Navegando por Palavras-chave "Pós-operatório"
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- ItemAcesso aberto (Open Access)Chronic postoperative pain: pathophysiology, risk factors and prevention(Sociedade Brasileira para o Estudo da Dor, 2011-03-01) Sadatsune, Eduardo Jun [UNIFESP]; Leal, Plínio da Cunha [UNIFESP]; Clivatti, Jefferson [UNIFESP]; Sakata, Rioko Kimiko [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND AND OBJECTIVES: Chronic postoperative pain (CPOP) prevalence is high, and is manifested both after minor and major surgeries. This subject has been increasingly studied. This study aimed at describing major aspects of this syndrome. CONTENTS: CPOP mechanisms, risk factors for its development, prevention and pain treatments are described. CONCLUSION: CPOP impacts patients' quality of life, is difficult to treat and the best approach is to prevent it. With a better understanding of pathophysiological bases for perpetuation of pain after a surgical procedure and of risk factors, new treatment options are appearing. The real benefits of preventive drugs are being increasingly studied. To prevent pain, surgical teams and patients have to be aware of the risks of each procedure, not only in the immediate postoperative period but also in the long run.
- ItemAcesso aberto (Open Access)Complicações da cateterização arterial em crianças(Associação Médica Brasileira, 2000-03-01) Souza, N. de [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Souza, R.l. de [UNIFESP]; Oliveira, N.f. de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The radial artery catheterization with the purpose of children's monitoring has been more and more used in Pediatric Intensive Care Units, and many times, is use is indispensable, like in cardiac surgery post-operative cases. However, there are only a few articles on the subject among us. PURPOSE: To analyse the complications of radial artery cathetherization in the post-operative of cardiac surgery in children. METHODS: We studied the complications of this procedure in 120 children in cardiac surgery post-operative range from 1 month to 2 years. The children were catheterized by pecutaneous technique (n = 67) and by cutdown technique (n = 53). The following complications were analysed in relation to the placement time of the catheter and the used technique: local infection, hemorrhagic complication, ischemia, catheter occlusion and accidental catheter displacement. RESULTS: Infection, ischemia and hemorrhage were more frequent and statistically significant in patients submitted to cutdown technique, while the catheter occlusion and accidental displacement were similar in both groups. The placement time of the catheter was an important variable in our study. All of the other infection cases occurred after 72 hours of the catheterization and the frequency of hemorrhage and ischemia was higher in the first 72 hours. CONCLUSION: The main complications of this proceeding are related to the technic utilazed , time of utilization of the catheter and to the characteristics of the patients.
- ItemAcesso aberto (Open Access)Estratégias de desmame ventilatório em crianças no pós-operatório de cardiopatia congênita: revisão sistemática da literatura(Universidade Federal de São Paulo, 2022-02) Garcia, Amanda Alves Assis [UNIFESP]; Nakano, Luís Carlos Uta [UNIFESP]; Flumignan, Ronald Luiz Gomes [UNIFESP]; http://lattes.cnpq.br/6751410694690699; http://lattes.cnpq.br/7498955151131694; http://lattes.cnpq.br/7104082420398503Contexto: Diversos são os protocolos de desmame ventilatório amplamente aceitos e utilizados na população adulta. Porém as mesmas diretrizes não são aplicáveis para a população pediátrica e, em especial à população pediátrica com cardiopatia congênita. Objetivos: Avaliar a eficácia e segurança das estratégias ventilatórias preditoras de extubação em crianças cardiopatas submetidas à cirurgia cardíaca. Métodos: Revisão sistemática da literatura de ensaios clínicos randomizados (ECR) seguindo as recomendações da colaboração Cochrane através do Cochrane Handbook for Systematic Reviews of Interventions. As bases de dados Medical Literature Analysis and Retrieval System Online (MEDLINE) via Pubmed, Excerpta Medica Database (EMBASE) via Elsevier, Literatura Latino Americana em Ciências da Saúde e do Caribe (LILACS) via portal da Biblioteca Virtual em Saúde (BVS), Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Library, Physioterapy Evidence Database (PEDro) e Cumulative Index to Nursing and