RESUMO
Abstract Background Ludwig's angina (LA) is an infection of the submandibular space, first described by Wilhelm Frederick von Ludwig in 1836. It represents an entity difficult to manage due to the rapid progression and difficulty in maintaining airway patency, a major challenge in medical practice, resulting in asphyxia and death in 8-10% of patients. Objective Describe a case of a patient with Ludwig's angina undergoing surgery, with emphasis on airway management, in addition to reviewing the articles published in the literature on this topic. Case report Male patient, 21 years, drug addict, admitted by the emergency department and diagnosed with LA. Difficult airway was identified during the anesthetic examination. In additional tests, significant deviation from the tracheal axis was seen. Undergoing bilateral thoracoscopic pleural drainage, we opted for airway management through tracheal intubation using fiberoptic bronchoscopy, and balanced general anesthesia was proposed. There were no complications during the surgical-anesthetic act. After the procedure, the patient remained intubated and mechanically ventilated in the intensive care unit. Conclusions Airway management in patients with Ludwig's angina remains challenging. The choice of the safest technique should be based on clinical signs, technical conditions available, and the urgent need to preserve the patient's life.
Resumo Justificativa A angina de Ludwig (AL) constitui uma infecção do espaço submandibular, primeiramente descrita por Wilhelm Frederick von Ludwig em 1836. Representa uma entidade de difícil manejo devido à rápida progressão e dificuldade na manutenção da via aérea pérvia, um importante desafio na prática médica, que culmina em asfixia e morte em 8-10% dos pacientes. Objetivo Descrever o caso clínico de um paciente com angina de Ludwig submetido a procedimento cirúrgico, com ênfase no manejo da via aérea, além de revisar os artigos disponíveis na literatura médica a respeito desse tema. Relato de caso Paciente masculino, 21 anos, drogadito, admitido pelo pronto socorro e diagnosticado com AL. Na propedêutica anestésica constatou-se via aérea difícil. Nos exames complementares foi possível observar importante desvio do eixo traqueal. Submetido à toracoscopia bilateral com drenagem pleural, optou-se pelo manejo da via aérea através de intubação nasotraqueal por fibrobroncoscopia e foi proposta anestesia geral balanceada. Não houve intercorrência durante o ato cirúrgico-anestésico. Após procedimento paciente permaneceu intubado e em ventilação mecânica na Unidade de Terapia Intensiva. Conclusões O manejo da via aérea nos pacientes com angina de Ludwig permanece desafiador. A escolha da técnica mais segura deve ser embasada no quadro clínico, nas condições técnicas disponíveis e na necessidade premente de preservação da vida do paciente.
Assuntos
Humanos , Masculino , Manuseio das Vias Aéreas/métodos , Anestesia , Angina de LudwigRESUMO
BACKGROUND: Ludwig's angina (LA) is an infection of the submandibular space, first described by Wilhelm Frederick von Ludwig in 1836. It represents an entity difficult to manage due to the rapid progression and difficulty in maintaining airway patency, a major challenge in medical practice, resulting in asphyxia and death in 8-10% of patients. OBJECTIVE: Describe a case of a patient with Ludwig's angina undergoing surgery, with emphasis on airway management, in addition to reviewing the articles published in the literature on this topic. CASE REPORT: Male patient, 21 years, drug addict, admitted by the emergency department and diagnosed with LA. Difficult airway was identified during the anesthetic examination. In additional tests, significant deviation from the tracheal axis was seen. Undergoing bilateral thoracoscopic pleural drainage, we opted for airway management through tracheal intubation using fiberoptic bronchoscopy, and balanced general anesthesia was proposed. There were no complications during the surgical-anesthetic act. After the procedure, the patient remained intubated and mechanically ventilated in the intensive care unit. CONCLUSIONS: Airway management in patients with Ludwig's angina remains challenging. The choice of the safest technique should be based on clinical signs, technical conditions available, and the urgent need to preserve the patient's life.
