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      Anestesia para intervenção cirúrgica endovascular na aorta abdominal Translated title: Anesthesia for endovascular surgery of the abdominal aorta Translated title: Anestesia para intervención quirúrgica endovascular en la aorta abdominal

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          Abstract

          JUSTIFICATIVA E OBJETIVOS: O procedimento endovascular para correção de aneurisma de aorta é menos invasivo que o convencional, além de apresentar outras vantagens, como ausência de incisão abdominal, ausência de pinçamento da aorta e menor tempo de recuperação pós-operatória. Por se tratar de procedimento cirúrgico relativamente novo e apresentar uma série de alterações que devem ser conhecidas pelo anestesiologista foi realizado este trabalho com o objetivo de revisar os aspectos mais relevantes do procedimento endovascular e possibilitar manuseio anestésico mais adequado no perioperatório. CONTEÚDO: Apresentação sucinta da técnica cirúrgica para reparo de aneurismas via endovascular, as possíveis vantagens e desvantagens do procedimento, bem como as complicações potenciais. Além disso, foram abordados os cuidados perioperatórios que o procedimento exige e as técnicas anestésicas que podem ser utilizadas. CONCLUSÕES: O conhecimento das alterações provenientes do procedimento endovascular possibilita conduta anestésica mais adequada e melhora dos resultados perioperatórios nesses pacientes.

          Translated abstract

          BACKGROUND AND OBJECTIVES: Endovascular surgery for aneurism of the aorta is less invasive than the conventional procedure besides other advantages such as the absence of abdominal incision, absence of ligature of the aorta, and reduced postoperative recovery time. Since it is a relatively new procedure and to presenting a series of changes that should be known by the anesthesiologist, the objective of this report was to review the most relevant aspects of endovascular surgery, allowing more adequate perioperative anesthetic management. CONTENTS: A brief description of the technique of endovascular aneurism repair, possible vantages and disadvantages of its use, as well as potential complications are discussed. CONCLUSIONS: Knowledge of the changes secondary to the endovascular procedure allows a more adequate anesthetic conduct and improves the postoperative results in those patients.

          Translated abstract

          JUSTIFICATIVA Y OBJETIVOS: El procedimiento endovascular para la corrección del aneurisma de aorta es menos invasivo que el convencional, además de presentar otras ventajas como la ausencia de incisión abdominal, ausencia de pinzamiento de la aorta y un menor tiempo de recuperación postoperatoria. Por tratarse de un procedimiento quirúrgico relativamente nuevo y por presentar una serie de alteraciones que deben ser conocidas por el anestesiólogo, se realizó este trabajo con el objetivo de revisar los aspectos más relevantes del procedimiento endovascular y posibilitar el manejo anestésico más adecuado en el perioperatorio. CONTENIDO: Sencilla presentación de la técnica quirúrgica para la cura de aneurismas vía endovascular, las posibles ventajas y desventajas del procedimiento, como también las complicaciones potenciales. Además de eso, se abordaron los cuidados perioperatorios que el procedimiento exige y las técnicas anestésicas que pueden ser utilizadas. CONCLUSIONES: El conocimiento de las alteraciones provenientes del procedimiento endovascular posibilita una conducta anestésica más adecuada y la mejora de los resultados perioperatorios en esos pacientes.

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          Surgeon volume and operative mortality in the United States.