Allied Health Literature (CINAHL) via Ebsco foram utilizadas para recuperar os ECRs. Também foram realizadas buscas manuais em resumos de anais de congressos relacionados ao tema proposto e listas de referências de estudos. Não houve restrição quanto ao idioma, data ou ainda status de publicação dos estudos recuperados. A seleção, extração dos dados e avaliação do risco de viés dos ECRs encontrados foram feitas por dois autores de forma independente e criteriosa conforme metodologia empregada. Resultados: Foi recuperado apenas um ECR que avaliou as estratégias de desmame ventilatório em crianças no pós-operatório de cardiopatia congênita. A avaliação dos resultados constatou que há baixa certeza de evidência em afirmar que pacientes que utilizaram PSV para extubação apresentaram taxas de sucesso superior ao grupo controle, associado ao menor tempo de permanência em UTI [HR2.96; IC 95%, (2 a 4,28), p<0.0; 110 participantes; 1 estudo].E, considerando os desfechos tempo de ventilação mecânica e tempo de permanência hospitalar, os achados não foram significantes entre os grupos intervenção e controle [(p:0,30) e (p:0,15); 110 participantes; 1 estudo] respectivamente. Visto que as evidências são escassas e de baixa certeza, não é possível determinar a efetividade e segurança das estratégias de ventilação mecânica preditoras de extubação nesta população. O único ECR disponível relata a viabilidade de usar a modalidade PSV para o desmame em pacientes cardiopatas. Conclusão: Não há evidencias suficientes para apoiar ou refutar a eficácia e segurança das estratégias de desmame ventilatório em crianças no pós-operatório de cardiopatia congênita.
- ItemAcesso aberto (Open Access)Momento da extubação e evolução pós-operatória de toracotomia(Associação Médica Brasileira, 2007-06-01) Almada, Carolina Pereira da Silva [UNIFESP]; Martins, Fernando Antonio Nogueira da Cruz [UNIFESP]; Tardelli, Maria Angela [UNIFESP]; Amaral, José Luiz Gomes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Early tracheal extubation following surgical procedures favors clinical evolution of patients and reduces incidence and time of stay in the Intensive Care Unit (ICU), minimizing hospital costs. Immediate postoperative period of pulmonary resections often takes place in the ICU and patients are kept intubated. This study evaluated hospital records of patients submitted to thoracotomy and a correlation between extubation time, postoperative evolution and ICU stay was established. METHODS: Retrospective cohort study of records of 121 patients submitted to pulmonary parenchyma resection (not biopsies) was carried out. Stay in the ICU and time of tracheal extubation were related. Postoperative evolution was classified as good or bad according to occurrence of some of the following conditions: infections, respiratory disorders (reintubation, bronchospasm, acute pulmonary edema, need of tracheotomy, atelectasis, fistulae), re-operation due to bleeding and death. Among the two groups preoperative conditions, anesthetic physical status (American Society of Anesthesyologists - ASA criteria), presence of associated diseases, respiratory functional evaluation and duration of surgery were analyzed. Relative risk was used to evaluate effect of time of extubation (immediate or non-immediate) on the postoperative evolution of patients. RESULTS: Patient distribution related to extubation time was: 81% immediate extubation, 15% non-immediate extubation and 4% not extubated. Destination after surgery was: 73% ICU and 27% post-anesthetic recovery room. Incidence of associated diseases (arterial hypertension, diabetes, obstructive or restrictive pulmonary disease and cardiopaty) among the immediately extubated group and non-immediately extubated group was 37% and 41.6%, respectively. Related to ASA physical status: 62% ASA 1 or 2 in the immediately extubated group and 58.3% ASA 1 or 2 in the non- immediately extubated group. Surgical time was (mean ± standard deviation) 372.34 ± 107.84 minutes and 432.61 ± 117.30 minutes in immediately extubated and non- immediately extubated group, respectively. Relative risk of immediate extubation leading to a poor evolution was of 0.81, while non- immediate extubation leading to a poor evolution was of 1.5. CONCLUSIONS: It's possible safe immediate tracheal extubation of patients submitted to pulmonary resection surgery. This kind of management favors postoperative recuperation out of ICU, which results in patients and hospital benefits, mainly referred to costs.