Assuntos
Manuseio das Vias Aéreas , Anestesia , Angina de Ludwig , Manuseio das Vias Aéreas/métodos , Humanos , MasculinoRESUMO
ABSTRACT BACKGROUND AND OBJECTIVES: The use of tranexamic acid in primary total knee replacement surgeries has been the subject of constant study. The strategies to reduce bleeding are aimed at reducing the need for blood transfusion due to the risks involved. In this study we evaluated the use of tranexamic acid in reducing bleeding, need for blood transfusion, and prevalence of postoperative deep vein thrombosis in primary total knee replacement. METHOD: 62 patients undergoing primary total knee replacement were enrolled in the study, from June 2012 to May 2013, and randomized to receive a single dose of 2.5 g of intravenous tranexamic acid (Group TA) or saline (Group GP), 5 min before opening the pneumatic tourniquet, respectively. Hemoglobin, hematocrit, and blood loss were recorded 24 h after surgery. Deep vein thrombosis was investigated during patient's hospitalization and 15 and 30 days after surgery in review visits. RESULTS: There was no demographic difference between groups. Group TA had 13.89% decreased hematocrit (p = 0.925) compared to placebo. Group TA had a decrease of 12.28% (p = 0.898) in hemoglobin compared to Group GP. Group TA had a mean decrease of 187.35 mL in blood loss (25.32%) compared to group GP (p = 0.027). The number of blood transfusions was higher in Group GP (p = 0.078). Thromboembolic events were not seen in this study. CONCLUSION: Tranexamic acid reduced postoperative bleeding without promoting thromboembolic events.
RESUMO JUSTIFICATIVA E OBJETIVOS: O uso do ácido tranexâmico, em cirurgias de artroplastia total primária de joelho, tem sido objeto de constante estudo. As estratégias para redução de sangramento visam à redução da necessidade de transfusão de sangue devido aos riscos que apresentam. Neste estudo, propomos a avaliação do uso do ácido tranexâmico na redução do sangramento, na necessidade de transfusão de sangue e na prevalência de trombose venosa profunda (TVP) pós-operatória em artroplastia total primária de joelho. MÉTODO: Foram estudados 62 pacientes submetidos à artroplastia primária total de joelho, de junho de 2012 a maio de 2013, randomizados para receber ácido tranexâmico 2,5 g endovenoso (grupo AT), em dose única, ou soro fisiológico (grupo GP), cinco minutos antes da abertura do torniquete pneumático, respectivamente. Foram feitas dosagens de hemoglobina e hematócrito e medida a perda sanguínea 24 horas após a cirurgia. A TVP foi pesquisada durante a internação do paciente, 15 e 30 dias após a cirurgia nas consultas de revisão. RESULTADOS: Não houve diferenças demográficas entre os grupos estudados. O grupo GT apresentou queda do hematócrito 13,89% (p = 0,925) comparado com o grupo placebo. O grupo GT apresentou diminuição de 12,28% (p = 0,898) da hemoglobina comparado com o grupo GP. O grupo GT apresentou uma diminuição média de 187,35 ml nas perdas sanguíneas (25,32%) quando comparado com o grupo GP (p = 0,027). O número de transfusões sanguíneas foi maior no grupo GP (p = 0,078). Eventos tromboembólicos não foram evidenciados neste estudo. CONCLUSÕES: O ácido tranexâmico diminuiu o sangramento pós-operatório sem promover eventos tromboembólicos.
Assuntos
Humanos , Masculino , Feminino , Idoso , Complicações Pós-Operatórias/prevenção & controle , Ácido Tranexâmico/uso terapêutico , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Hemorragia Pós-Operatória/prevenção & controle , Artroplastia do Joelho , Antifibrinolíticos/uso terapêutico , Transfusão de Sangue/estatística & dados numéricos , Hemoglobinas/efeitos dos fármacos , Trombose Venosa/prevenção & controle , Hematócrito/estatística & dados numéricos , Pessoa de Meia-IdadeRESUMO
BACKGROUND AND OBJECTIVES: The use of tranexamic acid in primary total knee replacement surgeries has been the subject of constant study. The strategies to reduce bleeding are aimed at reducing the need for blood transfusion due to the risks involved. In this study we evaluated the use of tranexamic acid in reducing bleeding, need for blood transfusion, and prevalence of postoperative deep vein thrombosis in primary total knee replacement. METHOD: 62 patients undergoing primary total knee replacement were enrolled in the study, from June 2012 to May 2013, and randomized to receive a single dose of 2.5g of intravenous tranexamic acid (Group TA) or saline (Group GP), 5min before opening the pneumatic tourniquet, respectively. Hemoglobin, hematocrit, and blood loss were recorded 24h after surgery. Deep vein thrombosis was investigated during patient's hospitalization and 15 and 30 days after surgery in review visits. RESULTS: There was no demographic difference between groups. Group TA had 13.89% decreased hematocrit (p=0.925) compared to placebo. Group TA had a decrease of 12.28% (p=0.898) in hemoglobin compared to Group GP. Group TA had a mean decrease of 187.35mL in blood loss (25.32%) compared to group GP (p=0.027). The number of blood transfusions was higher in Group GP (p=0.078). Thromboembolic events were not seen in this study. CONCLUSION: Tranexamic acid reduced postoperative bleeding without promoting thromboembolic events.