          Although the relation between hospital volume and surgical mortality is well established, for most procedures, the relative importance of the experience of the operating surgeon is uncertain. Using information from the national Medicare claims data base for 1998 through 1999, we examined mortality among all 474,108 patients who underwent one of eight cardiovascular procedures or cancer resections. Using nested regression models, we examined the relations between operative mortality and surgeon volume and hospital volume (each in terms of total procedures performed per year), with adjustment for characteristics of the patients and other characteristics of the providers. Surgeon volume was inversely related to operative mortality for all eight procedures (P=0.003 for lung resection, P<0.001 for all other procedures). The adjusted odds ratio for operative death (for patients with a low-volume surgeon vs. those with a high-volume surgeon) varied widely according to the procedure--from 1.24 for lung resection to 3.61 for pancreatic resection. Surgeon volume accounted for a large proportion of the apparent effect of the hospital volume, to an extent that varied according to the procedure: it accounted for 100 percent of the effect for aortic-valve replacement, 57 percent for elective repair of an abdominal aortic aneurysm, 55 percent for pancreatic resection, 49 percent for coronary-artery bypass grafting, 46 percent for esophagectomy, 39 percent for cystectomy, and 24 percent for lung resection. For most procedures, the mortality rate was higher among patients of low-volume surgeons than among those of high-volume surgeons, regardless of the surgical volume of the hospital in which they practiced. For many procedures, the observed associations between hospital volume and operative mortality are largely mediated by surgeon volume. Patients can often improve their chances of survival substantially, even at high-volume hospitals, by selecting surgeons who perform the operations frequently. Copyright 2003 Massachusetts Medical Society
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            Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial.

            To assess the relationship between body temperature and cardiac morbidity during the perioperative period. Randomized controlled trial comparing routine thermal care (hypothermic group) to additional supplemental warming care (normothermic group). Operating rooms and surgical intensive care unit at an academic medical center. Three hundred patients undergoing abdominal, thoracic, or vascular surgical procedures who either had documented coronary artery disease or were at high risk for coronary disease. The relative risk of a morbid cardiac event (unstable angina/ischemia, cardiac arrest, or myocardial infarction) according to thermal treatment. Cardiac outcomes were assessed in a double-blind fashion. Mean core temperature after surgery was lower in the hypothermic group (35.4+/-0.1 degrees C) than in the normothermic group (36.7+/-0.1 degrees C) (P<.001) and remained lower during the early postoperative period. Perioperative morbid cardiac events occurred less frequently in the normothermic group than in the hypothermic group (1.4% vs 6.3%; P=.02). Hypothermia was an independent predictor of morbid cardiac events by multivariate analysis (relative risk, 2.2; 95% confidence interval, 1.1-4.7; P=.04), indicating a 55% reduction in risk when normothermia was maintained. Postoperative ventricular tachycardia also occurred less frequently in the normothermic group than in the hypothermic group (2.4% vs 7.9%; P=.04). In patients with cardiac risk factors who are undergoing noncardiac surgery, the perioperative maintenance of normothermia is associated with a reduced incidence of morbid cardiac events and ventricular tachycardia.
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              Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians.

              Postoperative pulmonary complications play an important role in the risk for patients undergoing noncardiothoracic surgery. Postoperative pulmonary complications are as prevalent as cardiac complications and contribute similarly to morbidity, mortality, and length of stay. Pulmonary complications may even be more likely than cardiac complications to predict long-term mortality after surgery. The purpose of this guideline is to provide guidance to clinicians on clinical and laboratory predictors of perioperative pulmonary risk before noncardiothoracic surgery. It also evaluates strategies to reduce the perioperative pulmonary risk and focuses on atelectasis, pneumonia, and respiratory failure. The target audience for this guideline is general internists or other clinicians involved in perioperative management of surgical patients. The target patient population is all adult persons undergoing noncardiothoracic surgery.
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                Author and article information

                Journal
                rba
                Revista Brasileira de Anestesiologia
                Rev. Bras. Anestesiol.
                Sociedade Brasileira de Anestesiologia (Campinas, SP, Brazil )
                0034-7094
                1806-907X
                October 2008
                : 58
                : 5
                : 520-532
                Affiliations
                [02] orgnameHospital Life Center
                [01] orgnameBiocor Instituto
                Article
                S0034-70942008000500010 S0034-7094(08)05800510
                10.1590/S0034-70942008000500010
                52121b4b-430d-40be-992d-56a0c2794361

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 12 July 2007
                : 19 June 2008
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 57, Pages: 13
                Product

                SciELO Brazil

                Categories
                Artigos de Revisão

                DOENÇA, Vascular,DISEASE, Vascular,SURGERY, Vascular,CIRURGIA, Vascular

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