Assuntos
Anestesia Geral/métodos , Anestesia Obstétrica/métodos , Raquianestesia/métodos , Procedimentos Cirúrgicos em Ginecologia/métodos , Anestesia Geral/mortalidade , Anestesia Obstétrica/mortalidade , Raquianestesia/mortalidade , Feminino , Procedimentos Cirúrgicos em Ginecologia/mortalidade , Humanos , Reprodutibilidade dos Testes , Resultado do TratamentoAssuntos
Humanos , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Anestesia Geral/métodos , Anestesia Obstétrica/métodos , Raquianestesia/métodos , Procedimentos Cirúrgicos em Ginecologia/mortalidade , Reprodutibilidade dos Testes , Resultado do Tratamento , Anestesia Geral/mortalidade , Anestesia Obstétrica/mortalidade , Raquianestesia/mortalidadeRESUMO
Background: In order to reduce morbidity and mortality associated with anesthetic procedures in cats, it is important to carry out a thorough pre-anesthetic evaluation. The surgical risk depends on several factors related to the patient, the surgical procedure, and the anesthetic used. Evaluation of perioperative mortality and the identification of the main factors of death reduce mortality rates. This research was conducted to evaluate and obtain the classification of physical status and anesthetic risk in cats submitted for surgical procedures.Materials, Methods & Results: Ninety-two cats were classified into anesthetic categories according to the American Society of Anesthesiologists (ASA) classification. The group consisted of 62 females (67.39%) and 30 males (32.61%). In the ASA classification, the emergency qualifier was added, resulting in 52.17% (48/92) of the total number of surgeries being considered as emergencies. The ASA I patients constituted the majority of the study sample (33.69%, 31/92). There were no deaths among ASA I patients. The ASA II patients represented 20.65% (19/92), with surgeries divided into non-emergency (42.10%, 8/19) and emergency (57.89%, 11/19). All ASA II patients had mild localized infections, and there were no deaths. ASA III patients constituted 28.26% (26/92) of the study sample and had moderate systemic alterations. Surgeries in this group were also classified as emergency (24/26, 92.30%) or non-emergency (2/26, 7.69%). There was one postoperative death in this group. The ASA IV patients represented 17.39% (16/92) of the study sample. The emergency surgeries (81.25%, 13/16) had a greater percentage than the elective surgeries. In this group, two deaths occurring in the immediate postoperative period. The overall mortality for the entire study sample was 3.26% (3/92).[...]
Assuntos
Animais , Gatos , Anestesia Geral/mortalidade , Anestesia Geral/veterinária , Procedimentos Cirúrgicos Operatórios/veterinária , Anestesiologia/normasRESUMO
Background: In order to reduce morbidity and mortality associated with anesthetic procedures in cats, it is important to carry out a thorough pre-anesthetic evaluation. The surgical risk depends on several factors related to the patient, the surgical procedure, and the anesthetic used. Evaluation of perioperative mortality and the identification of the main factors of death reduce mortality rates. This research was conducted to evaluate and obtain the classification of physical status and anesthetic risk in cats submitted for surgical procedures.Materials, Methods & Results: Ninety-two cats were classified into anesthetic categories according to the American Society of Anesthesiologists (ASA) classification. The group consisted of 62 females (67.39%) and 30 males (32.61%). In the ASA classification, the emergency qualifier was added, resulting in 52.17% (48/92) of the total number of surgeries being considered as emergencies. The ASA I patients constituted the majority of the study sample (33.69%, 31/92). There were no deaths among ASA I patients. The ASA II patients represented 20.65% (19/92), with surgeries divided into non-emergency (42.10%, 8/19) and emergency (57.89%, 11/19). All ASA II patients had mild localized infections, and there were no deaths. ASA III patients constituted 28.26% (26/92) of the study sample and had moderate systemic alterations. Surgeries in this group were also classified as emergency (24/26, 92.30%) or non-emergency (2/26, 7.69%). There was one postoperative death in this group. The ASA IV patients represented 17.39% (16/92) of the study sample. The emergency surgeries (81.25%, 13/16) had a greater percentage than the elective surgeries. In this group, two deaths occurring in the immediate postoperative period. The overall mortality for the entire study sample was 3.26% (3/92).[...](AU)
Assuntos
Animais , Gatos , Anestesia Geral/mortalidade , Anestesia Geral/veterinária , Procedimentos Cirúrgicos Operatórios/veterinária , Anestesiologia/normasRESUMO
