RESUMO
Introduction: The application of enhanced recovery in shoulder surgery has not had such a favorable acceptance, therefore, the objective of this study was to present and describe the use of interscalene block to promote enhanced recovery in a series of patients undergoing shoulder arthroscopic surgery. Methods: Thirty-five patients undergoing arthroscopic shoulder surgery were included, in whom interscalene blockade and sedation were administered. Subsequently, pain intensity, nausea, vomiting, dyspnea, presence of Horner's syndrome, blurred vision, hoarseness, time elapsed to discharge, unplanned readmissions, patient satisfaction, and compliance with hospital discharge criteria in the first 12 weeks were evaluated, hours following the criteria of an enhanced recovery. Results: 27 patients (77,1%) had ASA I and 8 patients (22,8%) ASA II, 97,1% were rotator cuff repairs. Before discharge, two patients (5.7%) had nausea. At discharge, no patient had dyspnea or blurred vision, two patients (5.7%) developed hoarseness, and the median pain intensity was 1.0 (0.0-7.0). Between 24 and 48 hours only one patient (2.8%) presented nausea and the median pain intensity was 1.0 (0.0-8.0). All the patients were satisfied with their willingness to repeat the experience, 100% of the patients met the criteria for medical discharge after 12 hours, 30 patients (85.7%) were discharged the same day, the stay was 12 (11.5 to 12.5) hours, and no patient was readmitted. Conclusion: In selected patients with a committed, trained and experienced surgical-anesthetic team, there is a high possibility that the interscalene block will favor the performance of enhanced recovery programs in shoulder arthroscopic surgery.
Introducción: La aplicación de la recuperación acelerada en cirugía de hombro no ha tenido una aceptación tan favorable. Por ello, el objetivo de este estudio fue presentar y describir el uso de bloqueo interescalénico para favorecer la recuperación acelerada en una serie de pacientes sometidos a cirugía artroscopica de hombro. Métodos: Se incluyeron 35 pacientes sometidos a cirugía artroscópica de hombro, en quienes se administró bloqueo interescalénico y sedación. Posteriormente se evaluó la intensidad del dolor, náuseas, vómito, disnea, presencia de síndrome de Horner, visión borrosa, ronquera, tiempo transcurrido hasta el alta, reingresos no planeados, satisfacción del paciente y cumplimiento de los criterios de alta hospitalaria en las primeras 12 horas siguiendo los criterios de una recuperación acelerada. Resultados: En total, 27 pacientes (77,1%) tuvieron clasificación de la (ASA) I y 8 pacientes (22,9%) ASA II. Además, 97,1% fueron reparaciones de manguito rotador. Previo al alta, dos pacientes (5,7%) presentaron náuseas. Al momento del alta ningún paciente presentó disnea o visión borrosa, dos pacientes (5,7%) presentaron ronquera y la mediana de intensidad del dolor fue de 1,0 (0,0 a 7,0). Entre las 24 y 48 horas solo un (2,8%) paciente presentó náuseas y la mediana de intensidad del dolor fue de 1,0 (0,0 a 8,0). Todos los pacientes se mostraron satisfechos con disposición a repetir la experiencia. El 100% de pacientes cumplió los criterios médicos de alta a las 12 horas y 30 pacientes (85,7%) se dieron de alta el mismo día. La estancia fue de 12 (11,5 a 12,5) horas y ningún paciente reingresó. Conclusión: En pacientes seleccionados, con un equipo quirúrgico-anestésico comprometido, capacitado y con experiencia, hay una alta posibilidad de que el bloqueo interescalénico favorezca la realización de programas de recuperación acelerada en cirugía artroscópica de hombro.
Assuntos
Bloqueio do Plexo Braquial , Ombro , Humanos , Ombro/cirurgia , Rouquidão , Dor Pós-Operatória , NáuseaRESUMO
INTRODUCCIÓN: La aplicación de la recuperación acelerada en cirugía de hombro no ha tenido una aceptación tan favorable. Por ello, el objetivo de este estudio fue presentar y describir el uso de bloqueo interescalénico para favorecer la recuperación acelerada en una serie de pacientes sometidos a cirugía artroscópica de hombro. MÉTODOS: Se incluyeron 35 pacientes sometidos a cirugía artroscópica de hombro, en quienes se administró bloqueo interescalénico y sedación. Posteriormente se evaluó la intensidad del dolor, náuseas, vómito, disnea, presencia de síndrome de Horner, visión borrosa, ronquera, tiempo transcurrido hasta el alta, reingresos no planeados, satisfacción del paciente y cumplimiento de los criterios de alta hospitalaria en las primeras 12 horas siguiendo los criterios de una recuperación acelerada. RESULTADOS: En total, 27 pacientes (77,1%) tuvieron clasificación de la (ASA) I y 8 pacientes (22,9%) ASA II. Además, 97,1% fueron reparaciones de manguito rotador. Previo al alta, dos pacientes (5,7%) presentaron náuseas. Al momento del alta ningún paciente presentó disnea o visión borrosa, dos pacientes (5,7%) presentaron ronquera y la mediana de intensidad del dolor fue de 1,0 (0,0 a 7,0). Entre las 24 y 48 horas solo un (2,8%) paciente presentó náuseas y la mediana de intensidad del dolor fue de 1,0 (0,0 a 8,0). Todos los pacientes se mostraron satisfechos con disposición a repetir la experiencia. El 100% de pacientes cumplió los criterios médicos de alta a las 12 horas y 30 pacientes (85,7%) se dieron de alta el mismo día. La estancia fue de 12 (11,5 a 12,5) horas y ningún paciente reingresó. CONCLUSIÓN: En pacientes seleccionados, con un equipo quirúrgico-anestésico comprometido, capacitado y con experiencia, hay una alta posibilidad de que el bloqueo interescalénico favorezca la realización de programas de recuperación acelerada en cirugía artroscópica de hombro.