Assuntos
Antifibrinolíticos/uso terapêutico , Artroplastia do Joelho , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Complicações Pós-Operatórias/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Ácido Tranexâmico/uso terapêutico , Idoso , Transfusão de Sangue/estatística & dados numéricos , Feminino , Hematócrito/estatística & dados numéricos , Hemoglobinas/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Trombose Venosa/prevenção & controleRESUMO
BACKGROUND AND OBJECTIVES: The use of tranexamic acid in primary total knee replacement surgeries has been the subject of constant study. The strategies to reduce bleeding are aimed at reducing the need for blood transfusion due to the risks involved. In this study we evaluated the use of tranexamic acid in reducing bleeding, need for blood transfusion, and prevalence of postoperative deep vein thrombosis (DVT) in primary total knee replacement. METHOD: 62 patients undergoing primary total knee replacement were enrolled in the study, from June 2012 to May 2013, and randomized to receive a single dose of 2.5g of intravenous tranexamic acid (Group TA) or saline (Group GP), 5minutes before opening the pneumatic tourniquet, respectively. Hemoglobin, hematocrit, and blood loss were recorded 24hours after surgery. DVT was investigated during patient's hospitalization and 15 and 30 days after surgery in review visits. RESULTS: There was no demographic difference between groups. Group TA had 13.89% decreased hematocrit (p=0.925) compared to placebo. Group TA had a decrease of 12.28% (p=0.898) in hemoglobin compared to Group GP. Group TA had a mean decrease of 187.35mL in blood loss (25.32%) compared to group GP (p=0.027). The number of blood transfusions was higher in Group GP (p=0.078). Thromboembolic events were not seen in this study. CONCLUSION: Tranexamic acid reduced postoperative bleeding without promoting thromboembolic events.
RESUMO
BACKGROUND AND OBJECTIVES: Guillain-Barre syndrome during pregnancy is considered a rare neurological complication, and there is no consensus in literature for anesthetic management for cesarean section in such patients. The objective of this paper is to report the case of a pregnant woman with Guillain-Barre syndrome undergoing cesarean section. CASE REPORT: Female patient, 22-year old, 35 weeks and 5 days of gestation, undergoing cesarean section, hospitalized, reporting decreased strength and lower limb paresthesias. Cerebrospinal fluid (CSF) analysis showed increased protein (304 mg.dL-1) without increased cellularity. The anesthetic technique used was general anesthesia induced with propofol (1.5 mg.kg-1) and maintained with 2% sevoflurane in oxygen and fentanyl (3 µg.kg⻹). The procedure was uneventful for both mother and neonate. The patient was discharged 10 days after admission, after progressive improvement of neurological symptoms. CONCLUSION: The anesthetic technique for pregnant women with Guillain-Barre syndrome requiring cesarean section remains at the discretion of the anesthesiologist, who should be guided by the clinical conditions and comorbidities of each patient.