Introducción: la fractura de cadera es causa común de hospitalización, ocupa un lugar cimero en la morbilidad y mortalidad por enfermedad ortopédica. Objetivo: identificar las variables perioperatorias que influyen en la morbimortalidad de los pacientes que se operan de fractura de cadera en el Hospital Militar Central Dr. Carlos J. Finlay. Métodos: se realizó un estudio analítico, retrospectivo en 135 pacientes intervenidos quirúrgicamente entre enero y diciembre de 2014. Se dividieron en dos grupos para el análisis estadístico, fallecidos y vivos. Las variables estudiadas fueron: causa de muerte, tasas de mortalidad posoperatoria, factores clínicos y quirúrgicos pronósticos de muerte y principales complicaciones. Resultados: la tasa de mortalidad a los 30 días de operados fue 2,2 por ciento y al año 17,8 por ciento. Las principales causas de muerte fueron el infarto agudo de miocardio (45,8 por ciento) y el trombo embolismo pulmonar (16,7 por ciento). La probabilidad de morir los pacientes con cardiopatía isquémica o estado físico ASA 4 (American Society of Anesthesiologists) fue ocho veces superior, cinco veces más si presentaron anemia, cuatro veces mayor si recibieron anestesia general, transfusión de glóbulos intraoperatoria o alguna complicación postoperatoria, tres veces mayor en aquellos pacientes ASA 3 y pérdida sanguínea mayor de 500 mL, y se incrementa si la estadía supera los siete días. Las complicaciones más frecuentes fueron la anemia (33,3 por ciento) y la hipotensión arterial (16,7 por ciento). Conclusiones: se identificaron como factores pronósticos de muerte: el antecedente de cardiopatía isquémica, anemia preoperatoria, clasificación elevada del estado físico, uso de anestesia general, pérdidas sanguíneas mayores de 500 mL, uso de trasfusiones de glóbulos, estadía mayor de siete días y la aparición de complicaciones postoperatorias(AU)
Introduction: Hip fracture is a common cause of hospitalization, occupies a leading place in morbidity and mortality due to orthopedic disease. Objective: To identify the perioperative variables that influence the morbidity and mortality of the patients who undergo hip fracture surgery at the Central Military Hospital Dr. Carlos J. Finlay. Methods: a retrospective, analytical study was conducted in 135 patients surgically intervened between January and December 2014. They were divided into two groups for statistical analysis, deceased and alive. The variables studied were: cause of death, postoperative mortality rates, clinical and surgical prognostic factors of death and main complications. Results: The mortality rate at 30 days after surgery was 2.2 percent and 17.8 percent a year later. The main causes of death were acute myocardial infarction (45.8 percent) and pulmonary thrombus embolism (16.7 percent). The probability of dying due to ischemic heart disease or physical state ASA 4 was eight times higher, five times more if they had anemia, four times higher if they received general anesthesia, intraoperative blood transfusion or postoperative complication, three times higher in those patients ASA 3 and blood loss greater than 500 mL, and it increases if the hospitalization exceeds seven days. The most frequent complications were anemia (33.3 percent) and hypotension (16.7 percent). Conclusions: A history of ischemic heart disease, preoperative anemia, high physical status classification, use of general anesthesia, blood loss greater than 500 mL, use of blood transfusions, stay of more than seven days and appearance of postoperative complications(AU)
Assuntos
Humanos , Complicações Pós-Operatórias/mortalidade , Fraturas do Quadril/cirurgia , Fraturas do Quadril/mortalidade , Anestesia Geral/mortalidade , Estudos Retrospectivos , Causas de MorteRESUMO
BACKGROUND AND OBJECTIVES: Although many recognize that the first year of life and specifically the neonatal period are associated with increased risk of anesthetic morbidity and mortality, there are no studies directed to these pediatric subpopulations. This systematic review of the scientific literature including the last 15 years aimed to analyze the epidemiology of morbidity and mortality associated with general anesthesia and surgery in the first year of life and particularly in the neonatal (first month) period. CONTENT: The review was conducted by searching publications in Medline/PubMed databases, and the following outcomes were evaluated: early mortality in the first year of life (<1 year) and in subgroups of different vulnerability in this age group (0-30 days and 1-12 months) and the prevalence of cardiac arrest and perioperative critical/adverse events of various types in the same subgroups. CONCLUSIONS: The current literature indicates great variability in mortality and morbidity in the age group under consideration and in its subgroups. However, despite the obvious methodological heterogeneity and absence of specific studies, epidemiological profiles of morbidity and mortality related to anesthesia in children in the first year of life show higher frequency of morbidity and mortality in this age group, with the highest peaks of incidence in the neonates' anesthesia.