INTRODUCTION: The application of enhanced recovery in shoulder surgery has not had such a favorable acceptance, therefore, the objective of this study was to present and describe the use of interscalene block to promote enhanced recovery in a series of patients undergoing shoulder arthroscopic surgery. METHODS: Thirty-five patients undergoing arthroscopic shoulder surgery were included, in whom interscalene blockade and sedation were administered. Subsequently, pain intensity, nausea, vomiting, dyspnea, presence of Horner's syndrome, blurred vision, hoarseness, time elapsed to discharge, unplanned readmissions, patient satisfaction, and compliance with hospital discharge criteria in the first 12 weeks were evaluated, hours following the criteria of an enhanced recovery. RESULTS: 27 patients (77,1%) had ASA I and 8 patients (22,8%) ASA II, 97,1% were rotator cuff repairs. Before discharge, two patients (5.7%) had nausea. At discharge, no patient had dyspnea or blurred vision, two patients (5.7%) developed hoarseness, and the median pain intensity was 1.0 (0.0-7.0). Between 24 and 48 hours only one patient (2.8%) presented nausea and the median pain intensity was 1.0 (0.0-8.0). All the patients were satisfied with their willingness to repeat the experience, 100% of the patients met the criteria for medical discharge after 12 hours, 30 patients (85.7%) were discharged the same day, the stay was 12 (11.5 to 12.5) hours, and no patient was readmitted. CONCLUSION: In selected patients with a committed, trained and experienced surgical-anesthetic team, there is a high possibility that the interscalene block will favor the performance of enhanced recovery programs in shoulder arthroscopic surgery.
Assuntos
Humanos , Ombro/cirurgia , Bloqueio do Plexo Braquial , Dor Pós-Operatória , Rouquidão , NáuseaRESUMO
OBJECTIVE: Multiple factors are involved in the physiology and variability of postsurgical pain, a great part of which can be explained by genetic and environmental factors and their interaction. Epigenetics refers to the mechanism by which the environment alters the stability and expression of genes. We conducted a scoping review to examine the available evidence in both animal models and clinical studies on epigenetic mechanisms involved in the regulation of postsurgical and chronic postsurgical pain. METHODS: The Arksey and O'Malley framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Review and Meta-Analysis, scoping reviews extension) guidelines were used. The PubMed, Web of Science, and Google Scholar databases were searched, and the original articles cited in reviews located through the search were also reviewed. English-language articles without time limits were retrieved. Articles were selected if the abstract addressed information on the epigenetic or epigenomic mechanisms, histone, or DNA methylation and microribonucleic acids involved in postsurgical and chronic postsurgical pain in animal models and clinical studies. RESULTS: The initial search provided 174 articles, and 95 were used. The available studies to date, mostly in animal models, have shown that epigenetics contributes to the regulation of gene expression in the pathways involved in postsurgical pain and in maintaining long-term pain. CONCLUSION: Research on possible epigenetic mechanisms involved in postsurgical pain and chronic postsurgical pain in humans is scarce. In view of the evidence available in animal models, there is a need to evaluate epigenetic pain mechanisms in the context of human and clinical studies.
