kochs, Adrian W. Gelb, Klaus J. Wagner

Anesthesiology 2013; 118:729-42, Schulz et al.

ABSTRACT

Accurate situation awareness (SA) of medical staff is integral for providing optimal performance during the treatment of patients. An understanding of SA and how it affects treatment of patients is therefore crucial for patient safety and an essential element for research on human factors in anesthesia. This review describes the concept of SA in the anesthesia environment, including the interaction with associated medical teams.

Different approaches for its assessment in the work environment of anesthesia are provided. Factors contributing to expertise in SA are described and approaches for the training of SA in anesthesia are discussed, as are types of errors that occur during the development of SA. Finally, the authors briefly present strategies to improve SA during daily anesthesia practice through altered designs of monitor displays.

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5 de março de 2013

Artigo recomendado: Perioperative Therapeutic Plasmapheresis


Sloan C. Youngblood, Yi Deng, Alice Chen, Charles D. Collard

Anesthesiology 2013; 118:722-8, Youngblood et al.

Numerous disease states, including those often encountered in the perioperative setting, are mediated by excessive, deficient, or abnormal blood components. Although systemic immunosuppression has been used successfully to treat many of these, significant side effects and refractory disease often persist. Therapeutic apheresis facilitates the removal and replacement of both humoral and cellular blood elements and has found a unique niche in the treatment of these disorders.

In current practice, the terms “plasmapheresis” and “therapeutic plasma exchange” are often used interchangeably. However, plasma exchange takes the plasmapheresis procedure one step further. Plasma is separated from whole blood and discarded, whereas erythrocytes, leukocytes, and platelets are returned to the patient along with replacement fluid in a volume equal to that of the removed plasma. Perioperative plasmapheresis poses several challenges for the anesthesiologist, including alterations in intravascular volume, serum electrolytes, the coagulation cascade, and drug pharmacokinetics. We now review the plasmapheresis procedure and its implications for perioperative care.

Caso queira, deixe seu e-mail nos comentários abaixo desta postagem ou solicite pelo e-mail anestesiasegura@sma.com.br e lhe enviaremos o artigo completo.



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