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  • 11
    Online-Ressource
    Online-Ressource
    Ventilación mecánica en cirugía cardíaca: actualidades
    Universidad Tecnica de Ambato - Carrera de Medicina ; 2020
    In:  Mediciencias UTA Vol. 4, No. 3 ( 2020-07-06), p. 25-
    Details
    In: Mediciencias UTA, Universidad Tecnica de Ambato - Carrera de Medicina, Vol. 4, No. 3 ( 2020-07-06), p. 25-
    Kurzfassung: Introducción: La ventilación mecánica en la cirugía cardíaca constituye un reto anestesiológico, los nuevos protocolos de recuperación posquirúrgica mejorada (ERAS, en inglés) incluye, entre otros, ventilación mecánica protectiva determinada por bajos volúmenes corrientes, presión positiva al final de la espiración (PEEP) moderada, fracción inspiratoria de oxígeno (FiO2) que mantengan normoxemia, factores que influyen el posquirúrgico y en las complicaciones pulmonares. Es importante determinar que existen varios momentos en la cirugía cardíaca que modificara el patrón ventilatorio dependiendo del bypass cardiopulmonar, circulación con bomba extracorpórea, ventilación unipulmonar. Objetivo: Proporcionar la mejor evidencia científica en el manejo intraoperatorio de la ventilación mecánica en pacientes sometidos a cirugía cardíaca. Material y métodos: Se realizó una revisión sistemática de la literatura científica publicada en el periodo 2015-2020. Se realizó una búsqueda en los sitios a continuación utilizando los siguientes términos: “mechanical ventilation”, “ventilation”, “cardiac surgery”, “airway management”, “airway extubation”, “cardiopulmonary bypass”, “coronary artery bypass”, “coronary artery bypass, off-Pump”, “anesthesia, general”, “anesthesia recovery period”, “emergence delirium” en bases de datos: Medline, Best Practice & Research Clinical Anaesthesiology, Current Opinion in Anaesthesiology, Journal of Cardiothoracic and Vascular Anesthesia y Annals of Cardiac Anaesthesia. Resultados: La mejor evidencia científica sugiere que la ventilación mecánica en cirugía cardíaca debe proporcionarse bajo el modelo protectivo para mejores resultados posquirúrgicos inmediatos y mortalidad a largo plazo. Conclusiones: La ventilación mecánica protectiva ofrece menores complicaciones pulmonares posoperatorias, debe respetarse los volúmenes corrientes bajos en base al peso predicho del paciente, mantener PEEP moderada, FiO2 entre 40 – 60% para mantener normoxemia. Los protocolos de recuperación posquirúrgica mejorada (ERAS) se han establecido en el manejo de pacientes sometidos a cirugía cardíaca con mejores resultados globales en morbimortalidad.   
    Materialart: Online-Ressource
    ISSN: 2602-814X , 2602-814X
    URL: Article
    DOI: 10.31243/mdc.uta.v4i3.364.2020
    Sprache: Unbekannt
    Verlag: Universidad Tecnica de Ambato - Carrera de Medicina
    Publikationsdatum: 2020
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 12
    Online-Ressource
    Online-Ressource
    Variations in Serum Angiotensin-Converting Enzyme Activity following Lung Resection: A Controlled Study in a Clinical Setting
    SAGE Publications ; 1999
    In:  Annals of Clinical Biochemistry: International Journal of Laboratory Medicine Vol. 36, No. 2 ( 1999-03), p. 212-215
    Details
    In: Annals of Clinical Biochemistry: International Journal of Laboratory Medicine, SAGE Publications, Vol. 36, No. 2 ( 1999-03), p. 212-215
    Kurzfassung: Angiotensin-converting enzyme (ACE) plays an important role in postoperative cardiovascular control, especially in critical illness. Since the pulmonary endothelium is the major site of ACE production it would seem probable that surgical resection of lung tissue would significantly influence serum ACE (sACE) activity. The aim of this study was to investigate the effect of surgery on early postoperative sACE activity in patients undergoing lung resection ( n = 18) and a control group of patients ( n = 18) undergoing thoracotomy for other reasons. An early postoperative, sustained sACE fall without significant difference in sACE activity between the two groups was observed 6 h after the operation. Furthermore, there was no correlation between post-operative sACE variations and the amount of lung tissue resected. It appears that surgical removal of lung tissue does not significantly affect the post-operative sACE response. This may be due to the presence of important extra-pulmonary ACE-producing sites or to the compensation of the remaining pulmonary vascular endothelium.
    Materialart: Online-Ressource
    ISSN: 0004-5632 , 1758-1001
    URL: Article
    DOI: 10.1177/000456329903600213
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 1999
    ZDB Id: 2041298-8
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 13
    Online-Ressource
    Online-Ressource
    Peri-operative troponin monitoring using a prototype high-sensitivity cardiac troponin I (hs-cTnI) assay: comparisons with hs-cTnT and contemporary cTnI assays
    SAGE Publications ; 2014
    In:  Annals of Clinical Biochemistry: International Journal of Laboratory Medicine Vol. 51, No. 2 ( 2014-03), p. 258-268
    Details
    In: Annals of Clinical Biochemistry: International Journal of Laboratory Medicine, SAGE Publications, Vol. 51, No. 2 ( 2014-03), p. 258-268
    Kurzfassung: Non-cardiac surgery is associated with major vascular complications and higher incidences of elevated plasma troponin (cTn) concentration. Goal-directed therapy (GDT) is a stroke volume (SV)-guided approach to intravenous (IV) fluid therapy that improves tissue perfusion, oxygenation and reduces post-operative complications. In patients undergoing major gastro-intestinal surgery, we compared high sensitive and contemporary troponin assays and correlated results with patient outcome. Methods Patients ( n = 135) were randomized to receive IV fluid, guided by either the central venous pressure (CVP group, n = 45) or SV (± dopexamine inotrope, n = 45 per group). Serum was obtained pre- and post-operatively (0, 8 and 24 h) for troponin analysis by a prototype hs-cTnI assay (Abbott Laboratories), hs-cTnT (Roche Diagnostics) and contemporary cTnI (Beckman Coulter) assays. Results All troponin measurements were increased ( P ≤ 0.05) post-operatively but there was no difference ( P  〉  0.05) amongst treatments. Post-operative increases were reported more frequently ( P ≤ 0.05) and earlier with hs-cTnI. Temporal increases ( P ≤ 0.05) were reported in patients with and without complications for hs-cTnI/T assays but only in the complications group for cTnI measurements. Elevations ≥99th centile occurred most often ( P ≤ 0.05) for hs-cTnT measurements but with similar frequency for both outcome groups (all assays). Only the hs-cTnI assay showed an increased relative risk of mortality ( P ≤ 0.05) for elevations ≥99th centile Conclusions Our study may suggest a possible preference for the hs-cTnI assay in the peri-operative setting; however, our findings should be verified for larger cohort studies where emerging reference range data is incorporated for improving risk prediction with hs-cTn assays.
    Materialart: Online-Ressource
    ISSN: 0004-5632 , 1758-1001
    URL: Article
    DOI: 10.1177/0004563213494078
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2014
    ZDB Id: 2041298-8
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
    Online-Ressource
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