Assuntos
Epigenômica , Dor Pós-Operatória , Epigênese Genética/genética , Humanos , Dor Pós-Operatória/genéticaRESUMO
During coronavirus disease 2019 (COVID-19) pandemic, efforts have been made to rethink the health system and provide various recommendations to the best care of patients and for the protection of health personnel. In patients with suspicion or confirmation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who require surgical intervention and anesthetic management, strategies must be established to minimize aerosol-generating procedures. Regional anesthesia (RA) is not considered an aerosol-generating procedure per se and is currently proposed such as a safe strategy and part of comprehensive perioperative care. However, the preoperative evaluation has undergone changes in the context of the COVID-19 pandemic, so in addition to routine preoperative evaluation, a patient-oriented history, clinical, laboratory, and radiologic evaluation should be performed, and a series of general recommendations should be taken into account before, during, and after the performance of RA procedure. A search of PubMed/MEDLINE, Web of Science, and Google Scholar databases was performed until August 22, 2020, using the words: ãregional anesthesia or nerve block or peripheral nerve block or spinal anesthesia or epidural anesthesia and SARS-CoV-2 or COVID-19 or MERS or SARS-CoV-1 or influenza.ã We included in this review all articles, regardless of design, published in the English language. Given the benefits reported with the use of RA techniques, both for the patient and for healthcare personnel, it has recently been suggested that RA should be considered as the first choice. However, it is important to generate more precise and homogeneous management guidelines based on the evidence obtained every day during the care of patients with COVID-19.
Assuntos
Anestesia por Condução , COVID-19 , Anestesia Local , Humanos , Pandemias , SARS-CoV-2Assuntos
Anestesia por Condução , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Betacoronavirus , COVID-19 , Humanos , Oxigênio , SARS-CoV-2RESUMO
The purpose of this article is to review the characteristics of SARS-CoV-2, the clinical-epidemiological aspects of COVID-19, and the implications anesthesiologists when performing aerosol-generating procedures. A search of PubMed/MEDLINE, Scopus, SciELO, and Web of Science databases was performed until April 9, 2020, using the words: "COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia". Forty-eight articles with information on the management of the patient in the perioperative period or the intensive care unit when suspected or confirmed SARS-CoV-2 infection were included. In general, the postponement of elective surgeries for no more than 6 to 8 weeks, depending on the clinical condition of the patients is recommended. In the case of urgent or emergency surgeries, we review the use of personal protection gear, as well as the recommended strategies for carrying out the procedure.
El objetivo de este artículo es revisar las características del SARS-CoV-2, los aspectos clínico-epidemiológicos de COVID-19 y las implicaciones que tienen para los anestesiólogos al realizar procedimientos generadores de aerosoles. Se realizó una búsqueda en las bases de datos PubMed, Scopus, SciELO y Web of Science hasta el 9 de abril de 2020, utilizando las palabras: COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia. Se incluyeron 48 artículos con información sobre el manejo del paciente en el perioperatorio o en la unidad de cuidados intensivos ante la sospecha o confirmación de infección por SARS-CoV-2. En general, se recomienda el aplazamiento de las cirugías electivas por no más de seis a ocho semanas, de acuerdo a las condiciones clínicas de los pacientes. En el caso de cirugías de urgencia o emergencia, se revisan tópicos del sistema de protección personal así como las estrategias recomendadas para la realización de los procedimientos.
Assuntos
Anestesiologia/normas , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Doenças Profissionais/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Aerossóis , Anestesia por Condução/métodos , Anestesia Epidural/métodos , Anestesia Geral/métodos , Raquianestesia/métodos , Anestesiologia/organização & administração , Betacoronavirus/genética , COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Procedimentos Cirúrgicos Eletivos , Humanos , Unidades de Terapia Intensiva , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Bloqueio Nervoso/métodos , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Respiração Artificial/métodos , Respiração Artificial/normas , SARS-CoV-2 , Procedimentos Cirúrgicos Operatórios , Avaliação de Sintomas/métodosRESUMO
El objetivo de este artículo es revisar las características del SARS-CoV-2, los aspectos clínico-epidemiológicos de COVID-19 y las implicaciones que tienen para los anestesiólogos al realizar procedimientos generadores de aerosoles. Se realizó una búsqueda en las bases de datos PubMed, Scopus, SciELO y Web of Science hasta el 9 de abril de 2020, utilizando las palabras: "COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia". Se incluyeron 48 artículos con información sobre el manejo del paciente en el perioperatorio o en la unidad de cuidados intensivos ante la sospecha o confirmación de infección por SARS-CoV-2. En general, se recomienda el aplazamiento de las cirugías electivas por no más de seis a ocho semanas, de acuerdo a las condiciones clínicas de los pacientes. En el caso de cirugías de urgencia o emergencia, se revisan tópicos del sistema de protección personal así como las estrategias recomendadas para la realización de los procedimientos.
The purpose of this article is to review the characteristics of SARS-CoV-2, the clinical-epidemiological aspects of COVID-19, and the implications anesthesiologists when performing aerosol-generating procedures. A search of PubMed/MEDLINE, Scopus, SciELO, and Web of Science databases was performed until April 9, 2020, using the words: "COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia". Forty-eight articles with information on the management of the patient in the perioperative period or the intensive care unit when suspected or confirmed SARS-CoV-2 infection were included. In general, the postponement of elective surgeries for no more than 6 to 8 weeks, depending on the clinical condition of the patients is recommended. In the case of urgent or emergency surgeries, we review the use of personal protection gear, as well as the recommended strategies for carrying out the procedure.
