Universidade estadual da paraíba campus i centro de ciências biológicas e da saúde curso de graduação - fisioterapia

Cardiovascular disease has been the leading cause of mortality worldwide. In Brazil, the AMI has had great relevance, increasing the number of cardiac surgery, especially CABG. This procedure is responsible for reductions in lung volume and capacity, and reduce respiratory muscle strength, contributing to the increased incidence of postoperative complications, and when risk factors associated with medical and surgical, prolong hospital stay the patient. Physical therapy is part of the multidisciplinary team and their role is to prevent or treat respiratory complications, from weaning to maintain the patient in spontaneous ventilation after extubation. This study aims to point out the physical therapy techniques that have been used in patient care in postoperative coronary artery bypass grafting, noting its effectiveness against major injuries lung affected by this type of procedure, and clarify the effects physiotherapy in major pulmonary complications in this period. We searched randomized studies, published between 2002 to 2012, the databases LILACS, SCIELO, PEDRO and CAPES. Most articles have found positive responses to pipelines applied physiotherapy, physiotherapist as confirming the essential professional care to patients of coronary artery bypass grafting.

https://repositorio.bahiana.edu.br:8443/jspui/bitstream/bahiana/602/1/Disserta%c3%a7%c3%a3o.Santos.GiseleAssisdeOliveira.2012.001.BAHIANA.pdf

FISIOTERAPIA NAS COMPLICAÇÕES PULMONARES NO PÓS-OPERATÓRIO DE CIRURGIA DE REVASCULARIZAÇÃO DO MIOCÁRDIO Salvador

The persistence of the fourth right aortic arch (PRAA) is a congenital malformation that affects the heart base’s main vessels. Surgical treatment is recommended and should be advocated as a matter of urgency. In this context, efficient anesthesia planning is necessary, with satisfactory analgesia, associating multimodal techniques with regional blocks. The present work aims to report the anesthetic procedure during corrective surgery for PRAA in a dog. Neuroleptanalgesia was intramuscularly performed, using acepromazine (0.015 mg.kg-1) and methadone (0.3 mg.kg-1) in pre-anesthetic medication. Ketamine (1 mg.kg-1) and propofol (3 mg.kg-1) were administered at induction, both intravenously, followed by maintenance using total intravenous anesthesia with propofol (initial rate of 0.4 mg.kg-1 .minute) and remifentanil, (0.2 mcg.kg.-1.minute). In addition, ultrasound-guided regional intercostal block was performed, with 5% bupivacaine without vasoconstrictor (0.05ml.kg-1). Ketamine infusion was postoperatively maintained for one hour. The instituted protocol proved to be satisfactory in controlling trans and postoperative pain, maintaining all parameters stable during and after the procedure, without any intercurrence. Thus, the protocol provided quality recovery to the patient.

https://periodicos.ufersa.edu.br/index.php/acta/article/download/10265/10840

Multimodal anesthesia associated with regional block in a dog who underwent corrective surgery for persistent right aortic arch: case report

Objetivo: realcar aspectos da circulacao extracorporea relacionado ao desiquilibrio hidroeletrolitico. Metodos: trata-se de um ensaio teorico-reflexivo, embasado em um levantamento dos artigos cientificos disponiveis na Scielo, Lilacs e Medline entre os anos de 2004 e 2014 enfocando a tematica da circulacao extracorporea. Resultados: as alteracoes hidroeletroliticas, podem significar riscos iminentes ao paciente cardiaco cirurgicamente assistido, de modo que ao ser submetido ao procedimento, o individuo deve estar com suas funcoes sistemicas equilibradas ou, do contrario, ao se identificar as respectivas alteracoes, os orgaos artificiais devem realizar a adequacao das falhas e estabilizar o que estiver inadequado a preservacao da vida humana. Porem um dos desafios e dispor de uma equipe e recursos suficientes para essa assistencia e suporte diante de intercorrencias. Conclusao : verifica-se que os pacientes submetidos a CEC ficam sujeitos a sofrer com efeitos colaterais que levam a um efetivo desequilibrio hidroeletrolitico, sendo essencial que haja um monitoramento continuo de seu estado, no periodo intra e pos operatorio.