Assuntos
Anestesia Geral/mortalidade , Complicações Intraoperatórias/mortalidade , Complicações Pós-Operatórias/mortalidade , Humanos , Lactente , Recém-Nascido , MorbidadeRESUMO
CONTEXT AND OBJECTIVE: Taking the outcome of mortality into consideration, there is controversy about the beneficial effects of neuraxial anesthesia for orthopedic surgery. The aim of this study was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for orthopedic surgery. DESIGN AND SETTING: Systematic review at Universidade Federal de Alagoas. METHODS: We searched the Cochrane Central Register of Controlled Trials (Issue 10, 2012), PubMed (1966 to November 2012), Lilacs (1982 to November 2012), SciELO, EMBASE (1974 to November 2012) and reference lists of the studies included. Only randomized controlled trials were included. RESULTS: Out of 5,032 titles and abstracts, 17 studies were included. There were no statistically significant differences in mortality (risk difference, RD: -0.01; 95% confidence interval, CI: -0.04 to 0.01; n = 1903), stroke (RD: 0.02; 95% CI: -0.04 to 0.08; n = 259), myocardial infarction (RD: -0.01; 95% CI: -0.04 to 0.02; n = 291), length of hospitalization (mean difference, -0.05; 95% CI: -0.69 to 0.58; n = 870), postoperative cognitive dysfunction (RD: 0.00; 95% CI: -0.04 to 0.05; n = 479) or pneumonia (odds ratio, 0.61; 95% CI: 0.25 to 1.49; n = 167). CONCLUSION: So far, the evidence available from the studies included is insufficient to prove that neuraxial anesthesia is more effective and safer than general anesthesia for orthopedic surgery. However, this systematic review does not rule out clinically important differences with regard to mortality, stroke, myocardial infarction, length of hospitalization, postoperative cognitive dysfunction or pneumonia.
Assuntos
Anestesia Epidural/mortalidade , Raquianestesia/mortalidade , Procedimentos Ortopédicos , Anestesia Epidural/normas , Anestesia Geral/mortalidade , Anestesia Geral/normas , Raquianestesia/normas , Transtornos Cognitivos/etiologia , Feminino , Humanos , Tempo de Internação , Masculino , Infarto do Miocárdio/etiologia , Pneumonia/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Acidente Vascular Cerebral/etiologiaRESUMO
Objetivo: Evaluar el uso de la anestesia general en las pacientes sometidas a cesárea, las causas de su empleo y la morbimortalidad asociada a la anestesia. Material y métodos: Estudio observacional, retrospectivo y transversal. Se evaluó la base de datos de los servicios de anestesia y obstetricia por un periodo de dos años para determinar las causas que llevaron a anestesia general en las pacientes gestantes sometidas a cesárea, las causas de conversión de anestesia neuroaxial a anestesia general y las complicaciones anestésicas asociadas. Resultados: El 23.5% de los partos acabaron en cesárea, siendo la anestesia espinal la técnica neuroaxial más frecuente. La falla de la técnica neuroaxial intraoperatoria fue del 0.8% La anestesia general fue utilizada en el 2% de todos los partos por cesárea, siendo los problemas relacionados a la anestesia la primera causa que llevo al empleo de la anestesia general. conclusiones: Es factible alcanzar en un hospital universitario, los estándares de calidad propuestas en las guías de auditoría en obstetricia. Dado que la anestesia general no puede ser eliminada de esta práctica, el entrenamiento continuo en vía aérea difícil y el trabajo protocolizado en esta población son la base de una atención de alta calidad.