Assuntos
Humanos , SARS-CoV-2/genética , COVID-19/complicações , COVID-19/epidemiologia , Anestesiologia/normas , Doenças Profissionais/prevenção & controle , Respiração Artificial/métodos , Respiração Artificial/normas , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Eletivos , Aerossóis , Pandemias , Avaliação de Sintomas/métodos , Equipamento de Proteção Individual , COVID-19/diagnóstico , COVID-19/transmissão , Unidades de Terapia Intensiva , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Anestesia por Condução/métodos , Anestesia Epidural/métodos , Anestesia Geral/métodos , Raquianestesia/métodos , Anestesiologia/organização & administração , Bloqueio Nervoso/métodosRESUMO
Breast cancer is the most frequent cancer in women. Even though most women diagnosed with breast cancer survive, many of them experience pain as part of the disease process or as a side effect of diagnostic or therapeutic procedures. Given that chronic pain in patients with breast cancer is a complex experience, the objective of this article was to conduct a systematic review of the scientific literature available in the PubMed database in English language between January 2000 and September 2019 on the epidemiology, risk factors, clinical characteristics, preventive strategies and treatment of chronic pain in patients with breast cancer, since the knowledge of these aspects is transcendental to identify, treat and monitor patients in the long term, in order to avoid further impact on their quality of life, already altered.
El cáncer de mama es el cáncer más frecuente en la mujer. Aun cuando la mayoría de las mujeres diagnosticadas con cáncer de mama sobreviven, muchas de ellas experimentan dolor como parte del proceso de enfermedad o como un efecto colateral de los procedimientos diagnósticos o terapéuticos. Dado que el dolor crónico en las pacientes con cáncer de mama es una experiencia compleja, el objetivo de este artículo fue realizar una revisión narrativa de la literatura científica disponible en la base datos PubMed en idioma inglés entre enero de 2000 y septiembre de 2019 sobre la epidemiología, factores de riesgo, características clínicas, estrategias preventivas y tratamiento del dolor crónico en pacientes con cáncer de mama, ya que el conocimiento de estos aspectos es trascendental para identificar, tratar y vigilar a las pacientes a largo plazo, a fin de evitar una mayor afectación en su calidad de vida, ya de por sí alterada.
RESUMO
Breast cancer is the most recurrent cancer in female population, its mortality is related to the presence of distant metastases. Distant metastasis begins as a small group of cells that spread regionally and remotely from the site of primary origin. Circulating tumor cells (CTC) are present in the blood of cancer patients and are therefore considered disease markers and precursors of metastasis. It is trascendental the review of the molecular aspects of the metastatic process, the available techniques for the enrichment, identification and molecular characterization of CTC, as well as some examples of its usefulness and clinical application in patients with breast cancer, including aspects related to perioperative management during breast cancer surgery.
El cáncer de mama es el cáncer más recurrente en la población femenina, su mortalidad se relaciona con la presencia de metástasis a distancia. La metástasis a distancia inicia como un pequeño grupo de células que se diseminan a nivel regional y a distancia del sitio de origen primario. Las células tumorales circulantes (CTC) están presentes en la sangre de las pacientes con cáncer, por lo que se consideran marcadores de enfermedad y precursoras de metástasis. Es transcendental la revisión de los aspectos moleculares del proceso metástasico, las técnicas disponibles para el enriquecimiento, identificación y caracterización molecular de CTC, así como algunos ejemplos de su utilidad y aplicación clínica en pacientes con cáncer de mama, incluyendo aspectos relacionados con el manejo perioperatorio durante la cirugía oncológica mamaria.
RESUMO
BACKGROUND: The bilateral brachial plexus block is considered a contraindication, due to the possible development of complications, such as: toxicity from local anaesthetics or bilateral diaphragmatic paralysis. However, with the real time visualisation provided by the ultrasound scan, these complications have decreased and it is a safer procedure. CLINICAL CASES: Four cases are presented where the bilateral block was performed using guided ultrasound, as the patients were unable to receive general anaesthesia due to a history of adverse effects or the use of opioids in the post-operative or by the prediction of a difficult airway associated with obesity. A systematic review of the literature from January 1993 to June 2013, was also performed by using a search in the MEDLINE, EMBASE, ARTEMISA, LILACS, Google data bases, in Spanish and English language with the following words: bilateral brachial plexus block, bilateral interscalene block, bilateral infraclavicular block, bilateral supraclavicular block, bilateral lateral supraclavicular block, bilateral axillary block, ultrasound-guided bilateral brachial plexus block. CONCLUSION: Based on the evidence found, ultrasound-guided bilateral brachial plexus block in selected patients and expert hands, is no longer a contraindication.