The purpose of this update of the European Society of Anaesthesiology (ESA) guidelines on the pre-operative evaluation of the adult undergoing noncardiac surgery is to present recommendations based on the available relevant clinical evidence. Well performed randomised studies on the topic are limite

Pre-operative evaluation of adults undergoing elective noncardiac surgery: Updated guideline from the European Society of Anaesthesiology.

Primary Hepatic Actinomycosis

©Copyright 2019 by Turkish Anaesthesiology and Intensive Care Society Available online at www.jtaics.org Elektif Non-Kardiyak Cerrahi Geçirecek Erişkinlerin Pre-Operatif Değerlendirme Kılavuzu: Avrupa Anesteziyoloji Derneği’nden Güncellenmiş Önerilerin Özeti Pre-Operative Evaluation of Adults Undergoing Elective Noncardiac Surgery: Summary of the Updated Guideline From the European Society of Anaesthesiology Kılavuz / Guidelines

/pdf/elektif-non-kardiyak-cerrahi-gecirecek-eriskinlerin-pre-2axlxsu5r9.pdf

Elektif Non-Kardiyak Cerrahi Geçirecek Erişkinlerin Pre-Operatif Değerlendirme Kılavuzu: Avrupa Anesteziyoloji Derneği’nden Güncellenmiş Önerilerin Özeti: Pre-Operative Evaluation of Adults Undergoing Elective Noncardiac Surgery: Summary of the Updated Guideline From the European Society of Anaesthesiology.

O estudo teve por objetivo comparar os dados da espirometria e da frequencia de disturbios pulmonares antes e apos a cirurgia bariatrica Realizou-se estudo observacional de coorte, retrospectivo e analitico, de uma amostra de pacientes com diagnostico de obesidade e indicacao de gastroplastia Os dados da amostra constituiram-se de 28 obesos, dos quais 23 eram mulheres e cinco eram homens,para a analise das variaveis atraves da espirometria, em que foram seguidos os protocolos da ATS, utilizando-se o melhor sopro de tres e as melhores curvas dos resultados Apos a cirurgia,observou-se uma melhora significativa na Capacidade Vital Forcada (CVF), na Capacidade Vital Forcada/Volume Expiratorio no 1o segundo (CVF/VEF1), no Pico de Fluxo Expiratorio (PFE) e no Volume Expiratorio Forcado no 1o segundo (VEF1)Tambem se observou uma forte correlacao entre a perda de peso e as CVF/VEF1 e PFE Verificou-se um Risco Relativo de 2,8 vezes maior de desenvolvimento de disturbios pulmonares em obesos do que em nao obesos (pacientes pos-cirurgicos) Concluiu-se que a gastroplastia melhorou a funcao pulmonar, bem como reduziu a frequencia dos disturbios respiratorios apos a cirurgia Palavras chave: Obesidade peso espirometria gastroplastia indice de massa corporal doenca pulmonar

/pdf/efeito-da-obesidade-na-fisiologia-e-disturbio-pulmonar-antes-26r6xktw0o.pdf

Efeito da obesidade na fisiologia e distúrbio pulmonar antes e após a cirurgia bariátrica/ Effect of obesity on lung physiology and disturbances before and after bariatric surgery

BACKGROUND: Obese patients are at risk of developing postoperative pulmonary complications. We hypothesized that preoperative changes in dynamic spirometry due to body posture would correlate with the drop of forced vital capacity (FVC) measured early after surgery. METHODS: Thirty consecutive morbidly obese patients undergoing gastric banding were investigated. All subjects were studied the day before surgery (T0) and on postoperative day one (T1). Forced Vital Capacity (FVC) was measured, together with heart rate, mean arterial pressure and respiratory rate. At T0 measurements were taken in a random fashion with subjects in upright and in supine position. Subjects were then investigated after surgery in the supine position (T1). Postoperative pain was assessed at T1 using visual analogue scale. Intraoperative variables were also collected. RESULTS: Body Mass Index (BMI) of the investigated subjects was 43.9 ± 5.7 Kg/m2 (range 33.8-60); their age was 40 ± 8 years. All dynamic spirometric data decreased significantly from upright to supine position (P<0.05) and after surgery from 3.07 L (2.77-3.71) to 1.50 (1.15-2.12) (FVC T0 supine vs. T1, P<0.05). Changes of FVC due to body position did not correlate with changes of FVC occurring after surgery (R2=0.105, P=0.081). When subjects were stratified by the median postoperative drop of FVC (45.74%), preoperative (anthropometric and spirometric data), intraoperative (ventilatory settings and hemodynamics) and postoperative (FVC and pain) parameters were similar between groups. The duration of pneumoperitoneum was correlated with the drop of FVC (R2=0.551, P<0.05). CONCLUSION: The derangement of FVC that occurs in obese subjects after gastric banding is not predictable before surgery from anthropometric or spirometric data. The duration of pneumoperitoneum significantly contributes to postoperative impairment of respiratory function.

Preoperative changes of forced vital capacity due to body position do not correlate with postoperative respiratory function in obese subjects.

A case of acute post-traumatic pulmonary failure was treated by extracorporeal respiratory assist, after conventional therapy had failed. Veno-venous bypass was established, with low extracorporeal blood flow (1.6-2 l min-1), and high exchange surface area membrane lungs (7 m2), according to the technique of low-frequency positive-pressure ventilation with extracorporeal carbon-dioxide removal. After a first disconnection, the evolution of the lung disease necessitated a second surgical procedure, during which a chest tube perforated the patient's right lower, pulmonary lobe. A two-stage right thoracotomy was performed, with the patient connected to the extracorporeal system, and receiving full heparinization. Massive bleeding and severe hypoxia were encountered, but successfully overcome. The patient is now a long-term survivor.

Multidisciplinary approach to extracorporeal respiratory assist for acute pulmonary failure.

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Preoperative changes of forced vital capacity due to body position do not correlate with postoperative respiratory function in obese subjects.

Multidisciplinary approach to extracorporeal respiratory assist for acute pulmonary failure.