Objective: To evaluate the use of general anesthesia in patients undergoing cesarean section, the causes od their employment and morbi-mortality associated with anesthesia. Meterial and methods: Observational, retrospective and transversal study. We evaluated the database of anesthesia and obstetrics services for a period of two years to determie the causes that led to general anesthesia in pregnant patients undergoing cesarean section, the causes of neuroaxial anesthesia conversion to general anesthesia and anesthetic complications associated. Results: 23.5% of total births ended by caesarean section, beig spinal anesthesia was used in 2% of all cesarean deliveries, being the problems related to anesthesia the first cause that led to the use of general anesthesia. Conclusions: It is feasible to achieve in an university hospital, the quality standards proposed in obstetric audit guidelines. Since general anesthesia cannot be eliminated from this practice, the continuous training in difficult airway and work docketed in this population are the basis of high quality care.
Assuntos
Humanos , Feminino , Anestesia Geral/efeitos adversos , Anestesia Geral/mortalidade , Anestesia Obstétrica , Cesárea , Hospitais Universitários , Estudo Observacional , Estudos Retrospectivos , Estudos TransversaisRESUMO
BACKGROUND: Lower-limb revascularization is a surgical procedure that is performed to restore an adequate blood supply to the limbs. Lower-limb revascularization surgery is used to reduce pain and sometimes to improve lower-limb function. Neuraxial anaesthesia is an anaesthetic technique that uses local anaesthetics next to the spinal cord to block nerve function. Neuraxial anaesthesia may lead to improved survival. This systematic review was originally published in 2010 and was first updated in 2011 and again in 2013. OBJECTIVES: To determine the rates of death and major complications associated with spinal and epidural anaesthesia as compared with other types of anaesthesia for lower-limb revascularization in patients aged 18 years or older who are affected by obstruction of lower-limb vessels. SEARCH METHODS: The original review was published in 2010 and was based on a search until June 2008. In 2011 we reran the search until February 2011 and updated the review. For this second updated version of the review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, CINAHL and Web of Science from 2011 to April 2013. SELECTION CRITERIA: We included randomized controlled trials comparing neuraxial anaesthesia (spinal or epidural anaesthesia) versus other types of anaesthesia in adults (18 years or older) with arterial vascular obstruction undergoing lower-limb revascularization surgery. DATA COLLECTION AND ANALYSIS: Two review authors independently performed data extraction and assessed trial quality. We pooled the data on mortality, myocardial infarction, lower-limb amputation and pneumonia. We summarized dichotomous data as odds ratio (OR) with 95% confidence interval (CI) using a random-effects model. MAIN RESULTS: In this updated version of the review, we found no new studies that met our inclusion criteria. We included in this review four studies that compared neuraxial anaesthesia with general anaesthesia. The total number of participants was 696, of whom 417 were allocated to neuraxial anaesthesia and 279 to general anaesthesia. Participants allocated to neuraxial anaesthesia had a mean age of 67 years, and 59% were men. Participants allocated to general anaesthesia had a mean age of 67 years, and 66% were men. Four studies had an unclear risk of bias. No difference was observed between participants allocated to neuraxial or general anaesthesia in mortality rate (OR 0.89, 95% CI 0.38 to 2.07; 696 participants; four trials), myocardial infarction (OR 1.23, 95% CI 0.56 to 2.70; 696 participants; four trials), and lower-limb amputation (OR 0.84, 95% CI 0.38 to 1.84; 465 participants; three trials). Pneumonia was less common after neuraxial anaesthesia than after general anaesthesia (OR 0.37, 95% CI 0.15 to 0.89; 201 participants; two trials). Evidence was insufficient for cerebral stroke, duration of hospital stay, postoperative cognitive dysfunction, complications in the anaesthetic recovery room and transfusion requirements. No data described nerve dysfunction, postoperative wound infection, patient satisfaction, postoperative pain score, claudication distance and pain at rest. AUTHORS' CONCLUSIONS: Available evidence from included trials that compared neuraxial anaesthesia with general anaesthesia was insufficient to rule out clinically important differences for most clinical outcomes. Neuraxial anaesthesia may reduce pneumonia. No conclusions can be drawn with regard to mortality, myocardial infarction and rate of lower-limb amputation, or less common outcomes.
