Browsing by Author "Viana, JS"
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- Air embolism as a complication of venovenous bypass during liver transplant for diffuse hemangiomatosisPublication . Viana, JS; Furtado, E; Romero, A; Furtado, AL
- Burnout syndrome and wellbeing in anesthesiologists: the importance of emotion regulation strategiesPublication . Lapa, TA; Madeira, FM; Viana, JS; Pinto-Gouveia, JAnesthesiologists face stressful working conditions that can culminate in burnout syndrome. Despite various studies and protective measures which have attempted to prevent this situation, burnout continues to be a problem within the profession, impacting negatively on physicians' lives and their performance. In this review article mechanisms and consequences of burnout are described in addition to individual strategies for stress management and burnout reduction with potential impact on health care quality and wellbeing in anesthesiologists. Organizational strategies appear to have an important role in burnout reduction but need to be used in conjunction with individual programs. The latter are essential to both reducing stress and burnout in anesthesiologists and improving happiness and wellbeing. New measures of emotion regulation strategies such as mindfulness, self-compassion, resilience and empathy promotion have been shown to be approaches with substantial supporting evidence for reducing burnout and improving stress management. The evaluation and implementation of these self-regulatory competencies is a challenge. Further research is necessary to identify which programs will best suit the needs of anesthesiologists and to measure their effects on patient care and health care system quality.
- The Coimbra University Hospital experience in liver transplantation in patients with familial amyloidotic polyneuropathyPublication . Perdigoto, R; Furtado, AL; Furtado, E; Oliveira, FJ; Geraldes, B; Mota, O; Ferrão, J; Tomé, L; Viana, JS
- Diastolic Dysfunction in Liver Cirrhosis: Prognostic Predictor in Liver Transplantation?Publication . Carvalheiro, F; Rodrigues, C; Adrego, T; Viana, JS; Vieira, H; Seco, C; Pereira, L; Pinto, F; Eufrásio, A; Bento, C; Furtado, EBACKGROUND: Patients with liver cirrhosis may develop cirrhotic cardiomyopathy (CC), characterized by blunted contractile responsiveness to stress, diastolic dysfunction (DD), and electrophysiological abnormalities. It may adversely affect the long-term prognosis of these patients. METHODS: We conducted a retrospective analysis of patients undergoing liver transplantation (LT) for cirrhosis from January 2012 to June 2015. We analyzed demographic characteristics, the etiology of cirrhosis, Child-Pugh and Model for End-Stage Liver Disease (MELD) scores, the corrected QT (QTc) interval in the preoperative period, diastolic and systolic dysfunction, mortality and survival, and duration of mechanical ventilation and vasopressor support in the post-LT period. These variables were compared with diastolic dysfunction and prolongation of QTc, with the use of chi-square, Fisher, and Mann-Whitney U tests. RESULTS: The study included 106 patients, 80.2% male and overall average age 54.83 years. The median MELD score was 16, and Child-Pugh class C in 55.4%. Prolonged QTc interval before LT was present in 19% and DD in 35.8% of patients. QTc before LT or DD did not vary significantly with MELD or Child-Pugh score. CONCLUSIONS: The patients in the pre-LT period presented with a significant incidence of DD, which can predispose them to adverse cardiac events. The presence of DD correlates with mortality after LT in patients with hepatic cirrhosis.
- Haemodynamics during liver transplantation in familial amyloidotic polyneuropathy: study of the intraoperative cardiocirculatory data of 50 patientsPublication . Viana, JS; Bento, C; Vieira, H; Neves, S; Seco, C; Elvas, L; Coelho, L; Ferrão, J; Tomé, L; Perdigoto, R; Craveiro, AL; Providência, LA; Furtado, ALBACKGROUND: Circulatory instability frequently complicates liver transplantation for familial amyloidotic polyneuropathy (FAP) and may be a source of surgical morbidity and mortality. OBJECTIVE: To evaluate FAP intraoperative haemodynamic data and their relation to the duration of surgery, and need for anaesthetic drugs. RBC and sympathomimetic amines. SETTING: Clinical study during a four year period. PATIENTS (mean +/- SD): Group I included 50 consecutive FAP ATTR Met 30 recipients of first transplantation. Age was 35.3 +/- 7.1 years, neurological score 34.3 +/- 13 in 100 and time elapsed from first symptom 5.0 +/- 2.7 years. Group II (control), not different concerning age and sex, included 51 patients transplanted during the same period with other pathologies. METHOD: Anaesthetic protocol, monitoring and surgical techniques were similar in both groups. Data of the two groups were compared either by the Student's t-test or Fisher's exact test. RESULTS: Low values of systemic vascular resistance index were observed in both groups, with no differences between them. Systemic arterial pressures were usually lower in group I, because cardiac index and heart rate were also significantly lower, although within normal values. However, in group I, isoflurane (a vasodilator anaesthetic) was used during less time (p < 0.05) and in lower concentrations (p < 0.01) and phenylephrine was necessary in 26% of patients vs 0 patients in group II (p < 0.001). CONCLUSION: FAP patients presented a different intraoperative behaviour when compared to other patients submitted to liver transplantation. From a clinical point of view, the authors stress: 1--As a result of autonomic dysfunction, the administration of anaesthetic drugs to FAP patients always presents the risk of producing significant hypotension; even the use of ketamine does not prevent hypotension; 2--Safety is ensured by beat-to-beat surveillance of arterial pressures and the capacity to act immediately to support circulation; 3--These patients seem to be very sensitive to decreases in the pre-load; 4--Hypotension is also frequent with an adequate pre-load, usually as the result of low SVR; an infusion of a vasoconstrictor drug emerges as the most frequent treatment requested and our experience supports it as an effective one.
- Intraoperative management of liver transplantation for familial amyloid polyneuropathy Met30: what has changed in the last 10 years?Publication . Viana, JS; Vieira, H; Bento, C; Neves, S; Seco, C; Furtado, AL
- Local immunosuppression in clinical small bowel transplantation (report of two cases).Publication . Furtado, AL; Perdigoto, R; Oliveira, FJ; Geraldes, E; Furtado, E; Tomé, L; Mota, O; Ferrão, J; Viana, JS; Bento, C; Vieira, H; Neves, S
- Maximum sharing of cadaver liver grafts composite split and domino liver transplantsPublication . Furtado, AL; Oliveira, FJ; Furtado, E; Geraldes, B; Reis, A; Viana, JS; Bento, C; Vieira, H; Neves, S
- Recombinant factor VIIa in major abdominal surgery and liver transplantationPublication . Viana, JSThe author reviewed the literature regarding recombinant activated Factor VII (rFVIIa) in major abdominal surgery and liver transplantation and concluded that, on the basis of evidence-based medicine, there is no evidence to support an extensive use of rFVIIa. Nevertheless, various case reports suggest the usefulness of rFVIIa to treat life-threatening bleeding after failure of conventional therapies. It appears that there is a consensus that rFVIIa can be used with good results as a rescue therapy in extremely severe situations. Economic cost and potential thrombosis risk remain arguments against more widespread use of rFVIIa. Doses from 5 to 120 kg/kg in each administration have been reported without clear evidence to support a specific protocol. Efficacy of 15 to 20 kg/kg in surgical settings has been reported, but higher doses are more frequently used. The majority of the reviewed investigators accepted the use of rFVIIa after or simultaneously with the use of aprotinin; no data refute the safety of this association.
- Requirements of circulatory support during liver transplantation: are patients with familial amyloidosis different from other patients?Publication . Viana, JS; Bento, C; Vieira, H; Neves, S; Seco, C; Perdigoto, R; Craveiro, AL; Furtado, AL