/pdf/circulacao-extracorporea-e-desiquilibrio-hidroeletrolitico-3c9fpvnhlz.pdf

Circulação extracorpórea e desiquilíbrio hidroeletrolítico / Extracorporeal circulation and hydroelectrolytic imbalance / Circulación extracorpórea y desequilibrio electrolítico

SUMMARY BACKgRoUNd ANd oBJeCTIves : Cardiac surgery induces important alterations in several systems, due to the use of bypass. Some situations may delay the extubation process, like pulmonary compromise with hypoxemia increasing the ICU time and risk of mortality. The ideal time for extubation after cardiac surgery remains controversial. This literature review has the propose of verifying the principal articles related to mechanical ventilation weaning, limitations methods and the use of non invasive ventilation as adjunctive therapy after the extubation in postoperative period of cardiac surgery. CoNTeNTs: Although the mechanical ventilation is effective as a support after surgery, it is associated to several complications like infection, barotrauma, cardiovascular compromise, traqueal injury, and oxygen toxicity. Due to the necessity of shortening the intubation time, several methods of weaning have been proposed with the aim of a better management of ICU equipment’s and patient confort. Some studies have demonstrated the benefit of noninvasive ventilation in many different situations, including in the post-operative period. CoNCLUsIoNs: However the use of non- invasive ventilation as a weaning form of mechanical ventilation persists controversial. In this way the need for a safe and efficient method, minimally invasive, useful to reduce intubation time after cardiac surgery, remains a target of intense research.

http://www.amib.com.br/rbti/download/artigo_2010618115321.pdf

o Uso da v entilação com Pressão Positiva Não-Invasiva (NPPv) como Método Alternativo para a supressão da v entilação Mecânica no Pós-operatório de Cirurgia Cardíaca* The Use of Non Invasive Positive Pressure (NPPV) as Alternative Method during the Ventilatory Weaning in the Postoperative of Cardiac Surgery

SUMMARY Castellana FB, Malbouisson LMS, Carmona MJC, Lopes CR,Auler Jr JOC - Comparison between Pressure Controlled andControlled Mandatory Ventilation in the Treatment of Postope-rative Hypoxemia after Myocardial Revascularization BACKGROUND AND OBJECTIVES: Pressure controlled ven-tilation (PCV) has been used as the ventilation mode of choicein coronary artery bypass graft surgery patients who developseverehypoxemiaintheimmediatepostoperativeperiod.How-ever, there are no evidences showing that pressure controlledventilation is more effective in reversing postoperativehypoxemia than controlled mandatory ventilation (CMV). Thisstudy aimed at comparing the effects of both ventilation modeson systemic oxygenation in cardiac surgery patients who de-velop hypoxemia characterized by PaO 2 /FiO 2 ratio lower than200 in the immediate postoperative period. METHODS: Participated in this study 61 consecutive patientswith PaO 2 /FiO 2 ratio lower than 200 who were randomly allo-cated in two groups according to the ventilatory mode (CMVand PCV). Tidal volume, respiratory rate, inspiration/expirationratio and positive end-expiratory pressure were kept constantthroughout the study in both groups. PaO

Comparação entre Ventilação Controlada a Volume e a Pressão no Tratamento da Hipoxemia no Período Pós-Operatório de Cirurgia de Revascularização do Miocárdio * Comparison between Pressure Controlled and Controlled Mandatory Ventilation in the Treatment of Postoperative Hypoxemia after Myocardial Revascularization

SUMMARY MachadoLB,ChiaroniS,VasconcelosF o PO,AulerJrJOC,CarmonaMJC-IncidenceofCardiacSurgeryinOctogenarianPatients:RetrospectiveStudy BACKGROUND AND OBJECTIVES : Increased life expec-tancy makes increasingly older patients to be submitted to car-diac surgeries. This study aimed at evaluating the incidence ofoctogenarian patients submitted to cardiac surgeries in theHeart Institute, Hospital das Clinicas, FMUSP, in the last 16years. METHODS: The number of myocardial revascularization (MR)and valvar surgeries (VS) was analyzed for the period 1986 to2001and,withineachgroup,thenumberofsurgeriesinoctoge-narian patients. Data were descriptively analyzed. RESULTS: Data have shown a progressive increase in thenumber of octogenarian patients submitted to cardiac surgeries.Myocardial revascularization surgeries have increased from0.13% in 1986 to 3.5% in 2001. Valvar surgeries have in-creasedfrom0%in1986to1.44%in2001,withthehighestrateof 3.02% in 1999. CONCLUSIONS: The understanding of pathophysiology andsenility, and the advances in surgical trauma handling are al-lowing cardiac surgery resources to be expanded to elderly pa-tients.Anesthetictechniqueshouldbecarefullychosen,aswellas hydration, ventilatory assistance and postoperative analge-sia, to provide decreased morbidity and mortality in this highersurgical risk group.

/pdf/incidencia-de-cirurgia-cardiaca-em-octogenarios-estudo-45x871qtpk.pdf

Incidência de Cirurgia Cardíaca em Octogenários: Estudo Retrospectivo * Incidence of Cardiac Surgery in Octogenarian Patients. Retrospective Study

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Incidência de Cirurgia Cardíaca em Octogenários: Estudo Retrospectivo * Incidence of Cardiac Surgery in Octogenarian Patients. Retrospective Study