Assuntos
Anestesia Epidural/efeitos adversos , Anestesia Geral/efeitos adversos , Raquianestesia/efeitos adversos , Extremidade Inferior/irrigação sanguínea , Idoso , Amputação Cirúrgica/estatística & dados numéricos , Anestesia Epidural/mortalidade , Anestesia Geral/mortalidade , Raquianestesia/mortalidade , Feminino , Humanos , Extremidade Inferior/cirurgia , Masculino , Infarto do Miocárdio/epidemiologia , Pneumonia/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos VascularesRESUMO
CONTEXT AND OBJECTIVE: Taking the outcome of mortality into consideration, there is controversy about the beneficial effects of neuraxial anesthesia for orthopedic surgery. The aim of this study was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for orthopedic surgery. DESIGN AND SETTING: Systematic review at Universidade Federal de Alagoas. METHODS: We searched the Cochrane Central Register of Controlled Trials (Issue 10, 2012), PubMed (1966 to November 2012), Lilacs (1982 to November 2012), SciELO, EMBASE (1974 to November 2012) and reference lists of the studies included. Only randomized controlled trials were included. RESULTS: Out of 5,032 titles and abstracts, 17 studies were included. There were no statistically significant differences in mortality (risk difference, RD: -0.01; 95% confidence interval, CI: -0.04 to 0.01; n = 1903), stroke (RD: 0.02; 95% CI: -0.04 to 0.08; n = 259), myocardial infarction (RD: -0.01; 95% CI: -0.04 to 0.02; n = 291), length of hospitalization (mean difference, -0.05; 95% CI: -0.69 to 0.58; n = 870), postoperative cognitive dysfunction (RD: 0.00; 95% CI: -0.04 to 0.05; n = 479) or pneumonia (odds ratio, 0.61; 95% CI: 0.25 to 1.49; n = 167). CONCLUSION: So far, the evidence available from the studies included is insufficient to prove that neuraxial anesthesia is more effective and safer than general anesthesia for orthopedic surgery. However, this systematic review does not rule out clinically important differences with regard to mortality, stroke, myocardial infarction, length of hospitalization, postoperative cognitive dysfunction or pneumonia. .
CONTEXTO E OBJETIVO: Considerando o desfecho de mortalidade, existe controvérsia acerca dos efeitos benéficos da anestesia neuroaxial (AN) para cirurgias ortopédicas. O objetivo do estudo foi comparar efetividade e segurança da AN versus anestesia geral (AG) para cirurgias ortopédicas. TIPO DE ESTUDO E LOCAL: Revisão sistemática na Universidade Federal de Alagoas. MÉTODOS: Buscamos em Cochrane Central Register of Controlled Trials (2012, volume 10), PubMed (1966 até novembro de 2012), Lilacs (1982 até novembro de 2012), SciELO, EMBASE (1974 até novembro de 2012) e listas de referências dos estudos incluídos. Apenas ensaios clínicos randomizados foram incluídos. RESULTADOS: Dentre 5.032 títulos e resumos, 17 estudos foram incluídos. Não houve diferença estatística em mortalidade (diferença de risco, DR: -0,01; intervalo de confiança de 95%, IC: -0,04 a 0.01; n = 1903), em acidente vascular encefálico (DR: 0,02; IC 95%: -0,04 a 0,08; n = 259, em infarto miocárdico (DR: -0.01; IC 95%: -0,04 a 0.02; n = 291), tempo de hospitalização (diferença média, -0,05; IC 95%: -0,69 a 0,58; n = 870), em disfunção cognitiva pós-operatória (DR: 0,00; IC 95%: -0,04 a 0,05; n = 479) e pneumonia (razão de chances, 0,61; IC 95%: 0,25 a 1,49; n = 167). CONCLUSÃO: Até o momento, as evidências são insuficientes nos estudos incluídos para provar que AN é mais efetiva e segura do que AG para cirurgias ortopédicas. Esta revisão sistemática não descartou diferenças clínicas importantes para mortalidade, acidente vascular encefálico, infarto miocárdico, tempo de internação, disfunção cognitiva pós-operatória e pneumonia. .