Assuntos
Anestesia Obstétrica , Cesárea , Síndrome de Guillain-Barré , Complicações na Gravidez , Feminino , Humanos , Gravidez , Adulto JovemRESUMO
JUSTIFICATIVA E OBJETIVOS: A Síndrome de Guillain-Barré durante a gestação é considerada uma CIRURGIA, Cesárea; complicação neurológica rara e o manejo anestésico para a cesariana nessas pacientes ainda não é consenso na literatura. O objetivo deste artigo é relatar o caso de uma paciente gestante portadora da Síndrome de Guillain-Barré submetida à cesariana. RELATO DO CASO: Paciente feminina, 22 anos, com 35 semanas e cinco dias de idade gestacional, da celularidade. A técnica anestésica empregada foi a anestesia geral, induzida com propofol 1,5 mg.kg-1 e mantida com sevofiurano 2% em oxigênio e fentanil 3 µg.kg-1. O procedimento transcorreu sem complicações, tanto para a gestante quanto para o concepto. A paciente obteve alta no décimo dia de internação, após melhora progressiva do quadro neurológico. CONCLUSÕES: A técnica anestésica a ser empregada em gestantes portadoras da Síndrome de Guillain-Barré que necessitam fazer cesariana permanece como escolha do anestesiologista, que deve ser guiado pelo quadro clínico e pelas comorbidades de cada paciente.
BACKGROUND AND OBJECTIVES: Guillain-Barre syndrome during pregnancy is considered a rare neurological complication, and there is no consensus in literature for anesthetic management for cesarean section in such patients. The objective of this paper is to report the case of a pregnant woman with Guillain-Barre syndrome undergoing cesarean section. CASE REPORT: Female patient, 22-year old, 35 weeks and 5 days of gestation, undergoing cesarean section, hospitalized, reporting decreased strength and lower limb paresthesias. Cerebrospinal fl uid (CSF) analysis showed increased protein (304 mg.dL-1) without increased cellularity. The anesthetic technique used was general anesthesia induced with propofol (1.5 mg.kg-1) and maintained with 2% sevofl urane in oxygen and fentanyl (3 µg.kg-1). The procedure was uneventful for both mother and neonate. The patient was discharged 10 days after admission, after progressive improvement of neurological symptoms. CONCLUSION: The anesthetic technique for pregnant women with Guillain-Barre syndrome requiring cesarean section remains at the discretion of the anesthesiologist, who should be guided by the clinical conditions and comorbidities of each patient.
JUSTIFICATIVA Y OBJETIVOS: El Síndrome de Guillain-Barré durante la gestación se considera una complicación neurológica rara y todavía no se ha llegado a un consenso en la literatura sobre el manejo anestésico para la cesárea en esas pacientes. El objetivo de este artículo, es relatar el caso de una paciente gestante portadora del Síndrome de Guillain-Barré sometida a la cesárea. RELATO DEL CASO: Paciente femenina con 22 años, con 35 semanas y cinco días de edad gestacional, sometida a cesárea e ingresada, relatando una disminución de fuerza y parestesias en los miembros inferiores. El examen del líquido cefalorraquídeo arrojó elevación de proteínas (304 mg.dL-1) sin el aumento de la celularidad. La técnica anestésica usada fue la anestesia general, inducida con propofol 1,5 mg.kg-1 y mantenida con sevofl urano al 2% en oxígeno y fentanilo 3 µg.kg-1. El procedimiento trascurrió sin complicaciones, tanto para la gestante como para el feto. Se le dio el alta a la paciente al décimo día del ingreso, posteriormente a la mejoría progresiva del cuadro neurológico. CONCLUSIONES: La técnica anestésica que se usa en las gestantes portadoras del Síndrome de Guillain-Barré que necesitan cesárea, permanece como siendo una elección del anestesiólogo, que debe dejarse guiar por el cuadro clínico y por las comorbilidades de cada paciente.
Assuntos
Feminino , Humanos , Gravidez , Adulto Jovem , Anestesia Obstétrica , Cesárea , Síndrome de Guillain-Barré , Complicações na GravidezRESUMO
BACKGROUND AND OBJECTIVES: The practice of anesthesiology is not without risks to the anesthesiologist. The operating room (OR), in which anesthesiologists spend most of their time, is regarded as an unhealthy workplace due to the potential risks it offers. In this review, we propose an analysis of the occupational hazards that anesthesiologists are exposed in their daily practice. CONTENT: We present a classification of risk and its relationship to occupational diseases. CONCLUSION: Control of occupational hazards to which anesthesiologists are exposed daily is necessary in order to develop an appropriate workplace and minimize risks to the good practice of anesthesiology. This contributes to decrease absenteeism, improve patients' care and quality of life of anesthesiologists.